Lasers are some of the most versatile of all tweakment options: they can deal with pigmentation, sensitivity, veins, acne, wrinkles, excess hair, tattoos, pores, scars… we could go on. ‘Laser treatment’ can mean many things and comprise many different devices, so finding the right one for your particular skin concern or type is a challenge. So we got answers to everything you ever wanted to know about lasers, but were too confused to ask. We spoke to London’s premier laser specialist, Debbie Thomas of D.Thomas Clinic, to get to the bottom of it all and determine once and for all which laser treatment is right for YOU.
How does laser treatment work?
Lasers use focused light energy at a specific wavelength depending on how deeply they penetrate the skin and what they do (typically the higher the wavelength, the deeper they go). Unlike LED light for example, which is diffuse, laser channels light into a precise beam that can do anything from making small red veins collapse and disappear to triggering bacteria-killing molecules that target acne.
These light beam wavelengths can home in on a specific colour or molecule in the skin (think red blood, or brown pigment, water). This is how individual ‘imperfections’ such as brown spots, small veins or unwanted tattoos can be destroyed with ‘laser precision’.
Your practitioner can vary the strength of the laser shots in the same way that you can time and set your microwave to high or low power, says Thomas, or administer it in short sharp bursts, depending on your skin concern and the laser. It’s a very bespoke art.
Which treatments are often confused with lasers?
The word ‘laser’ is often bandied about for any treatment that produces energy, and therefore heat, in the body. Radiofrequency(radio and microwaves), ultrasound(sound waves), and LED and IPL (diffused light energy) certainly have their powerful and therapeutic uses, but they are not lasers. IPL (Intense Pulsed light) and BBL (Broad Band Light, a slightly more advanced version of IPL) are most often erroneously called ‘laser’ (for more about IPL, see below).
How many laser treatments do you normally need?
Generally, you’ll need more than one session. “Most laser treatments are three to six initial sessions,” says Thomas. “Followed by maintenance treatments every few months for long-term concerns such as acne or age management. The exceptions would be standard sun damage (pigment spots) or dilated veins. They’re often successfully reduced in one to three sessions.” Ablative laser (see below) normally requires just one session.
What can I expect to pay for laser treatment?
Thomas, who as a London practitioner is at the dear end of the scale but not the most expensive by a long shot, charges £2725 for six bespoke laser sessions, and £1225 for six sessions of Intense Pulsed Light (IPL). One ablative CO2 session can cost £3000.
Outside London, she says, you could be looking at half the price. But in the capital, there are also practitioners who will charge £1000 for a single non-ablative session with a fashionable new laser.
Are the newest lasers always the best ones?
“There are hundreds of different brands of lasers,” says Thomas. “But there are only roughly ten laser technologies commonly used in aesthetics. These have been around for about 50 years, with very little unique technology being developed for over 30 years. When a ‘new’ laser hits the market with much fanfare, it usually is a brand launching their version of existing technology, with small individual tweaks or combination-option,” she says. “New technologies can be super-useful, but at the same time, some of the most established machines are still the best for consistent results.”
“I believe, with lasers as with any skin treatments, you need treat the precise causes of the issue but also overall skin health,” says Thomas. “A laser may be great for zapping acne bacteria, but might not deal with the inflammation and scarring that are also intrinsic to acne. Or it may target melasma pigmentation but not the underlying inflammation.”
In other words, you want to avoid a protocol-by-numbers, where a clinic is limited to one or two lasers with which they may only be able to treat part of your problem, or which aren’t actually the right technology for your issue.
Just like you would choose the right skincare ingredients and formulas for your concerns and skin type, lasers and other energy-based treatments such as ultrasound or radiofrequency (which all work by injuring skin in a controlled manner to provoke a healing or re-generative response) should be bespoke as well. That, along with the fact that lasers in inexperienced hands can cause unwanted side effects, means that you want to find a highly trained, highly experienced specialist for your treatments.
Are laser treatments painful?
It depends on the laser.
Most lasers are non-ablative which means they do not burn and peel off the top layer of skin. They work under the skin surface and cause little to no downtime: You may end up with temporary red blotches or small bruises at most. They don’t hurt bar a feeling of hot elastic bands being snapped against your skin.
These lasers (Nd:Yag, pulsed dye and Alexandrite technology, among others) work by either bulk-heating deeper skin layers to set off collagen production, or blasting apart pigment clusters and cauterising veins more superficially. They can be used for skin rejuvenation, acne control, treating redness, hair removal, and more. Famous non-ablative machines are are Fotona SP Dynamis, Norseld Dual Yellow and Candela V-Beam.
Made famous by the SATC episode where Samantha had a laser peel, ablative lasers, which use CO2 or Erbium technology, work by vaporising entire layers or sections of skin in order for the body to lay down entirely fresh one. It can give spectacular results on advanced signs of ageing, acne scars and other texture issues.
Unsurprisingly, topical anaesthetic cream is required to make this bearable, with the deepest peels entailing two weeks or so of weeping, swelling, peeling and scabbing and another few weeks of pinkness, plus the necessity of wound aftercare and antibiotics. Most people today choose to avoid this level of downtime in favour slightly less intense options (see below), but there are cases where only ablative laser (machines include Fraxel Re:pair and Deka Smartxide Touch) will do.
Just to mess with your mind, there are also ‘non-ablative’ lasers that are better described as ‘sub-ablative’: they do not break the skin and are therefore often described as ‘gentle’. But they cause significant heat damage under the surface, resulting in swelling, redness and subsequent peeling for days or even weeks.
It’s much like ablative laser (and treats the same things), only the skin’s protective barrier remains intact for more effective healing and less chance of bacterial infection. This technology is called ‘Erbium Glass’ and the most famous branded machines that feature it are Lumenis ResurFX and Fraxel Re:store. The Sciton Moxi laser is another example.
What is the difference between IPL and laser?
They sort of feel the same and have many overlapping properties (which is why we’ll include IPL treatments here), but should not be confused with each other. Where lasers are a single wavelength with a clear purpose, IPL works with filters that each allow through a spectrum of wavelengths. Each filter focuses on a specific concern, but the light is less precise and can unintentionally affect surrounding tissue causing unexpected reactions.
So lasers are more predictable to work with, but the idea that they’re more powerful while IPL is less aggressive is wrong, says Thomas. “IPL needs to be administered with a lot of care and respect, just like laser,” says Thomas. As with the mildest non-ablative lasers, there is no real pain, just some hot ‘snapping’, and little to no downtime.
“IPL filters can be combined within a session to give a more complete treatment, affecting several skin concerns. This makes it particularly great for combined redness and specific types of pigmentation associated with sun damage” says Thomas.
The ability to adjust the machine to so many skin concerns makes it a very cost-effective investment, which explains why IPL is so widely available, and cheaper than laser treatment.
But, says Thomas, you want to get a very experienced therapist who knows their way around the filters and understands their limitations. “IPL is great for overall general rejuvenation focused on colour correction or for treating moderate acne or rosacea,” she says. “But for intense and focused treatment of major concerns, it’s often best to start with lasers.” The Lumenis M22 and Inmode Lumecca are examples of IPL machines.
Which laser treatment is good for the face?.
Most of the below treatments are focused on the face but some may also be used to treat body skin. But the question you need to ask is not what area but what issue you want to treat. No one laser will give your skin a ‘total makeover’, dealing with texture, pigmentation, redness, hair, spots, signs of ageing and so on all at the same time. Don’t get waylaid by hype and ‘best new facial laser’ claims – focus on your individual goals and find the right laser treatment (or alternative technology) to tackle them.
As said, there are specific lasers for most skin concerns. Some can be put to work on more than one issue, but aren’t always the best option for each of these complaints. To make sure you get exactly what you need out of your laser treatment, we asked Thomas to spell out the best course of ‘laser action’ depending on your problem
Which laser treatment is best for dark spots and hyperpigmentation?
Image: Victoria Woodhall, Get The Gloss
Sun spots, age spots and other pigmented lesions are treated with wavelengths that are absorbed by melanin, or brown pigment. “Mainly I use IPL with a 515nm filter as it works the best,” says Thomas. “Green laser, comprised in the Norseld Dual Yellow laser, is really good at zapping pigment as well.”
Alternatively, Alexandrite technology such as in the Candela Gentlelease “also works well destroying pigment,” says Thomas. She names Nd:Yag Q-Switched technology, which produces short, sharp blasts of energy “like a water drop in a frying pan” to break apart superficial pigment clusters, as another, but “not the best”, option when it comes to targeting brown pigment in the skin.
Can laser treatment remove veins?
Vascular lesions such as broken blood vessels spider veins and port-wine stains are candidates for yellow lasers: “the yellow wavelengths are the most highly absorbed by red pigment,” says Thomas. She prefers her Advalight Advatx yellow laser for this but says the Norseld Dual Yellow, which combines a green and yellow laser, works great too. Pulsed-dye yellow laser technology, as in the Candela V-Beam, works as well, but “pulsed-dye lasers are just not the best choice anymore: they are more painful than other technologies and cause more downtime, as there is a high chance of bruising,” says Thomas.
Nd:Yag laser, which offers two cell-regenerating wavelengths, “is also absorbed by red pigment, but its real strength is the depth it penetrates to,” says Thomas. “It’s perfect for little veins, while the fact that it heats the collagen-producing dermis also prompts stronger, healthier skin to make it less prone to redness over time.”
Finally, IPL can be a good option for zapping veins: “We use a specific filter and settings for veins over more diffused redness,” says Thomas. “We also have smaller applicators so we can focus the energy just on the vein rather than over the larger area we normally treat with IPL. In fact, for vascular lesions and vein removal, IPL works exactly the same as Nd:Yag laser.”
Can laser treatment help rosacea and sensitivity?
Diffused, flushed redness that can be the result of rosacea or sensitivity is best treated with yellow wavelengths as well. “Yellow laser as in the AdavaTx and IPL with filters that focus on yellow wavelengths are both great,” says Thomas. “IPL doesn’t penetrate as deep as most lasers so mainly works on upper skin layers, meaning general redness responds well to it.”
In addition to ‘closing’ dilated capillaries, yellow wavelengths have been shown to help destroy Demodex parasites which are implied in the development of rosacea – so a series of yellow laser sessions can help reduce the flushing, pustules and veins so associated with the condition. It can also significantly calm rosacea-prone or reactive skin.
Cold laser (or LLLT) such as the Byonik, which is basically a powerfully souped-up version of calming, anti-inflammatory red and near-infrared LED light, “reduces the growth factors associated with inflammation that are often the first stage of post-inflammatory hyperpigmentation (PIH) and melasma,” says Thomas. So entirely pain and downtime-free cold laser treatments are a good option for calming general sensitivity and redness as well as pigmentation issues with underlying inflammation.
Which laser treatment is best for melasma?
Melasma or ‘pregnancy mask’ shows as large patches of hyperpigmentation, but is to a large extent underpinned by inflammation. “The most crucial point with treating melasma is not to set off further inflammation and make things worse,” says Thomas. “So we work with gentle lasers at not-too-powerful settings, and more on reducing the inflammatory triggers rather than ‘blasting’ the pigment.” So that primarily means gentle yellow lasers like the AdvaTx, “which suppresses pigmentation rather than attacks it,” and IPL.
Q-Switched technology (see ‘tattoo removal’ below), which works by causing an almost mechanical shattering of pigment particles, “can be helpful for melasma if used cautiously,” she says. “But you must slowly chip away at melasma as well as post-inflammatory hyperpigmentation over a good number of sessions (six at the very least). If you go in hard or use too much heat, you’ll just create more inflammation”.
Can laser treatments tackle active acne?
Acne is really multiple issues rolled into one – you need to deal with bacteria, oil control, inflammation, and post-inflammatory hyperpigmentation. “So we must target the individual elements in a holistic way,” says Thomas. Reducing inflammation is key, she says, because of the quick visual win you get from taking down redness around the acne marks and because it allows the skin to become healthier, “which is vital when dealing with persistent skin conditions.”
Again, yellow wavelengths are perfect for this, especially thanks to their ability to nuke Demodex parasites which are a cause of acne as well as rosacea.
“On top of that, you need deep-penetrating Nd:Yag technology lasers. These, she explains, are not absorbed by colour in the skin but penetrate to the dermis where they trigger collagen production to a very effective degree. “This not only aids repair, healing and strengthening, it also heats up the oil glands to a specific temperature. This temporarily shuts them down, reducing acne-promoting oil.”
The beauty of the latest laser machines such as the Advalight AdvaTx (again), says Thomas, is that they combine more than one type of laser to offer the multiple modalities needed for complicated issues such as acne. “Even wrinkles have multiple facets,” she says. “So combo-lasers, which really put the focus on holistic skin health, can be great.”
IPL can be very helpful for acne too: “You can reduce the redness and promote superficial healing, and the Lumenis M22 IPL mode (the machine incorporates a laser as well) has a specific blue light filter that works on killing the bacteria,” says Thomas.
If oiliness and blackheads are your main concern, a laser-assisted carbon peel can help. A layer of oil-absorbing carbon (charcoal) solution is painted onto your face and zapped with Q-Switched laser on a relatively low power setting. The carbon painlessly vaporises and takes with it the gunk from your pores and dead skin cells3. Result: clearer, smoother skin without the oil slick.
Which laser treatment is best for acne scars and open pores?
Scarring is an acne-related topic all on its own, as to smooth deeper scars (whether from acne or not), the ‘big gun’ ablative and sub-ablative ‘resurfacing’ lasers are often required. Warts, skin tags, moles (but only after assessment by a dermatologist) and open pores (basically, any texture issues) can also be tackled with CO2 and Erbium lasers, which are even used to cut the skin in laser-assisted surgery.
Erbium Glass technology doesn’t break the skin but gives lots of very hot stimulation in the deeper skin layers. “The downtime can run into weeks but the textural improvements can be dramatic,” says Thomas. The Fraxel Dual and Lumenis ResurFX have this technology, as does the Moxi laser, although the latter is used at a lower power level so the downtime is reduced. “The redness and flaking with the Moxi lasts for three to five days which is ‘gentle’ compared to some other sub-ablative lasers, but I’d hardly describe it as a ‘lunch-hour peel,” says Thomas.
Full-on ablative (skin-vaporising) lasers with CO2 and Erbium (also called Er:Yag) technology, as found in the Sciton Halo and Deka Smartxide Touch lasers, give the most dramatic results as well as downtime, but they’re not for everyone. “I only do light to medium ablative peels” [she uses ablative lasers at low to medium power and favours ‘fraxelated’ technology, which creates microchannels of damage rather than fully removing the skin]. “The stronger the treatment, the better the potential results but the higher the risk of the skin not responding well, she says.”
At the lighter end of the scale, non-ablative lasers such as the highest Nd:Yag wavelength in the Fotona SP Dynamis and AdvaTx lasers “also stimulate strong regeneration, creating collagen which plumps the skin to smooth scars and push the opening of pores closed, all without surface irritation,” says Thomas. “Also, with these newer machines, pain really shouldn’t be an issue. The results will not be as dramatic as with ablative lasers, but for milder scars they work well”.
Which laser treatment is best for wrinkles and skin tightening?
“All lasers will trigger some element of rejuvenation; they all to some extent stimulate collagen regeneration and that has an effect on wrinkles, sagging, dullness and uneven skin tone,” says Thomas. “The ones that are the most effective are the deeper-penetrating no-downtime lasers such as the Nd:Yag ones mentioned above, or the ones that cause more obvious ‘damage’ like resurfacing ablative lasers.
Thomas particularly likes the Fotona SP Dynamis ‘Piano’ mode, which is specific to this Nd:Yag technology laser. “They have manipulated the laser pulse to be super long, which means the energy goes in slower and therefore deeper. This really stimulates circulation and firming, smoothing collagen production but with no recovery time,” she says.
The sub-ablative Moxi laser, she says, will massively increase cellular turnover which will help smooth wrinkles and help firm and even out skin, but will also help fortify it against redness. “But if I had someone with very delicate or reactive skin, I would possibly do other treatments first to strengthen and prepare it before jumping in with something as potent as this,” says Thomas, who for overall age management always favours using a bespoke combination of different lasers
Which laser treatment is best for hair removal?
Successful laser hair removal, says Thomas, requires the laser to be absorbed by melanin (the pigment in hair) well and travel right into the hair to blast the bulb, killing the hair growth. “Alexandrite technology as in the Candela Gentlelase is most absorbed by hair melanin,” she says. Diode technology lasers such as the Lumenis Lightsheer also work well.”
Alternatively, IPL is a good hair removal device, when used with the right filters to target melanin.
Nd:Yag lasers, which are not attracted to pigment but travel deep enough to zap the hair bulb, also work quite well, though slower than melanin-targeting lasers. As Nd:Yag wavelengths are not attracted to pigment, they are the right course of action for hair removal in dark skins (for more, see below). If they were absorbed by pigment, they would affect both the hair and the surrounding skin and cause burns!
Which laser treatment is best for tattoo removal?
This is a job for Q-switched, Pico and Nano technology, as featured in the Lumenis M22 and Fotona Starwalker machines. Q-switching cuts the original wavelength in half (or even less in the case of pico/nano), turning the energy from deep, slow-cooking of the deeper skin layers to ‘flash-frying’ the skin surface. This literally blows apart pigments found there, like those from tattoo ink.
But it’s not a process for the faint-hearted: “there’s blistering, bleeding, crusting – it can really hurt,” says Thomas. But over the course of several treatments, it’s possible for a black (coloured ink is much more of a challenge) tattoo to be removed altogether. It’s considered safe for darker skins, “but not very dark ones!” warns Thomas. With olive to brown Fitzpatrick type 4 or higher, “it’s possible to have no adverse side effects but you’re at a much higher risk than light skin.” Approach with caution and a very experienced therapist.
Is laser treatment safe for dark skins?
Some lasers are, but make sure you see a laser expert that also specialises in highly pigmented skins. “Mainly you don’t want a laser that is highly absorbed by pigment,” says Thomas. “But also you don’t want to use too much heat (lasers that aren’t attracted to pigment work by creating high heat deep inside the skin), because that increases the chances of post-inflammatory hyperpigmentation.” So it’s a bit of a delicate catch-22.
Nd:Yag is universally considered the best option for dark skin “because the longer wavelength means you get good energy penetration without overheating the upper pigmented layers,” says Thomas. “It works well for rejuvenation, acne control and hair removal in Fitzpatrick types 4, 5 and 6, with a secondary effect on lightening pigmented patches through the increase in skin cell turnover,” she says.
The energy (power) level of the lasers is an important factor to consider: “we often use just 25 to 40 per cent of the energy we would use on pale skin,” says Thomas, who says that yellow laser and Q-Switched technology can also be used, but very, very cautiously, that is to say, using very low power and on a case-by-case basis.
The Fotona SP Dynamis ‘Piano mode’, which heats skin slowly and gently to boost collagen, is safe for black skin, says Thomas. But ablative laser is best avoided: “I wouldn’t do anything other than the lightest ‘baby’ ablation on a darker skin tone if at all,” she says. “It always comes down to the individual and to the experience of practitioner.”
IPL is definitely not suitable for skin types 5 and 6, because of the wider light spectrum it employs, even with filters: this makes it almost impossible to fully control the light being attracted to, and burning, healthy skin. Fitzpatrick type 4 (olive to brown) could be a candidate, “but only in really experienced hands,” says Thomas. Some claim that BBL (a new type of IPL which comprises a 590nm wavelength that regular IPL does not have) allows some types of pigment (notably age spots) to be targeted in darker skin tones, but again, don’t just take any laser cowboy’s word for it!