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  • Skin resurfacing is a common aesthetic procedure, and can result in improvement in rhytides, skin texture, dyspigmentation, and skin tightening.

  • Several laser and energy devices are available, and they can broadly be divided into ablative nonfractional lasers, nonablative nonfractional lasers, ablative fractional lasers, and nonablative fractional lasers.

image Beginner Tips

  • There is generally a tradeoff between efficacy, or number of required treatments, and the amount of downtime that a patient can expect.

  • Ablative nonfractional lasers have the most dramatic effect for resurfacing, but also the greatest downtime. At the other end of the spectrum are nonablative fractional lasers, which require the most treatments but have the least downtime.

image Expert Tips

  • Closely overlapping fractional laser pulses can lead to the MTZs blending together, resulting in a nonfractional result.

  • Needed treatment energy and density is not uniform across the face; select areas may require increased fluence or an increased density.

image Don’t Forget!

  • Ablative nonfractional lasers may lead to dramatic improvement after a single treatment, but other approaches generally require a series of multiple treatments.

  • When combining PDL or IPL and resurfacing lasers, be sure to treat for erythema before resurfacing so that the immediate postprocedure erythema is not the target of the PDL or IPL.

image Pitfalls and Cautions

  • Ablative nonfractional lasers should generally not be used in skin types V to VI, given the risk of dyspigmentation and scarring.

  • The rate of acneiform eruptions and milia formation for laser resurfacing remains fairly high, and this should be discussed with patients preprocedure.

image Patient Education Points

  • For all treatments other than ablative nonfractional lasers, patients should be told to expect several treatment sessions before seeing meaningful results.

  • Patients should have realistic expectations regarding the healing process, and should be warned that they will be out of commission for up to 2 weeks with ablative nonfractional lasers.

image Billing Pearls

  • Almost all insurers in the United States exclude laser treatments from coverage.

  • Patients may benefit from committing to a series of treatments, as this may allow significant cost savings.

  • Pretreatment with occluded topical anesthesia can be started at home, and prescription plans may cover the cost of this medication.


Skin resurfacing with energy-based devices decreases dyspigmentation, reduces rhytides and improves texture. Tighter skin is made possible through thermal damage to dermal collagen bundles and stimulation of dermal fibroblasts. In order to produce dermal collagen damage, energy is transmitted through the epidermis and into the dermis at a minimum temperature of 65°C, the temperature required to damage collagen.

Originally, energy devices required destruction of the epidermis along with the dermis. These ablative nonfractionated lasers are effective at collagen destruction, but also cause full epidermal destruction, requiring a significant recuperation period. Lasers that do not destroy the epidermis, but produce heat in ...

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