Transcription
That halo or Fraxel laser that you're considering having, is it the right laser for you before you go dropping thousands of dollars and undergoing all the recovery, etc.? Don't you want to know if it's actually going to do what you're hoping for it to do?
If I'm being honest, some of these treatments can be a painful waste of money and often times leave people disappointed. In this video, I'm going to cut through the hype and give you my top ratings for the anti-aging laser treatments that are available so you can make the best choice possible.
I'm Dr. Amir Karum, board-certified facial plastic surgeon and founder and creator of CarMD Skin. You all love the last rankings video that I did, but we didn't mention a single laser in that ranking. That's going to change today. Patients ask me all the time what I think about this laser and that laser, and I have some pretty strong opinions, and I've been around lasers for nearly 20 years. I'm going to give it to you straight.
So, in this video, I'm going to break down eight of the most popular anti-aging laser treatments. I'm going to give you a ranking of 1 to 10 for each of them. We're going to look at downtime, intensity, and efficacy for each of them. Some of my rankings may actually surprise you.
But first, if you're new here, make sure you subscribe to the channel. Each week, we post a new video talking about skin health, anti-aging, and all things facial rejuvenation.
All right, let's kick things off with our first laser, the fully ablative laser resurfacing. In this category, there are two wavelengths that you should know about. Number one is the CO2. Number two is the Erbium:YAG. They have different characteristics but accomplish the same general thing. In my opinion, the Erbium:YAG wins, and you're going to see why. And it's actually the laser that I have been using in my practice for over 10 years. And I'm going to talk to you specifically about when I use it, where it's beneficial, and how it compares to the CO2 in the same indications.
So, some common brand names that you may have heard about in the Erbium:YAG category is Fotona as well as the Sciton Contour TRL. And TRL stands for tunable resurfacing laser. And I'm going to explain why that characteristic is so important, actually.
Now, keep in mind, CO2 lasers have been around for a very long time. Actually, they've been around longer than almost any other laser, and they have a wide range of applications in medicine in general. But when it comes to the skin, there's some very specific things you need to know about which has made the CO2 a little bit less popular today than it used to be, and what has made Erbium:YAG the frontrunner, in my opinion, in the full-field total facial resurfacing category.
So, what does the term ablative mean, or fully ablative laser? So, ablative, basically, think of it as removal in a very physical sense. It's basically an implosion or explosion of some of the tissue, and as a result, that tissue disappears. And in the case of both Erbium:YAG and CO2, the tissue target that is being affected is water in the skin. So, as a result, since the majority of the skin is made up of water, the second it hits the skin, it begins to cause this ablative process. I always describe it as shedding, or shearing, or, you know, mowing down the skin one layer at a time. And that's the best way to think about it, because every pass of the laser is removing a section, a thickness of the skin with each pass. And that's how ablative lasers fundamentally work.
And how we can use it to our advantage is treating conditions like deep lines and wrinkles. That's the primary area that these really shine, because, for example, around the mouth, deep lines and wrinkles that form in this region, around the chin. Think of a wrinkle as a trough in the skin. So, what you're doing is with these lasers is you're shearing off one segment of the top as you go, hoping that you get down to the bottom of the wrinkle. The only condition that would keep you from being able to completely remove every wrinkle on the face is if those lines and those wrinkles happen to go below the middle part of the dermis of the skin. If they go below that layer, you can't keep chasing them because there is a portion of the skin that once it's removed, that skin will never heal as normal skin. It will only heal as scar. And no one wants a face full of scar tissue, right?
That is one of the complications of reckless and inexperienced fully ablative laser resurfacing. And the biggest advantage of Erbium versus CO2 is that you're very precisely removing sections of the skin down to the very micron that you want to remove. And this gives you total, total confidence that you're not getting into a layer that you shouldn't get into and causing some of these untoward side effects.
In addition to removing the fine lines and wrinkles on the surface of the skin, you're also stimulating a lot of collagen because you've created a massive injury to the skin, and the skin just recognizes the fact that it needs to stimulate collagen in response. So, you get a net increase in stimulation of collagen, which always is a good thing. In addition, the top layers of the skin where the laser is physically ablating and removing the tissue, any pigment that happens to live in that layer, because remember, pigments rise from below at the basement layer of the skin and they rest in the epidermis and the upper dermis. So, once they get to that layer and you're removing them, well, there goes pigment as well. So, you can improve the tone and discoloration of the skin, as well as fine lines and wrinkles, because you're effectively putting on a new upper third of the skin, depending on how deep you go.
So, who should get this laser? Typically, people who get a full-field resurfacing laser fall into a few categories. Number one, people who are in their 50s and 60s and above who really haven't been taking good care of their skin, meaning that there's a lot of dullness to the skin, discolorations that have built up, sunspots, etc., and fine lines and wrinkles throughout their skin. Another category is people who may have taken great care of their skin, but have deep vertical lines around their mouth. This can happen in the upper lip and the lower lip. Those are perfect targets for a fully ablative laser. And probably in my practice, the number one indication for laser resurfacing is these lines around the mouth. When I'm doing this procedure in addition to a vertical restore, everything else gets beautifully lifted and repositioned, and the jawline and neck look lovely and gorgeous, but then you've got all these lines around this area, and you want to get after it. And that's where the Sciton Contour TRL, which we use in our practice, comes in very handy as a tool for this.
But it's important to recognize that it doesn't take care of laxity. This is a key point. So, if you are in your 50s and 60s or older and you have laxity, and that laxity is causing the skin to bend and break, lasering it is not going to help it. It needs to be lifted, and the skin sort of unraveled. And then if there's lines and wrinkles still there because they've impregnated into the surface of the skin, then a laser can help in that. So, don't make the mistake of thinking that you can replace looseness of your skin by doing a fully ablative laser.
Another caveat here is that you can't use these lasers on the neck. The neck skin is just simply too thin.
So, how much do lasers like this generally cost? They're typically around $2,500 to $8,000 plus, depending on the expertise of the surgeon who's doing them and the level of confidence that they have to be able to do this safely and super effectively. So, there is a range, like anything else in this industry. The beauty of it is, however, once you get it done, especially those deep lines and wrinkles around the mouth, usually you don't need to get it done again. And that is a key, key, key point to keep in mind. It's usually one and done, which is something I love about it.
Now, I want to back up for a second and explain what has happened evolutionarily in our practice. There was a time, not that long ago, where I was doing three to four Contour TRLs in addition to the vertical restores each week. So, we were constantly lifting and resurfacing the face simultaneously. But since a lot of our surgical patients have been on the CarMD Trifecta for sometimes a year plus before their surgery, as they're waiting for their surgical time to roll around, the number of lasers that we do outside of these vertical lines has gone to maybe three or four a year. It's so rare that we do a full-field resurfacing. I usually only do it around the mouth these days because the rest of the skin looks so good. And that is an incredible testament to the Trifecta, but it's also a really nice thing for the patients because, at the end of the day, you don't have to deal with recovering your entire face.
So, when it comes to downtime, here's the deal. CO2 lasers have an extended downtime because there's a process called nonspecific thermal injury, meaning that it causes redness and swelling deep into the tissues, and the tissues take a lot of time to recover. As a result of that prolonged inflammatory phase that people are in, the consequences of these lasers increase, the side effects, if you will. So, things like post-inflammatory hyper- and hypopigmentation are higher with a CO2 laser, in addition to this standard downtime associated with it. Bad news with hypopigmentation is that it's permanent. There's nothing you can do to recover from it. Once that pigment is gone, the pigment is gone. Hyperpigmentation, on the other hand, is temporary and oftentimes resolves on its own or with some bleaching, retinol, and hydroquinone, or things that have lightening agents in them.
For this very reason, I prefer the Erbium:YAG category because if you can recover faster, which an Erbium:YAG is usually around a 14-day recovery, unless you go very deep around this mouth area, it can take an extra week or so. Typically, the recovery is quick before the post-inflammatory hyper- and hypopigmentation can really take hold. And as a result, you get back to life much sooner. So, you can see what the rationale is for why I like the Erbium so much more. Equal or maybe even better outcomes, more precise, less downtime, less complications. And as a result, honestly, very, very few practices that I'm aware of are still doing full facial CO2 resurfacing. It used to be so common back in the day, but people simply don't have the time to go through that type of recovery. And with alternatives that are better, they don't want to go through things that are going to risk some of those complications.
So, my score ultimately, I give a CO2 laser for this category a 9 out of 10. I think it's still a great laser. And I give Erbium:YAG a 10 out of 10 in this category. And why do I give it such a high rating? Well, because ablative is basically surgical. It's a physical removal of something. It's going to have a positive change, no matter what.
So, who shouldn't get the CO2 laser or the Erbium:YAG full-field resurfacing? Basically, younger patients, people who have generally good skin and think that they need to do more. I would give it a zero out of 10 for that application. If you don't have significant problems, you shouldn't be going anywhere near these lasers. In addition, if you have melasma, stay away from this particular laser. I've learned the hard way of treating patients who I didn't totally diagnose and realize that they had melasma, and I thought it was just sunspots, and they had a very, very tough time recovering from this laser in terms of creating a very significant amount of melasma as a consequence of the laser and the intensity that they went through.
Next up, we have a very popular younger sibling of the fully ablative laser, and that is the fractional ablative lasers. These consist of CO2-based and Erbium-based categories. So, here's some CO2 variations, some brands that you may have heard about. There's the Mixto laser, there's a DEKA SmartXide, there's a Lumenis UltraPulse, there is the Lutronic ECO2, and the Candela Core E, and many, many more. In the Erbium fractional category, you've got Sciton's Profractional, Fotona, Lutronic with Action II, and other fractionated Erbium lasers, but those are the big ones.
So, why would you do a laser like this? What's the difference? So, as we said, ablative means every part of your skin sees the laser. It literally sheers through the entire thing. Fractional means there's a fraction of the skin that sees this. There's columns of laser that are hitting the skin, almost like a pixelated grid. And typically, it's anywhere from the range of 11 to 22% or so that the skin is getting the laser exposure. The reason for this is that the skin that hasn't been treated by the laser, the other 90 or 80% of the skin can quickly surround and heal this tissue very nicely, and you're back to recovery quick. So, especially for the CO2, this has become extremely popular because, I said, very few times are you doing full-field resurfacing with CO2, but doing a fractionated CO2 is a good alternative, and a lot of people use that.
What are the indications for this? Specific things are like, you know, you can definitely improve fine lines and wrinkles with this. It's nowhere near the corrective ability that you get with full-field resurfacing because you're just not treating it and you're not getting down layer after layer into the bottom of that wrinkle. But it's very handy for things like acne scars, surgical scars, and just all-around kind of collagen stimulator and building up the skin, etc. Fractionated lasers can be used on the neck, which comes in really handy. You can treat the face and neck, which you should always do with the exception of fully ablative lasers, and get that collagen stimulation and improvement and tightening all the way through your face.
So, who's the ideal person for this? People who are in their 40s and 50s who want something a little bit more aggressive but aren't willing to go through the recovery and downtime, and quite frankly, don't need it. So, this is a good alternative just to keep the skin healthy and in good shape. And very specifically for people who do have problems with scarring, especially acne scarring, this is the go-to treatment for that particular condition.
Let's talk cost. So, typically for a laser like this, I have here around $2,000 to $5,000 per treatment. And with these type of lasers, because you're not completely treating the entire surface of the skin, you definitely need to consider doing a series of these. Anywhere from three to five treatments is what it typically takes to get the results that you're looking for. If you're not willing to go that direction, if it's not within your budget and you don't want to go that way, well, I don't recommend even starting the series because oftentimes you're going to be disappointed with one treatment.
As far as downtime, again, because you're not treating the entire skin, it's much, much less. It's typically between 5 to 10 days, again, depending on how deep each of those laser passes go. And with the Erbium variety, you can really control and tune it to how deep you want to go with each of those columns. So, deeper scars, scar tissue, etc., you can really kind of go deep with this. Whereas CO2 is a little bit more tricky if you try to get layer after layer on that area. And I personally don't have very much experience with fractional CO2 lasers. I have a lot of experience with the fractional Erbium in the Sciton Profractional system.
So, my score for what it does, again, it's ablative, it's fractional, it actually does good work, I would give it a nine out of 10 in this category. And why do I give it that? Because it actually is doing something, as I mentioned, but it's also doing it in a way that's balanced and doesn't risk too much. There's a low risk threshold with this type of laser treatment. And I like things that have high reward and low risk. And that's how I'm considering all of these rankings as well.
So, who shouldn't get a laser like this? Well, basically anyone with severe skin aging, deep lines and wrinkles, a lot of pigmentation, melasma, and ultimately anyone with expectations that are lofty beyond what I just explained here. This is kind of a a cruisy type of a laser. Um, it's doing more good than harm, but it's not going to be a miracle.
All right, moving on to our third laser, which is really become one of the most popular lasers in this category, and that is the hybrid fractional laser. So, hybrid fractional lasers typically are lasers that combine some ablative with a non-ablative wavelength. And the idea is that the ablative is going to do exactly what we just talked about in the fractionated ablative category. And then the non-ablative is going to target pigmentation, browns and reds, which we'll talk about a little bit more. So, as a result, you're getting something that is going to help with pigment and giving you the benefits of the fractionated laser in one treatment because it's giving you two lasers at once.
So, who's a perfect candidate for a laser like this? Basically, anyone in their 30s and 50s, again, younger, who have changes that are going on in their face, their neck, even their décolleté, chest area, and who want to improve the not only the texture of the skin and the lines and wrinkles of the skin, but also want to improve tone and discoloration. This is a great laser. Perhaps the most popular in this category is the Sciton Halo laser, and there's also the Alma laser.
So, what's the investment? So, for the Halo laser, which again is one of the most popular in this category, it typically costs between $1,500 and $2,500 per treatment. Now, you can get results after one treatment, but because only a portion of the skin is getting the laser done, you're not going to see as good of a result as you would if you did two to three, and sometimes even four treatments, depending on how much discoloration your skin is getting. So, plan for this and prepare for this so that you don't find yourself disappointed after one treatment. Although again, if your expectations are on the lower side, even one or two treatments can give you a nice result.
Now, as far as downtime, plan for at least five to seven days. There's going to be a little bit of swelling. There's going to be some discoloration from the pigments. We call them mends, which are basically coffee ground look that comes to the surface of the skin and then sloughs off. Five to seven days is a good window to prepare for a laser like this. Now, when it first came out, it was really positioned as a no downtime type of laser. And I can tell you firsthand, we've had some pretty disappointed and upset patients who we set their expectations in the wrong way and told them, "Hey, yeah, this is no downtime. Go ahead and do it." And sure enough, there was downtime. And, you know, they weren't obviously very happy with recognizing. But then that was our experience, too. I mean, we took the word of the laser companies, and then we had to learn the hard way that that's not exactly um reality. It was more marketing. So now we're much more clear about what to express to people and, and so for you, just plan on a week or two before any type of major event.
So, my score for a laser like this, I give it about a 7 out of 10 because it's not quite as good for discoloration as an IPL or BBL, which I'm going to talk about in a moment. And it's not quite as good as a fractional laser um for fine lines and wrinkles. It's a little bit of a, you know, kind of a softening of both. So, 7 out of 10, I think is a fair rating for such a laser. And who shouldn't get a laser like this? Well, basically again, just like fractional, anyone with any kind of severe condition. There's better lasers for discoloration, and there's better lasers for fine lines and wrinkles. This is more just kind of like a do something positive for your skin. Don't take a lot of downtime. Don't take a lot of risk. It's a good laser in that way.
Next up, number four, is also an extremely popular laser, and that is in the category of non-ablative fractional lasers. The most popular one of them is the Fraxel Restore. So, a non-ablative laser is exactly as it sounds. So, there is no tissue being basically removed or evaporated in this type of a laser. It does its work by putting energy into the deeper layers of the tissue that will help stimulate collagen potentially, and also help with discolorations.
So, for the ideal candidate, you're looking at people within their 30s and 40s who want to be proactive with their skin and get in front of some of the collagen loss that's heading their way, and also reduce some of the discoloration that happens. And that's about it. No miracles, no major changes, just slow and steady improvements over time. I think you're starting to understand the theme that if you're doing these lighter lasers, you're probably doing them in a series. And the Fraxel is no exception to this category. You're going to want to do them in a series to get the changes that you're hoping for.
So, what's the cost? The cost is typically between $500 and $2,500, again, depending on who you're doing it with and their expertise. And as far as downtime, you're looking at typically 3 to 5 days of redness, some swelling, almost like you have a moderate or mild sunburn, and your skin might feel like sandpaper as it's going through this process.
My score for Fraxel in this non-ablative category is six. And I think I'm being slightly generous for the cost, the changes. Not bad. Let's just give it a 6 out of 10. I'm feeling a little generous today. I could easily be pushed into giving it a five, but six is not bad. You get what you expect if you know what to expect in this particular laser.
So, who should skip a laser like this? Well, frankly, anyone who thinks they're going to get a wow effect, a major change, or if they've got a lot of aging changes on their skin, deep lines and wrinkles, this is not a laser for you. And again, melasma, stay away from this particular laser.
All right, so let's talk about our fifth laser, which I like to kind of have fun with it and call it a skincare on steroids type of a laser. This is the gentle fractional laser. Perhaps the most common term you've heard for this or brand name is the Clear + Brilliant. It's from the same makers as the Fraxel. Kind of like a baby Fraxel, if you will. And you'll understand why in a moment. Same exact concept, but just even less aggressive. Really less change, less expectations, definitely something you're doing on an ongoing basis.
So, ideal candidate for this, somebody in their 20s and 30s who want to be proactive, who want to kind of keep things going, but doesn't want to go through a lot of recovery and a lot of cost. This is a lovely choice. Cost-wise, it's even less expensive than the other lasers. It's between $250 to $750 per treatment. Again, you're going to be doing this in a series as well, typically between three to six as an initial treatment, and then doing it regularly to keep the changes. I'm going to talk to you about what that means in a moment. And the best part of this laser is that the downtime is very minimal. You're talking about a day or two usually of just some pinkness. Not much in the way of planning that needs to go into this. Very, very, very low risk or consequence associated with this laser.
My overall score for this baby Fraxel Clear + Brilliant is a 7 out of 10. I'm actually giving it a better score because again, low downtime, low risk, low cost, and for people who know what to expect, it gets the job done. It's just a little collagen stimulation. And, uh, I'm always in favor of anything that can stimulate collagen. As you all know, that's a major, major tactical approach to anti-aging. Who shouldn't get it? Well, I'm sure you already know. Anyone with real skin aging changes, stay away from this one.
Okay. Now, for a little bit of perspective, and this is super important, because this wouldn't be an appropriate video if I didn't give you this perspective here. Many people approach skincare and anti-aging completely backwards. They do one or many of these lasers, and they think they're doing a really, really good job of handling their skin aging changes and getting in front of it. The fact of the matter is, as you have seen in all the lasers that we've talked about, and even the ones we're going to talk about, the changes are temporary. You do a series followed by a maintenance regimen as you go on. That gets costly. A lot of these lasers do have downtime, etc.
The reality of the matter is, and this is in my strong opinion, how you should approach this. You start with science-backed smart skincare that's going to work at the cellular level on a daily basis. Things like retinol, vitamin C, niacinamide, peptides. These are just stimulating collagen, decreasing pigmentation, making the skin younger and younger and younger day after day. Say you want to get in a hurry and you want to boost your skin and get it looking better right out of the gates. Well, then do one of these lasers for the situation that's appropriate, but none of them is going to keep those changes from coming back. Even the deep laser resurfacing, eventually the skin is going to start to age again. Maybe the deep lines won't come back. Discoloration and fine lines will definitely come back. Collagen loss will still continue.
So, skincare is at the crux of your anti-aging regimen, as is sun protection. This was the reason why I developed the CarMD Trifecta. Why? Because I wanted something super effective but super simple that people could actually use and do it over time, because nothing works if you start and stop over time. Even these lasers, and being only three steps makes it so easy to remain consistent with it. Literally one or two minutes, and you've got every single skincare category that you need on your skin to really defy skin aging. The proof is in the pudding. We've got over 10,000 people loving it and using it on a daily basis. So, if you can do something every day that's positive for yourself, sun protection, use the Trifecta. In many cases, you're not going to need these lasers. And reality is, if you get the lasers done and you get on the Trifecta, you're probably not going to need another laser. That's been our clinical experience with it. And that's been the experience of my wife, who literally has never done a laser and managed her entire skin at age 53 all this time through skincare only.
For more information, if you want to learn more about it, check out the website. That is the perspective you should have in terms of a pyramid. You go sun protection, skincare, and then add one of these lasers for a specific problem. And for the CarMD Trifecta, I honestly give it a 10 out of 10. Try it for yourself. I think you would give it the same exact score.
All right, now let's get back to lasers. So, we're on the gentle category, right? So, the next category of gentle lasers are the superficial ablative lasers, and the top of that list is Contour's MicroLaserPeel. I love this particular laser because you can tune it down to four to 10 microns and literally just remove the upper layer, the epidermis, the stratum corneum, the stuff that makes the skin look dull. You can remove that in one fell swoop. Yes, there is some downtime, you know, again, four to five days sometimes of redness, etc. But it's not a bad heavy downtime like it is when you go deeper with the Contour. Not even close. Think of this as almost like a weekend peel where you take a little bit of time, and then you come out looking glowy and fresh because that upper layer, when you exfoliate it, that's where you get that brightness. I always think of it as kind of like, you know, when you're peeling an onion, that top layer is very dull looking, and then you get down to that glistening layer below it. When you peel off the top layer, well, that's what happens when you remove the stratum corneum and the upper epidermis, and you get to see that bright, glowy skin come forward.
These are awesome, awesome lasers for people who are in their 30s, 40s, and even 50s who just simply want to exfoliate and get that skin looking bright and fresh again. It will help with some superficial fine lines and wrinkles, and it will help with some discoloration, and it will help with stimulating some collagen. So, this is a lovely little laser. The cost for a laser like this is typically around $250 to $700, and that's usually depending on how deep the practitioner needs to go. The beauty of this laser is that you will definitely see results literally after one treatment because you're removing the entire layer of the skin. You're not fractionating it. You're removing an entire layer. It functions almost like a chemical peel in that way.
So, my score for the MicroLaserPeel from Contour is an 8 out of 10. It really does the job. Low risk, really no complications associated with it, short downtime, low cost, all-around good little treatment to do to jump-start things, get your skin looking beautiful. I think it's a highly, highly underutilized laser. Even in our practice, although we have it, I don't think we do enough of these. And you know what the cool thing about it is? You rarely even need to do heavy numbing associated with it. It's hardly painful. Who should skip it? I'm going to let you answer that. Basically, anyone with serious skin aging concerns, this isn't going to do much for a little glow-up. Lovely.
So, number seven is a little tricky because IPL and BBL are not actually lasers. They're a spectrum of light, actually. And their real targets are brown spots and red spots. That's their chromophore: melanin for the browns and blood hemoglobin for the reds. And you can adjust the filters to get the type of spectrum that you're looking for for each of these specific problems. Now, IPL is the most common term that's used because most laser companies have an IPL device. Contour has the BBL, which stands for broadband light, and it's specific to them. It's a different technology, a totally different wavelength, and a little bit broader in terms of what it covers, and more filter options that you can do to target specific conditions and specific skin types and color. In my opinion, I love the BBL. I have no problem with the IPL, but we have the BBL and see amazing results when it comes to removing discolorations, both red and brown.
So, think of this as the brown and red spot eraser. And it's really for people of any age, 30s all the way to 60s, even older, who have these particular conditions and want to go after the pigment. And for pigment, it's the gold standard. Why? Because it penetrates quite deep and it gets those pigments that are below what a MicroLaserPeel can do, even below what a deep laser resurfacing can often get. So, a really good way of clearing the skin and going forward.
Typical cost for these lasers are somewhere around $400 to $700. I always recommend doing your face and neck and sometimes including the chest as well, so you get a nice even tone all the way through. But like the other lasers, this requires a series, usually between three to five, depending on the category or brand you're using, and also depending on how severe your discoloration is. But it can be pretty dramatic improvement.
What does downtime look like? Well, for the brown discolorations, it forms this coffee ground effect on the skin. So, it's a darkening effect at first. And anywhere from 7 to 14 days, these kind of rise up and exfoliate eventually, and then you have nice clear skin. It's basically the fragmented pigments that are, you know, needing to be basically absorbed or or expressed. The red discoloration, same sort of process. You're going to go through something, even sometimes bruising, etc., as these capillaries are basically heated and then contracted.
With this particular laser, keep in mind you cannot have sun before or after this. I mean, all these lasers, you got to be careful after, but this particular one, if you're tanning or going on a vacation, make sure you let your practitioner know and cancel that appointment and reschedule it because typically around two weeks before, you really shouldn't be getting much sun before this because it puts your skin in a situation where you have too much pigment, and now all of a sudden you can burn from this laser.
Now, this laser, more than almost any other ones we talked about, is more technically nuanced in terms of how to use it and the, you know, wavelengths and the passes and all these other things. Something that I'm personally intimidated by. I'll be honest with you. I've always gotten the training from my team, my nurses, etc., to do this particular laser from the experts, but I never got that myself and I wouldn't even attempt this because there's just too much decision-making going on with this. Unlike a lot of the other lasers, the risks are real: burning, striping, hyperpigmentation, hypopigmentation, definitely not good for melasma, all these things can happen. But in the right hands, using the right, you know, application filters, etc., you can have a lovely, lovely result. But the results are temporary. Keep that in mind. Those pigments go away, they will come back. Those capillaries shrink, they will come back.
This is why I said what I said earlier about skincare, because if you wipe away the slate and then you suppress pigment from forming, well, guess what? Now you get to see the benefits of that IPL or BBL for years and years to come. Like you're not going to need to do it because you don't have the mechanism for creating new pigment. That is a key, key point, and that'll make your life significantly more efficient and the outcome significantly more satisfying. And don't expect your broken capillaries to go away. They definitely do recanalize and they come back. And this is something for reds, especially skincare doesn't address. You're going to have to do it on a continuous basis.
So, straight out of the gate, in terms of what it can do to remove all these things, I would I would give it a 10 out of 10. But in the scheme of everything that I just mentioned to you, I'd give it a five out of 10. My opinion, skincare beats this when it comes to pigmentation in the long run. And ultimately, again, doing something repetitively over time can get very expensive. But if cost is not an issue for you and you're willing to go the distance and do it, then this is a very, very good approach to improving tone for your skin. And also keep in mind, this does nothing for fine lines and wrinkles. So, if you're considering this for that type of application, you're going to be severely disappointed. It's not going to do anything in that department. Just pigment.
And finally, our last treatment is the most specialized of all the lasers, and that is the pulsed dye laser, commonly known as PDL. Common terms for this is the Vbeam. I hear that all the time. I think that's a very common laser that's used out there. Think of this as the ultimate redness remover. IPL and BBL can help with small capillaries, but they don't do well with larger caps and larger vessels. PDL does. It also works really well for the smaller ones. The PDL laser wavelength targets red blood cells and the components of it, and it breaks it up in a very, very efficient way. All around the best laser for reds. And once it targets that hemoglobin molecule, well, the heat generated from that causes the blood vessel to collapse and shrink. And as a result, that blood vessel goes away, again, temporarily, because right around the corner, you're getting a new process of neovascularization, creating a new blood vessel that eventually needs to be ablated as well. But this is a very, very good way to clear the skin right out of the gates.
So, who is it for? Anyone at any age whose trouble is red discoloration. And I'm specifically talking about capillaries and anything with blood contained, which is most red pigment. Very commonly, you'll see these broken capillaries on the nose and around the nose. People with persistent rosacea and people with birthmarks. These are categories that PDL is a very, very good choice for, probably the best choice of anything out there. Another very, very good option is for people who have redness from surgery along their scars or acne, and there's that persistent redness. You hit with a PDL, and that breaks up the inflammatory process and decreases the pigmentation and the redness that sometimes can be the most visually upsetting for people who are going through recovery of a scar because, as you know, scars go through an inflammatory phase and then a final scar resolution phase, and that could take up to a whole year. So, if you can get in front of the redness, if you're having that persistence, a great choice.
Typically, these lasers are anywhere from $150 for these spot treatments up to $500 for more broad areas. And once again, you're going to need between one to five treatments to get the job done. Downtime is minimal, although you definitely can bruise from this, and the bruising can take, you know, days for it to go away. So, account for that when you're planning this type of a laser.
My score for the PDL laser, I would give it a 9 out of 10. I think it's a very, very effective, probably the best tool in the toolbox for red pigmentation. It gets a good score. Low risk, low cost, low recovery, and effective. You get a 9 out of 10.
So, there you have it. Eight very popular laser treatments ranked from a facial plastic surgeon's perspective. I'd love to know if you agree with these rankings, your own personal experiences. Fill in the comments section. I love hearing your stories. I know the community benefits from hearing your experiences. Again, this is my own personal experience from the treatments that we've performed in our practice, as well as hearing from patients who've done other things and my dermatology and other plastic surgery colleagues. Also, in the comment section, make sure you let me know what other anti-aging skincare or otherwise treatments you would like me to rank and discuss in a subsequent video. Thanks for watching. Check out the CarMD Journal. And if you haven't already, make sure you subscribe to this channel. Once a week, you're going to get expert testimony on treatments and concepts that will help you remain empowered and make good decisions moving forward. Until next time, Dr. Amir Karum.