Chromophores for each "defect" of the skin are different. For rejuvenation, the target chromophore is water. Why water? Because water deposits are located in the dermis, in the same place where fibroblasts are located, synthesizing the main supporting proteins and elements of the extracellular matrix necessary for skin elasticity, including the famous hyaluronic acid.
Today clinics offer us three main options for laser therapy.
Non-ablative effect: tone and rejuvenation
What is it:Non-ablative means that the epidermis is not damaged and this technique has a high degree of safety. Basically, procedures are indicated at the first stage of aging (fine wrinkles, slight loss of turgor), post-acne, etc. As a rule, they are prescribed in courses (3–8 procedures) and are recommended for young patients - up to 35–40 years old. As a result, sebum production decreases, pores become smaller, the level of moisture increases, microcirculation improves, which means that post-acne has a chance to dissolve, and acne scars - to smooth out. In general, you will look fresh and "fit".
How it works:The laser beam "warms up" the skin to the temperature of denaturation of proteins, such as collagen, as a result, the production of new protein and other components of the extracellular matrix is activated. That is, the effect is only on the deep layers of the skin, and on the surface the temperature does not exceed 40-48 degrees and no damage occurs.
What laser is needed: The most popular are diode lasers with a wavelength of 1064 nm (Nd: YAG), 1540 nm (Er: Glass).
Ablative effect. Grinding
What is it:Ablative - it means damage to the epidermis occurs, tissue is removed. This is undoubtedly one of the most effective methods, since after the procedure a complete restart of the system takes place, that is, the skin starts to work like "10 years ago", the structure of the dermis is completely remodeled.
There is, in fact, only one minus in this, but what a disadvantage. In the course of the procedure, you are simply "flayed". This is an open wound with all the ensuing consequences (pigmentation, the possibility of infection, bleeding crusts, necrosis) and rehabilitation within a month. The selection of patients for such a procedure is very serious, you just won't get to such an execution. But if you have hyperkeratosis, the oval of the face has already completely swam and all the signs of aging have long been on the face - you are a candidate for resurfacing.
How it works:By absorbing laser energy, water turns into water vapor and evaporates along with cells and connective components - this is ablation. Thus, the skin receives a powerful boost and begins to intensively regenerate. As a result, even deep wrinkles are tightened and smoothed. The effect builds up gradually, that is, after a couple of months you will look better, and then even better and even better, and then there will be a second procedure.
What kind of laser is needed:The most popular is the CO2 laser (CO2 Reliant re: pair 10 600 nm). Fear of it has been known to women since the early 90s, when CO2 lasers were recognized as the "gold standard" and "holy grail" of laser rejuvenation. As an alternative to them, later appeared erbium lasers with a wavelength of 1550 or 2940 nm (Er: YAG 2940 nm), they do not act so deeply, the healing process after them takes an average of a week (however, the first days after the procedure are still very difficult). It is worth noting that such procedures are carried out by the most highly qualified specialists, and in their hands it is an excellent tool.
Fractional thermolysis
What is it:Another way of rejuvenation, not as "draconian" as the previous one. After doctors realized that non-ablative treatment did not work the way they wanted, and laser resurfacing had too many side effects, an intensified search for alternative options began. In 2004, a fractional technique was proposed.
Fractional means that the impact occurs only on a specific area - the microthermal treatment zone (MLZ). Fractional thermolysis is indicated for stretch marks, including postpartum, atrophic scars, sagging skin, all types of aging, wrinkles around the eyes - it can do almost anything! Today it is the most effective and popular rejuvenation procedure. But again, you will not get off with one procedure.
How it works:Similar to laser resurfacing, the water heats up - all the excess evaporates. But the top layer of skin is not completely removed, the "damaged" and "undamaged" areas alternate, like on a punched card or a checkerboard. The smaller such zones are, the more the skin is "rejuvenated", while the recovery period is significantly reduced in comparison with resurfacing. The ideal size of the zone has not yet been established, each specialist has his own opinion on this. As a rule, the zone diameter is 100–200 µm at a depth of 300–1400 µm. For reference - the thickness of the epidermis is about 200 microns, which means that the laser can "pierce" to the dermis (where we need to get).
What kind of laser is needed:Fraxel can be done on ablative and non-ablative systems, respectively, the effect is different. With a non-ablative effect, only coagulation of the epidermis occurs, and not its removal, but the effectiveness of rejuvenation also decreases (wavelengths of 1440, 1540 and 1550 nm). In ablative systems, Active-FX CO2 (10 600) and an erbium system with an IPL system (intense pulsed light - polychrome light, wide wavelength range, unlike a monochrome laser) are popular.
A new trend in this area is "nanoperforation", or SMA (Space Modulated Ablation, not to be confused with ultrasonic SMAS lifting), MLZs have a diameter of 50 microns and the same depth - almost a piece of jewelry. The rehabilitation period is also short here.
Reference: SMAS, or Superficial Muscular Aponeurotic System - the effect on the muscular-aponeurotic layer, a thin layer (fascia) below the fatty subcutaneous tissue, which connects with the muscles of the face and neck. We are getting old - this layer is "going down", lift it up - and the face will look much younger. The procedure is especially effective for the lower third of the face, which sags with age. Lasers cannot penetrate that deep, but ultrasound can do it. Typically, the Ulthera System is used for SMAS lifting.
Because the water evaporates during rejuvenating laser treatments, you may become dehydrated. Based on this, you can prepare for the procedure by taking a course of biorevitalization with hyaluronic acid. Do not be surprised if the clinic offers you these injections before or between laser treatments.
Tip: Choose not a device and a laser, but a specialist. The result depends on his qualifications. Whatever the recommendation, make sure that you are fully informed about what result to expect, what the risks are for you (especially if you have a tendency to scar formation) and what to do before and after the procedure. You may need to make changes to your care routine.
In my opinion, lasers resemble a magic wand that can turn Cinderella into a princess. The main thing here is to choose the right fairy.