Skin Resurfacing 101: Microneedling vs. Fractional Laser Treatments

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As a medical aesthetics professional, you know there can be a big difference between skin resurfacing treatment modalities. The outcomes of each modality and the long-term treatment plans you prescribe to your patients can vary dramatically. To help determine the best uses for each modality based on a patient’s skin type and desired outcome, refer to this quick reference guide to the top skin resurfacing procedures to help you deliver optimal results.

Micro-needling

How it works: Micro-needling utilizes tiny needles that are applied to the skin with gentle pressure or pulses, creating thousands of micro-dermal wounds. These micro-dermal injuries send a signal to the skin to kick start the healing process, increasing collagen production and promoting healthy skin cell turnover. Because this process relies on a healthy skin response, it is best used on younger patients who are likely to have a faster cell renewal cycle. 

Pros and cons: Depending on needle depth, micro-needling often affords a quick recovery time, from a couple days to a week. Skin may appear slightly sun burnt and beauty products or makeup application should be avoided prior to scabbing, meaning this may not be the best treatment for patients with busy schedules. Finally, micro needling is best used to achieve less, targeted, all-over results and will require multiple sessions to obtain an optimal outcome. 

Contraindications: Because the treatment does not utilize heat, it is generally safe for all skin types, with three significant contraindications being active acne breakouts, a high level of active inflammation, and any active skin infections. Having said that, it’s important to consider more than a patient’s skin color when assessing protocols; ethnicity, past and current health records, and even history of sun exposure are other factors that can weigh in on your decision. In all cases, test spots are imperative.

Fractional CO2 Laser Resurfacing

How it works: Fractional carbon dioxide (CO2) laser resurfacing devices utilize infrared light delivered through a carbon dioxide-filled tube to create micro-thermal wounds in targeted tissue. As the light is absorbed by the skin, tissue is vaporized, leading to the removal of aged and damaged skin cells from the outer layer of the treated area. Thermal damage caused by the laser also contracts existing collagen, which firms up skin and boosts new collagen production alongside a spike in healthy cell renewal.

Pros and cons: While non-surgical, this treatment modality is more invasive than many other skin resurfacing treatments, which can translate to more noticeable results. That being said, the fact that it is more invasive also means that partial or complete sedation may be necessary for patient comfort and treatment times often average between 60 to 90 minutes. Skin will be red and warm to the touch, and at least one week of downtime is expected.

Contraindications: There are several standard contraindications, such as active infections in the desired treatment area. In addition, patients who have used isotretinoin in the past six months should wait to be treated. CO2 laser resurfacing is also not recommended for darker skin types.

Fractional Erbium Laser Resurfacing

How it works: Erbium, or YAG, lasers utilize infrared light to deliver thermal energy deep below the skin’s surface. Fractional erbium laser resurfacing creates tiny micro-thermal patches (injuries) in the dermis, the middle layer of skin, damaging collagen and aged skin cells and prompting the production of new collagen and healthy cell renewal. In other words, this treatment modality performs a sort of controlled tissue vaporization to treat and heal damaged skin for an improvement in skin’s texture, tone, and elasticity.

Pros and cons: Fractional erbium laser treatments are better suited to older patients, since, compared to micro-needling, they target tissue that is deeper below the surface for an improved boost in collagen production. However, there isn’t a firm guideline to determine who may be too young for these particular treatments. This treatment also requires significant downtime with redness lasting for several days. Erbium fractional laser treatments are not ideal for darker skin tones due to a high risk of discoloration.

Contraindications: Because lasers heat the skin, there are more side effects to consider, including concerns regarding post-inflammatory hyperpigmentation, alongside a longer downtime and post-treatment care.

Fractional Ablative Radio Frequency (RF) Resurfacing

How it works: Advances in medical aesthetics are beginning to see the advantages of combining modalities for improved aesthetic results. Fractional ablative radio frequency (RF) skin resurfacing technologies are one such example. These devices combine the benefits of ablation with RF’s proven track record in skin tightening to offer treatment providers with improved control over treatment outcomes. For example, Venus Viva™, a customizable skin resurfacing device, offers complete control of ablation, coagulation, and resurfacing with two applicators optimized for specific outcomes. Powered by Nano-fractional Radio Frequency (RF) technology, the first applicator features a tip with tiny pins that penetrate through the epidermis, delivering RF energy to the deeper layers of the skin to effectively improve the appearance of scars (including acne scars), striae, rosacea, dyschromia, deep wrinkles, enlarged pores, and other uneven skin texture and pigmentation concerns.

The second DiamondPolar™ applicator utilizes proprietary (MP)2 technology, a combination of Multi-Polar RF and Pulsed Electro Magnetic Fields (PEMF), for the improved treatment of moderate to severe wrinkles and rhytides for tighter skin. Both applicators improve the natural proliferation of collagen, blood cells, fibroblasts, and growth factors deep within the skin to even out texture and tone.

Pros and cons: An alternative modality such as radio frequency can deliver the benefits of an energy therapy in a way that is safe for darker skin tones, unlike other fractional laser treatment options. Also, because of the ability to control ablation and coagulation, Venus Viva™ skin resurfacing treatments are able to resolve mild to severe skin damage, making it suitable for a wide range of patients. Another major benefit is that these treatments offer a non-surgical solution that is more comfortable than alternatives like the CO2 laser and require little to no downtime with quick 15- to 30-minute sessions, making it the ideal solution for busy patients. Patients can resume their regular skin care routine after only 24 hours.

Contraindications: Most standard skin resurfacing contraindications apply, including cosmetic injections within the last two weeks, tattoos or permanent makeup, or excessively tanned skin in or immediately around the treatment area.

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