Which laser is best for aging?

When your primary concern is uneven texture - fine lines, mild surface roughness, enlarged pores, superficial irregularities - what you really want is a laser that remodels collagen in the dermis without excessive damage to the outer layers.

 

Here's the breakdown:

Fractional resurfacing (fractional lasers) are generally considered the "sweet spot" for improving texture. The idea is that instead of blasting the entire skin surface uniformly, the laser delivers energy in microscopic "dots" (or pixels), leaving intervening skin untreated. This approach allows faster healing and less risk of pigment changes, while still stimulating collagen remodeling in the dermis.

 

Among fractional lasers, there are two classes:

Nonablative fractional lasers: These deliver heat below the surface without fully removing (ablating) the epidermis. The downtime is modest (perhaps a few hours to a few days of mild pinkness or dryness). Examples include BMFR17, etc.

Ablative fractional lasers: These are more aggressive; they create microscopic wounds by vaporizing columns of skin, which leads to more robust collagen formation but also longer downtime (scabbing, peeling, redness for days to weeks). They are often reserved for deeper texture problems, more significant wrinkling, or acne scarring.

 

Another interesting option is picosecond (pico) laser technology. Though more often known for pigment or tattoo work, when used with a diffractive lens it can act like a fractional treatment, stimulating collagen with limited downtime.

 

The laser does not merely "peel off" the top layer, as older ablative lasers or harsh chemical peels might have. Modern fractional lasers aim to penetrate and stimulate from within, leaving islands of untreated skin that help with faster healing and preservation of melanocytes (pigment cells). 

 

 

So, for surface textural issues, a fractional resurfacing laser (nonablative or mild-to-moderate ablative) is often the best choice. It balances efficacy with safety and downtime.

 

Is laser the "best" method for treating wrinkles?

"Best" depends on the wrinkle depth, skin type, downtime tolerance, budget, and risks. Lasers are powerful tools - but they are not the sole or universal answer. Here's how I see their role:

Pros of lasers for wrinkles:

Stimulate collagen remodeling - Many wrinkles arise from weakening, disorganization, or thinning of dermal collagen. Laser energy can trigger new collagen formation and reorganization, reducing wrinkle depth and improving skin "architecture."

 

Address multiple issues simultaneously - Besides wrinkles, lasers can help with discoloration (pigment), redness, uneven tone, fine lines, and texture irregularities in one session or treatment plan.

 

Non-surgical - Compared to facelift surgery (which removes or re-drapes skin but doesn't improve underlying collagen quality), lasers carry fewer risks, less invasiveness, and often less downtime. 

 

Limitations and challenges:

Depth limitation: Lasers (especially nonablative types) might not reach the deeper dermis or addressing deep folds and sagging - those may need adjunctive treatments (radiofrequency, ultrasound, microneedling + RF, or surgical lifts).

 

Downtime, risk of side effects: More aggressive laser treatments carry risks of redness, scabbing, pigment changes (especially in darker skin), infection, or prolonged recovery.

 

Variable response: Different individuals respond differently. A laser might give excellent improvement in one person but only modest change in another. 

 

Cost and multiple sessions: Achieving optimal wrinkle improvement often requires multiple sessions.

 

Not a one-stop fix for sagging: Lasers are great at improving firmness and skin quality, but when the underlying support structures droop significantly, mechanical lifting (e.g. ultrasound, RF, or surgery) may be needed.

 

Therefore, while I believe lasers are among the strongest non-surgical tools for wrinkle improvement, I would not universally say they are the best in all cases. They should often be part of a multimodal approach.

 

Focus: Fractional Resurfacing (Microscopic Fractional Laser / "Pixelated" Approach)

Because this is the most commonly used and balanced laser approach for aging skin, let's deep dive:

Principle

The laser delivers micro-beams (columns of energy) into the skin in a grid pattern, leaving untouched skin between treatment zones.

These microthermal zones create controlled injury, triggering a wound-healing cascade: fibroblasts, growth factors, collagen synthesis, remodeling.

The untreated intervening skin helps accelerate recovery by providing "reservoirs" of healthy cells.

Over time (weeks to months), collagen deposition and remodeling smooth out irregularities, improve thickness, firmness, and reduce fine lines/texture issues.

 

Target / Ideal Candidates

People with mild-to-moderate fine lines or wrinkles, dull texture, coarse pores, photodamage, hyperpigmentation, or early signs of sagging.

Patients who can tolerate mild to moderate downtime.

Skin types I–III (lighter), or darker skin types under cautious parameter settings (risk of hyperpigmentation).

Individuals who can commit to sun protection, proper healing, and follow-up care.

 

Changes You'll See in the Skin

Initial days: microcrusts, redness, possible peeling, sensitivity.

Weeks to months: smoother surface, firmer texture, reduction in fine lines, more uniform tone.

Longer term: improvement in dermal thickness and skin elasticity.

 

Strength Level Choices

Mild fractional: minimal downtime, subtle improvements, useful for maintenance or incrementally improving tone.

Aggressive fractional (ablative or deep) for those with heavier texture, deeper wrinkles, scarring - but with more downtime and risk.

 

Combining Lasers with Other Modalities

To maximize benefit and minimize risk, combining laser with adjunct treatments often yields superior results. Some strategies:

Topicals & skincare (retinoids, growth factors, antioxidants): Prepare skin before laser, and maintain gains after laser.

Botox / neuromodulators: Use for dynamic wrinkles (muscle activity). Lasers can't block movement.

Fillers: To restore volume loss or fill deep folds, complementing what lasers do for collagen and texture.

Radiofrequency / Ultrasound: For deeper tightening, especially in lower face or neck where lasers might not reach sufficiently.

Microneedling + RF: Allows deeper stimulation with less surface injury.

Platelet-Rich Plasma (PRP): After laser, applying PRP (rich in growth factors) may enhance healing and collagen response. In the Goop article, Dr. Anolik mentions using PRP post-laser to support outcomes. 

Staging / alternating treatments: For example, do a laser session, then six months later RF or ultrasound, then perhaps another laser, adjusting treatment based on tissue response. 

This "layered" or "stacked" approach tends to give more comprehensive, durable, and safer outcomes.

 

Summary & My Recommendation

For surface textural problems, the best bets are fractional resurfacing lasers (especially nonablative or mild fractional ablative). They strike a good balance of efficacy and safety.

Lasers are among the core tools for wrinkle and aging treatment, but they are rarely the only tool. Their strength is in stimulating collagen, improving tone, and refining texture.

The fractional approach is key: micro-injury in controlled dots, leaving intact skin in between to aid healing.

The best outcomes often come from combination strategies - pairing lasers with neuromodulators, fillers, RF, ultrasound, PRP, and disciplined skincare.