"Laser resurfacing" sounds like one treatment. It isn't. The phrase covers a range from a non-ablative session where you might be back at work the same day to a fully ablative CO2 treatment that leaves the face raw for a week or more. The device, the settings, and the person holding the handpiece all change what you can expect, including what can go wrong.
This guide explains the main categories, what each is generally used for, the risks dermatologic and plastic surgery sources describe, and why skin tone is one of the most important factors in choosing. It doesn't cover radiofrequency microneedling or skin tightening (see our RF microneedling and skin tightening guide) or melasma, which has its own treatment considerations (see how to treat melasma).
Two questions sort almost every laser
Ablative or non-ablative? Ablative lasers vaporize the outer layers of skin. The American Society for Laser Medicine and Surgery (ASLMS) names the two classic ones: CO2 and Er:YAG (erbium). Non-ablative lasers heat the skin without removing the surface, stimulating collagen to improve texture and tone. Per ASLMS, non-ablative lasers have less downtime than ablative ones.
Fully ablative or fractional? A fully ablative (sometimes called "traditional") treatment removes the entire surface layer across the treated area. A fractional treatment delivers energy in a grid of microscopic columns, leaving the skin between them intact, which speeds healing. Fractional delivery can be either ablative (fractional CO2 or erbium) or non-ablative.
That gives you three broad families:
•Fully ablative (CO2 at 10,600 nm, Er:YAG at 2,940 nm): the entire surface layer is removed. Largest change from one treatment, longest healing, highest risk.
•Fractional ablative (the same lasers, delivered in columns): microscopic wounds with intact skin between them. Strong results with faster healing than fully ablative.
•Non-ablative fractional (e.g., 1,540/1,550 nm and 1,927 nm thulium): heated columns with the surface left intact. Least downtime, and it usually takes a series.
Wavelengths are from a review of fractional photothermolysis in Seminars in Cutaneous Medicine and Surgery and a 2022 best-practices paper on 1,550/1,927 nm systems in Dermatologic Surgery. Brand names vary; what matters is which category your proposed treatment falls into. Ask the provider directly.
What each is used for
The American Society of Plastic Surgeons lists fine lines and wrinkles, acne scars, sun damage, and age spots among the concerns laser resurfacing addresses. Roughly:
•Deeper wrinkles and significant sun damage. Ablative lasers, especially CO2, produce the most change. ASLMS notes ablative lasers "can lead to significant improvement in wrinkles," and Johns Hopkins Medicine describes CO2 as effective for deep wrinkles.
•Texture, fine lines, and acne scarring. Both fractional ablative and non-ablative fractional lasers are used. The fractional photothermolysis review describes uses including photodamage, scarring, and stretch marks.
•Sun spots and uneven pigment from sun exposure. A 2025 ASLMS article describes the 1,927 nm wavelength as aimed at "sun-related damage and dyschromia," with 1,550 nm aimed more at wrinkles, scars, and uneven pigmentation.
Pigment problems are where diagnosis matters most. Sun spots, melasma, and post-inflammatory darkening can look alike and respond very differently to heat. A dermatologist should identify what you have before anyone picks a laser.
Downtime and number of sessions
Published figures vary by source and by how aggressive the settings are, so treat these as ranges to discuss, not promises.
•Ablative resurfacing. The American Society for Dermatologic Surgery says to expect swelling for 24 to 48 hours, peeling at five to seven days, and healing that "typically takes 10 to 21 days, depending on the size and location of the procedure." Johns Hopkins says most people need only one ablative treatment but that healing can take four to six weeks. Redness can last longer than the open-wound phase: a review of periocular laser complications in Seminars in Plastic Surgery reported redness lasting 6 to 12 weeks after traditional CO2 and about four weeks after erbium, on average.
•Fractional ablative. Faster healing than fully ablative. The fractional photothermolysis review described one to two days of open wound care in the studies it covered, with notable improvement after one or two treatments.
•Non-ablative fractional. ASDS says most patients can return to work immediately, and that multiple sessions are sometimes needed. Johns Hopkins describes four to six sessions; the fractional photothermolysis review describes three to seven, with redness and swelling lasting about two days.
The practical takeaway: non-ablative treatments trade downtime for a series of visits and more modest results per session. Ablative treatments do more at once but require real recovery time.
The risks, stated plainly
Most laser resurfacing goes well. When problems occur, they tend to fall into a handful of categories.
Infection, including cold sores. Ablative treatments create a wound, and wounds can become infected. A review of fractional CO2 complications in Seminars in Plastic Surgery identified postoperative infection as the most common cause of scarring. The herpes simplex virus that causes cold sores can reactivate after treatment; the American Academy of Dermatology advises patients prone to cold sores to take medication to prevent them before laser treatment. Tell your provider if you've ever had a cold sore, even once.
Scarring. Uncommon, but more likely after aggressive ablative treatment, infection, or treatment of thin skin such as the lower eyelids. The periocular review reported hypertrophic scarring at 0.9% in its source data.
Prolonged redness. Expected for a period after ablative treatment, as above; longer than expected is a reason to follow up.
Darkening (post-inflammatory hyperpigmentation, or PIH). Skin can darken in response to the inflammation from treatment. The periocular review lists Fitzpatrick skin types III–VI as higher risk.
Lightening (hypopigmentation). This is the one people don't expect. Loss of pigment can appear months after treatment and may be permanent. The periocular review describes it as a late effect. Johns Hopkins notes that CO2 lasers risk hypopigmentation in darker skin tones, that erbium lasers are less likely than CO2 to cause it, and that non-ablative lasers do not pose a risk of hypopigmentation.
Darker skin tones: not "no," but "carefully"
If your skin tans easily and rarely burns, or you have medium-brown to deep-brown skin (roughly Fitzpatrick types IV–VI), pigment changes are the central risk to discuss.
A 2017 evidence-based review in The Journal of Clinical and Aesthetic Dermatology, "Nonablative Fractional Laser Resurfacing in Skin of Color", makes several points worth knowing:
•Melanin-rich skin is more susceptible to pigment changes after resurfacing.
•Ablative fractional lasers are usually more effective but carry a longer recovery and a higher risk of complications in skin types IV–VI.
•Non-ablative fractional lasers target water rather than melanin, and the authors consider them safe for use in darker skin types when used appropriately.
•Treatment density (how much of the skin surface is treated per pass) matters more than energy in driving PIH. One study cited found PIH in 43% of patients at lower density versus 71% at higher density.
•Hydroquinone is often recommended before and after treatment to prevent PIH, but the authors note studies confirming that it works for this purpose are lacking.
•If PIH develops between sessions, lengthening the interval before the next session is advisable.
Things to ask if you have a darker skin tone:
- 1.How many patients with my skin type have you treated with this specific device and setting?
- 2.Is a non-ablative fractional option appropriate for my goal, and what would I give up by choosing it?
- 3.Will you use conservative density and energy, and more sessions if needed?
- 4.Do you recommend a test spot in a less visible area first? (Practices vary on this; ask what they do and why.)
- 5.What is the plan if I develop darkening?
A provider who has a ready answer for each of these, and shows you before-and-after photos of patients with your skin type, is giving you useful information.
Isotretinoin: older advice has changed
For years, patients were told to wait six to twelve months after finishing isotretinoin (formerly sold as Accutane) before any laser treatment. That advice rested on a few small case reports from the 1980s.
In 2017, an American Society for Dermatologic Surgery expert panel published a systematic review in JAMA Dermatology of 32 publications and 1,485 procedures. It found insufficient evidence to justify delaying fractional ablative and non-ablative laser procedures for patients currently on or recently finished with isotretinoin. The exceptions: mechanical dermabrasion and fully ablative laser resurfacing, which the panel said should still not be performed during isotretinoin treatment; a report on the panel's guidance indicated fully ablative resurfacing should generally wait until six months after completion.
Tell your provider about any isotretinoin use in the past year. Decisions here are individual.
Who is allowed to operate the laser?
This varies widely by state, and it is one of the most practical things you can check.
California. The Medical Board of California states that physicians may use lasers for cosmetic procedures, and that physician assistants and registered nurses may do so under a physician's supervision. It also states that unlicensed medical assistants, licensed vocational nurses, cosmetologists, electrologists, and estheticians "may not legally perform these treatments under any circumstances." The Board's medical spa guidance warns patients to ask whether the supervising physician is real or "a paper-only supervisor."
Texas. Texas Medical Board rules effective January 9, 2025, treat non-surgical medical cosmetic procedures, including use of a prescription medical device for cosmetic purposes, as the practice of medicine that must be properly delegated and supervised. Under 22 Tex. Admin. Code § 169.26, the delegating physician must ensure the person performing the procedure is trained, a practitioner-patient relationship must be established first, the practice must disclose the identity and title of whoever performs the procedure, and a physician, physician assistant, or advanced practice registered nurse must be onsite or immediately available for emergencies.
Florida. Florida's most specific laser rules address hair removal: licensed electrologists may use laser and light-based hair removal devices only with required training and under the direct supervision of a physician. We did not find an equally specific Florida rule on who may perform laser resurfacing, so if you're in Florida, ask who will perform your treatment, what their license is, and which physician supervises them.
In every state, you're entitled to know the name and license type of the person treating you. Our guide to checking a provider's license shows how to look that person up, and the supervising physician too, on the state licensing board's website.
Aftercare basics
Your provider's instructions come first. Common themes from AAD and ASDS:
•Keep treated skin clean and moisturized as directed, especially after ablative treatment while the skin is open.
•Protect from the sun. AAD notes that a dermatologist cannot treat you if you show up tanned or sunburned, and advises protecting the skin from the sun until it heals. ASDS recommends SPF 30 or higher after non-ablative treatment. Johns Hopkins Medicine advises daily sunscreen afterward.
•Don't pick or peel. Shedding skin should come off on its own.
•Watch for warning signs. Increasing pain, pus, fever, clusters of small blisters or sores, or redness that is getting worse rather than better should prompt a call the same day.
•Smoking. AAD advises quitting at least two weeks before laser treatment.
The right laser for you depends on your goal, your skin type, and how much recovery time you can accept. Look for a provider who explains that trade-off honestly, can show experience with skin like yours, and is licensed to perform the treatment in your state. You can confirm that last part yourself in a few minutes.
This article is educational and does not constitute medical advice. Always consult a licensed medical professional for personalized recommendations.
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