Resurfacing Lasers Explained by a Dermatologist: UltraClear, Halo, Fraxel & More

 

By Heather D. Rogers, MD, FAAD, Double Board-Certified Dermatologist

What Is Laser Resurfacing?

Resurfacing lasers are laser treatments that improve sun-damaged skin by creating controlled microscopic injury that stimulates skin renewal and collagen production. 

If I could only choose one category of cosmetic laser, it would be a resurfacing laser.

Resurfacing lasers remain one of the most effective ways to improve sun damage, skin texture, pores, acne scars and fine lines because they stimulate your skin to replace damaged cells with healthier ones but they are powerful and can harm the skin if not used correctly which is why choosing an experienced provider is so important.

These lasers work by targeting water in the skin and creating thousands of microscopic treatment zones. As these tiny injuries heal, old damaged cells are replaced with healthier ones and new collagen is produced. The deeper the treatment goes, the greater the potential improvement, but also the longer the recovery and the higher the risk of complications.

One important thing to understand is that resurfacing lasers do not help with redness. In fact, they can make underlying redness more noticeable, particularly in people who already tend to be pink.

What Does a Resurfacing Laser Treatment Do for the Skin?

Resurfacing lasers can improve:

• Sun damage
  
• Brown spots
  
• Splotchy pigmentation
  
• Rough texture
  
• Acne scars
  
• Large pores
  
• Fine lines
  
• Dull skin

The degree of improvement depends on the type of resurfacing laser used and the treatment settings selected. 

One of the biggest misconceptions about lasers is that multiple gentle treatments equal one aggressive treatment. They do not.

Three or even five gentle treatments may improve the surface of the skin, but they often cannot reach the deeper layers where collagen remodeling occurs. Sometimes one well-executed aggressive treatment produces results that would be difficult to achieve with many lighter treatments.

A gentle treatment generally means:

• Less pain
  
• Less downtime
  
• Lower risk
  
• More subtle results

A more aggressive treatment generally means:

• More improvement
  
• More downtime
  
• More discomfort
  
• Higher risk of unwanted pigmentation or scarring
  

The right treatment depends on your goals, skin type and tolerance for recovery.

Can Resurfacing Lasers Help Prevent Skin Cancer?

One of the most exciting areas of laser research is the potential role of resurfacing lasers in treating field cancerization, the widespread sun damage that accumulates in the skin long before a skin cancer becomes visible.

We have long known that resurfacing lasers improve the appearance of sun-damaged skin by removing damaged cells and stimulating the growth of healthier skin. More recent research shows they may also reduce the burden of precancerous cells. Studies have shown that both ablative and non-ablative fractional resurfacing lasers can decrease the number of actinic keratoses (precancerous lesions), improve markers of UV-induced skin damage and potentially reduce the future development of skin cancers. 

Researchers believe this occurs because resurfacing lasers remove photodamaged cells while stimulating repair pathways that restore healthier skin architecture. While more research is needed, the current evidence suggests that resurfacing lasers provide both cosmetic and medical benefits for patients with significant sun damage. Ablative resurfacing lasers appear to be more effective than non-ablative resurfacing, although more research is needed. 

What Are the Different Types of Resurfacing Lasers?

Resurfacing lasers are generally divided into four categories: gentle non-ablative lasers, deeper non-ablative lasers, hybrid lasers and ablative lasers. The differences between them are treatment depth, recovery time, risk and the amount of improvement they can achieve. 

Gentle Non-Ablative Resurfacing

Examples:

• Clear + Brilliant
  
• LaseMD
  
• UltraClear 3DMIRACL

These treatments primarily improve the epidermis, the outer layer of skin.

Pros

• Minimal downtime
  
• Safer for darker skin types
  
• Excellent for maintenance
  
• Brightens dull skin

Cons

• Less dramatic improvement
  
• Results tend to be shorter lasting
  
• Limited collagen stimulation

Deep Non-Ablative Resurfacing

Examples:

• Fraxel Dual
• Icon 1540

These lasers penetrate deeper into the skin and stimulate more collagen production.

Pros

• More noticeable improvement
  
• Better for pigmentation, texture and mild acne scarring
  
• Longer-lasting results

Cons

• More downtime
  
• More swelling and peeling
  

Hybrid Resurfacing Lasers

Examples:

• Halo

Halo is a hybrid resurfacing laser that combines both non-ablative and ablative wavelengths in a single treatment. 

To learn more, check out my feature in Cosmopolitan, "Testing, Testing: My Honest Review of the $$ Halo Facial Laser."

1470 nm non-ablative wavelength

• Targets pigmentation
  
• Improves sun damage
  
• Improves superficial texture

2940 nm ablative erbium wavelength

• Creates controlled injury in the skin
  
• Stimulates collagen production
  
• Improves texture and fine lines

Because Halo delivers both wavelengths during the same treatment, it can achieve more improvement than most non-ablative lasers while generally requiring less downtime than a fully ablative treatment.

Ablative Resurfacing Lasers

Examples

• UltraClear Ultra
  
• Erbium lasers
  
• CO2 lasers

These treatments remove microscopic columns of tissue and create the greatest degree of collagen remodeling among resurfacing lasers.

Pros

• Most significant improvement in texture
  
• Best for acne scars
  
• Best for crepey skin
  
• Best for wrinkles
  
• Longest-lasting results

Cons

• More discomfort
  
• Longer recovery
  
• Higher risk of pigmentation changes
  
• Higher risk of scarring

Traditionally, CO2 lasers have been considered the most aggressive resurfacing option, followed by erbium lasers. Newer platforms such as UltraClear allow us to achieve significant resurfacing with greater flexibility in treatment depth and thermal injury, making them my preferred option for most patients.

Why I Prefer UltraClear for Resurfacing Treatments 

Over the last few years, UltraClear has become my preferred aggressive resurfacing laser.

One of the reasons I like it is that it allows me to customize treatment depth and thermal injury very precisely. This flexibility allows me to tailor treatments to different skin types, concerns and recovery preferences while still achieving significant improvement. It has become my go-to laser to improve skin quality, texture, sun damage, acne scars and wrinkles because of its excellent balance of results, safety and recovery.

Which Resurfacing Laser Is Right for You?

The best resurfacing laser depends on your skin concerns, goals and tolerance for downtime. These are the treatments I most commonly recommend for each concern. 

Concern	My Typical Choice
Brightening and glow	Clear + Brilliant, UltraClear 3DMIRACL
Mild sun damage	Clear + Brilliant, LaseMD
Brown spots and pigmentation	Fraxel Dual, Halo, UltraClear
Acne scars	UltraClear
Fine lines	Halo, UltraClear
Significant texture improvement	UltraClear
Minimal downtime	Clear + Brilliant, LaseMD
Most dramatic overall improvement	UltraClear, CO2

What is a Resurfacing Laser Treatment Appointment Like?  

You will arrive before your appointment to have photos taken and topical numbing medication applied.

Most laser treatments take between 30 and 90 minutes depending on:

• The laser being used
  
• The size of the treatment area
  
• The treatment settings

After treatment, your provider should review post-procedure instructions and explain what to expect during recovery.

As a general rule, the more aggressive the treatment, the longer the recovery.

How Many Resurfacing Laser Treatments Will I Need?

This depends entirely on your goals. Some patients are looking for maintenance and choose a series of lighter treatments. Others prefer a single, more aggressive treatment with a longer recovery period and more dramatic results.

The important thing is understanding that a series of gentle treatments is not necessarily equivalent to one aggressive resurfacing treatment because the depth of injury and collagen stimulation are different.

Who Is a Good Candidate for Resurfacing Lasers?

Patients with the following concerns are often excellent candidates for resurfacing lasers: 

• Sun damage
  
• Brown spots
  
• Dull skin
  
• Acne scars
  
• Enlarged pores
  
• Rough texture
  
• Wrinkles
  
• Laxity

Resurfacing lasers are less effective for significant skin laxity. In those situations, surgery may be more appropriate.

What About Skin of Color and Melasma?

Patients with skin of color or melasma require additional caution because any resurfacing laser can trigger unwanted pigmentation. This does not mean you cannot have laser treatments. It means your provider needs experience treating your skin type and selecting the appropriate settings.

One reason I like UltraClear is that it allows me to reduce thermal injury while still achieving meaningful resurfacing. For many patients with darker skin tones, that flexibility can make it a safer option than some older resurfacing technologies.

I routinely use UltraClear for acne scarring in Fitzpatrick skin types IV and V, but at lower settings than I would use in lighter skin types. Patients with darker skin types also benefit from pretreatment with topical medications or oral tranexamic acid to reduce the risk of post-inflammatory hyperpigmentation

How to get the Best Results from a Resurfacing Laser Treatment

Before Treatment

• Have a consultation.
  
• Ask questions.
  
• Review before-and-after photos.
  
• Make sure you understand the expected recovery.

If you are new to resurfacing lasers, consider starting with a gentler treatment before moving to a more aggressive one.

Plan Your Recovery Before Your Treatment

One of the biggest mistakes I see is patients scheduling a laser treatment without planning adequate recovery time. Proper recovery planning is one of the most important factors in achieving a good resurfacing laser outcome. 

Make sure you:

• Clear your calendar.
  
• Avoid travel immediately afterward.
  
• Avoid sunny destinations during healing.
  
• Understand your aftercare instructions before treatment.

My Approach to Laser Recovery

This is one of the reasons I created Doctor Rogers Skin Care. I wanted safe, effective products that support healing skin without unnecessary irritation.

I provide all of my laser patients with a post-procedure kit that includes:

• Doctor Rogers Face Wash
  
• Doctor Rogers Face Cream
  
• Doctor Rogers Restore Healing Balm
  
• Written recovery instructions

An outstanding outcome requires the right patient, using the right laser the right way and the right post-procedure care at home. So often patients are not given the information or products they need to speed recovery.

The Bottom Line

Resurfacing lasers work. Few treatments can improve sun damage, texture, pores, acne scars and fine lines as effectively as a well-executed laser treatment.

The question is not whether you should choose Halo, Fraxel, UltraClear or CO2. The question is how much improvement you are looking for and how much downtime you are willing to accept. Like most things in dermatology, there is no free lunch. More aggressive treatments generally produce more impressive results, but they also require more recovery. My job is to help patients find the right balance between those two things. 

About the Author: Dr. Heather D. Rogers, MD

Dr. Heather D. Rogers, MD is a double board-certified procedural dermatologist and Mohs surgeon and the co-founder of Modern Dermatology in Seattle, where she sees patients full-time. She is nationally recognized for her expertise in skin health, aging, and skin cancer prevention, and for her clear, evidence-based skincare guidance. Dr. Rogers serves on the American Academy of Dermatology Media Team, the Credo Beauty Council, the Sorette for Motherhood Scientific Advisory Board, and the NewBeauty Brain Trust.

She is the founder of Doctor Rogers Skincare, a dermatologist-developed line reflecting her less-is-more, science-backed approach to healthy skin. Dr. Rogers is a graduate of Stanford University, the University of Washington School of Medicine, and completed her dermatology training at Columbia University Medical Center.

Instagram: @drheatherrogers
Practice: mdinseattle.com
Skincare: doctorrogers.com

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References

Iyer, S., Friedli, A., and Bowen, G.M. "Full Face Laser Resurfacing: Therapy and Prophylaxis for Actinic Keratoses and Non-Melanoma Skin Cancer." Lasers in Surgery and Medicine, vol. 34, no. 2, 2004, pp. 114–119. PubMed, https://pubmed.ncbi.nlm.nih.gov/15004822/.

Benson, T.A., Hibler, B.P., Kotliar, D., and Avram, M.M. "Nonablative Fractional Laser Treatment Is Associated With a Decreased Risk of Subsequent Facial Keratinocyte Carcinoma Development." Dermatologic Surgery, vol. 49, no. 2, 2023, pp. 149–154. PubMed, https://pubmed.ncbi.nlm.nih.gov/36728065/.

Spandau, D.F., Lewis, D.A., Travers, J.B., et al. "Randomized Controlled Trial of Fractionated Laser Resurfacing for the Prevention of Actinic Keratoses and Nonmelanoma Skin Cancers in Geriatric Skin." Journal of Clinical Investigation, vol. 131, no. 18, 2021, p. e150972. PubMed, https://pubmed.ncbi.nlm.nih.gov/34428179/.