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Decoding Ablative Laser Skin Resurfacing: 5 Quick Ways to Compare Erbium & CO2

Erbium (erbium-doped yttrium aluminum garnet, or Er:YAG) and CO2 (carbon dioxide) skin resurfacing are popular methods used in aesthetics for skin revitalization and treatment of various skin conditions. Both 'ablative' lasers use high-powered light beams to heat and vaporize the top layer of skin—removing old or damaged skin, triggering the natural healing process, and stimulating neocollagenesis. 

While these laser treatments share the goal of improving the skin's appearance, there are differences in their mechanisms, depth of treatment, downtime, and suitability for specific skin conditions. 

Here are five quick ways to compare erbium and CO2 skin resurfacing:

1. Laser Type:

Erbium: Erbium lasers emit light at a wavelength of around 2940 nanometers, which corresponds to the chromophore absorption peak of water. Water molecules absorb this specific wavelength very effectively, leading to the rapid heating and vaporization of water in the targeted tissue. This makes erbium lasers highly precise for removing thin layers of tissue with minimal damage to surrounding areas.

CO2: CO2 lasers emit light at a wavelength of approximately 10,600 nanometers, which also corresponds to the strong chromophore absorption peak of water molecules. While the 10,600nm CO2 laser primarily targets water, it can indirectly affect other skin components due to the thermal energy it generates. The heat produced during CO2 laser treatment can stimulate collagen production and improve skin texture and tone over time.  

2. Depth of Treatment:

Erbium: Erbium lasers are typically used for superficial to moderate-depth treatments. For superficial treatments, such as addressing fine lines, mild wrinkles, and superficial pigmentation, the erbium laser may remove the outermost layer of the epidermis, the stratum corneum, typically in the range of 10-50 microns. This depth is considered more conservative and is suitable for milder skin concerns.

For moderate-depth treatments, erbium lasers can penetrate deeper into the skin, reaching the uppermost part of the dermis, specifically the papillary dermis. The depth of ablation may extend to several hundred microns, typically in the range of 100-300 microns. This allows for more significant improvement in conditions like moderate wrinkles, sun damage, and mild to moderate acne scars.

CO2: CO2 lasers can penetrate deeper into the skin, making them suitable for more substantial resurfacing, including deep wrinkles, scars, and other significant skin imperfections. For superficial to moderate-depth treatments, such as addressing fine lines, wrinkles, sun damage, and mild to moderate acne scars, CO2 lasers can remove skin tissue in the range of approximately 20-100 microns, so both the stratum corneum and papillary dermis. This allows for more significant skin resurfacing and improvement in these conditions under the operator's control.

In cases where a deeper treatment is required, such as targeting deep wrinkles, severe acne scars, and more extensive skin damage, CO2 lasers can penetrate even deeper into the skin, reaching several hundred microns in depth into the reticular dermis, which is situated beneath the papillary dermis and plays a crucial role in providing structural support to the skin. The depth of ablation in such cases may range from 100-500 microns or more, depending on the specific treatment goals.

3. Precision and Control:

Erbium: Erbium lasers typically have greater precision and allow for more controlled ablation of the skin. They can be used in a 'full-field' mode, treating the entire surface area, or in a "fractional" mode, targeting only a fraction of the skin, leaving surrounding tissue intact. 

CO2: Fractional ablative CO2 lasers differ in the degree of control and precision they offer and also offer a “fractional” mode.  Newer CO2 laser technologies, like the Tetra CO2 and HELIX, set themselves apart with advanced pulse control, increasing the precision and control available with this technology. This minimizes damage to surrounding tissue typical of traditional CO2 ablative treatments.

4. Downtime and Recovery:

Erbium: Erbium laser treatments generally have a shorter recovery time compared to traditional CO2 laser treatments. The healing process is usually faster, with redness and swelling lasting for a few days to a week.

CO2: Recovery time will depend on the power, pulse duration, and depth used on the skin. Traditional CO2 laser treatments that go deep and are fully ablative require a longer recovery period. The skin may remain red and swollen for up to two weeks, and the complete healing process can take several weeks. However, the greatest advancement in CO2 technology came with the introduction of the Tetra CO2. The Tetra CO2 has advanced pulse control giving the provider the ability to perform highly effective treatments with lower downtime.  For instance, a unique high peak power pulse eliminates the lingering heat, so skin resurfacing treatments are superficial with only a few days of redness (no social downtime).  Further advancements, like combining CO2 with non-ablative treatments with the HELIX have also helped reduce downtime and recovery time even further.

5. Skin Conditions Treated:

Erbium: Erbium lasers are effective in treating fine lines, mild to moderate wrinkles, sun damage, age spots, and superficial scars. They are also suitable for individuals with darker skin tones, as they carry a lower risk of pigmentation changes.

CO2: CO2 lasers are more commonly used for deep wrinkles, severe sun damage, deep scars (such as acne scars), and skin conditions requiring substantial resurfacing. Some technologies may have a higher risk of pigmentation changes, making them less suitable for individuals with darker skin tones.

It's important to note that the suitability of a specific treatment option depends on various factors, including the individual's skin type, the severity of the condition being treated, and the desired outcomes. Ultimately it is up to the provider to help determine the most appropriate treatment approach for a patient’s specific needs.

CO2 with Cartessa: Two Options, Each with Advanced Pulse Control

Cartessa also offers two CO2 devices with advanced pulse control: Tetra, and the new HELIX⎯both manufactured by DEKA. Cartessa and DEKA first disrupted traditional fractional ablative industry norms in 2019 with the launch of CoolPeel treatment on the SmartXide Tetra laser. The popularity of the treatment earned CoolPeel the “The Best CO2 Laser Treatment” in New Beauty’s 13th Annual Beauty Awards in 2023 and significant coverage across beauty outlets.

In May 2023, Cartessa launched HELIX, which has the technical features that made DEKA's TETRA CO2 the market leader in North America and adds a 1570nm fiber laser to use alone or in combination with the CO2 energy. HELIX boasts 70 watts of power and a wide range of settings for low-downtime treatments. Select between seven mixed sequential and alternating modes, enabling providers to expertly tailor ablative and non-ablative resurfacing treatments. 

Erbium with Cartessa: Take Your Pick of Quanta Systems Platforms 

Interested in adding Erbium to your practice? Cartessa Aesthetics, a leading distributor of advanced aesthetic technologies, offers Erbium add-ons for all the Quanta System platforms, including Chrome, Discovery Pico, and the new Suprema. By integrating Erbium technology into these platforms, Cartessa provides practitioners with enhanced versatility and treatment options along with the various other wavelengths each platform features. 

Both erbium and advanced CO2 laser skin resurfacing are effective treatments for your practice.  The key is to understand which technology fits with your practice clientele and goals.  Cartessa Aesthetics can help you determine what ablative and non-ablative treatments would work best for your business.

Cartessa Aesthetics provides end-to-end support to help leading providers deliver safe, impressive results, with cutting-edge technology. To learn more about enhancing your practice with ablative laser technology, contact us today.

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