To Ablate, or Non-Ablate? A Deep Dive into Laser Skin Resurfacing Options
The efficacy of Ablative versus Non-Ablative skin treatments depends on various factors, including the specific skin concerns, individual skin types, and desired outcomes. When considering introducing laser skin resurfacing technology to improve the appearance of wrinkles, fine lines, skin laxity, pigmentation and scars, the question most aesthetic practitioners ask themselves is: What device offers the most and best treatment options for my patients?
We’ll explore the benefits and limitations of popular ablative and non-ablative technologies in the hopes of setting proper clinical expectations. We’ll also review the newest evolution of CO2 laser skin resurfacing that delivers the widest variety of treatment options with predictable downtimes and the best clinical outcomes with one or both technologies: HELIX.
Ablative Laser Skin Resurfacing
Ablative lasers emit a high-powered light beam to heat and vaporize the top layer of skin—removing old or damaged skin, triggering the natural healing process, and stimulating neocollagenesis.
Ablative laser treatments are a particularly effective option for improving overall skin appearance, particularly for more severe conditions.
Within ablative treatments, there are two main types of lasers: CO2 and erbium lasers. To understand more about these two options, read the complement article, “Decoding Ablative Laser Skin Resurfacing: 5 Quick Ways to Compare Erbium & CO2.”
After treatment with traditional ablative lasers, the skin may be raw, red, or swollen. The healing process can take several weeks, during which skin will regenerate and become smoother, tighter, and more youthful looking.
Fractionated CO2 ablative treatments, when introduced, helped to reduce the amount of downtime necessary as laser light creates narrow columns in between uninjured tissue. The newest technology used by the HELIX and Tetra lasers can now provide treatments like the CoolPeel, where any redness or swelling is minimized, and downtime is generally limited to 24 hours or less.
Given the potential side effects of ablative lasers, such as scarring, infection, and changes in skin pigmentation, it's crucial for providers to prioritize technologies that optimize results while minimizing risks.
Non-Ablative Laser Skin Resurfacing
Non-ablative laser resurfacing treatments rejuvenate the skin without removing its topmost layer.
These treatments work by delivering a targeted beam of light energy to the skin’s deeper layers, where it is absorbed by water in the tissue—heating and denaturing surrounding tissue and stimulating both collagenesis and a natural wound-healing response. As the collagen is remodeled, the skin becomes firmer and more youthful looking as fine lines and wrinkles are reduced.
Non-ablative lasers can also even out skin tone by reducing the appearance of hyperpigmentation, such as age spots and sun damage. Typically, a series of treatments are required to achieve the desired results.
Non-ablative resurfacing is also commonly used to reduce the appearance of fine lines and wrinkles and treat conditions such as acne scarring and hyperpigmentation.
By creating a micro-thermal zone that denatures epidermal and deeper tissues, providers can deliver results, limit side effects, and reduce recovery times. Different devices utilize various wavelengths of 1440, 1540, 1550, 1565, 1570, and 1927 nanometers, with an overall similar impact and results to each other.
While non-ablative lasers are considered safe and effective, they do not typically deliver the same significant results as ablative treatments.
Introducing HELIX: An Elite Duality in CO2 Laser Skin Resurfacing
HELIX combines advanced fractional CO2 ablation with a non-ablative technology to deliver the widest range of low-downtime treatment options, the best clinical outcomes, and an optimal patient experience. HELIX features DEKA’s exclusive Pulse Shape Design (PSD™) to generate four pulse modes, including Deka-Pulse and H-Pulse. H-pulse, high-peak-power short pulse, makes the award winning, no-downtime superficial laser resurfacing treatment, CoolPeel, possible.
With multiple unique treatment combinations, HELIX enables practitioners to expertly choreograph ablative and non-ablative resurfacing treatments, to deliver the highest efficacy, and maximize ROI.
DEKA CEO Paolo Salvadeo shared, “HELIX represents the next evolution of DEKA and Cartessa’s partnership and leverages our sophisticated laser technology to create important and extremely effective devices for the US market.”
Cartessa’s Founder and CEO, Gabe Lubin echoes Salvadeo’s sentiments, saying “HELIX is another example of our unique partnership that brings world-class laser technology together with Cartessa’s keen insight into provider and patient needs. Cartessa worked closely on the HELIX design and developed marketable treatment protocols like we did with CoolPeel to help drive demand for our customers.”
Dr. Mark Halsey, owner and lead physician at Halsey Dermatology in Sag Harbor, NY states, "The HELIX is a skin resurfacing dream. I can now mix ablative and non-ablative modalities for extraordinary results, fast, on one efficient platform, and with less downtime than ever before."
HELIX’s three branded treatments include:
- CoolPeel, fractional CO2 ablation
- Sultra, standalone 1570 nm deep thermal non-ablative treatment
- Fusion, which combines both technologies with virtually limitless combinations
Let’s examine each more closely.
CoolPeel: Advanced CO2 Laser
CoolPeel uses a fractional CO2 laser to resurface skin without the harsh side effects of traditional ablative laser treatments. It's designed to treat fine lines, sun damage, and uneven skin texture—all while minimizing redness and downtime.
Studies have demonstrated improvement in fine lines by up to 90% when using high-energy pulsed CO2 lasers. In 2019, Cartessa and DEKA disrupted traditional fractional ablative industry norms with the launch of the CoolPeel treatment on the SmartXide Tetra laser.
With a higher peak power than traditional CO2 laser treatments, CoolPeel minimizes discomfort and reduces damage to surrounding skin, and its exclusive Pulse Shape Design (PSD™) gives providers complete control over duration, energy, and pulse shapes. This delivery also allows treatment options for darker skin types, which usually do not tolerate CO2 solutions well.
During treatment, a controlled beam of laser energy is delivered to the skin in a fractional pattern—creating micro-injuries in the skin’s surface, triggering healing, and stimulating collagenesis.
This procedure usually takes less than 10 minutes, with typically no social downtime afterward. Patients may experience some redness, swelling, and mild discomfort, but these side effects usually subside within a day or so. To achieve optimal results, these treatments are often spaced several weeks apart.
Patients can expect noticeable improvements in skin texture, tone, and radiance, as well as fewer fine lines and wrinkles and a more youthful-looking appearance. The impact of these results was recognized in 2023 with CoolPeel by Tetra CO2 awarded “The Best CO2 Laser Treatment” in New Beauty’s 13th annual award.
Sultra: 1570 nm, Deep Thermal Non-Ablation
Exclusive to HELIX, Sultra’s 1570nm non-ablative deep thermal laser treatment gently targets damaged skin cells for a smoother, more youthful complexion.
With controlled thermal coagulation, providers can comfortably treat a full range of skin types, pigments, and conditions while keeping the outer layer of skin intact—minimizing downtime. Non-ablative solutions are also industry and clinically recognized as being safer for darker skin types. Having a non-ablative solution like Sultra also helps ensure an inclusive treatment base.
For many patients, Sultra is the perfect introduction to laser skin resurfacing, and when combined with CoolPeel via a Fusion treatment, it provides the most personalized skin resurfacing treatment on the market.
Fusion: The Ultimate Win-Win
Fusion combines the benefits of the HELIX fractional ablative and non-ablative laser treatments to achieve the best clinical outcomes for aesthetic patients. Fusion uses the ablative laser to remove the outer layer of skin, and the non-ablative laser to stimulate collagen production beneath the dermis.
HELIX's Fusion can deliver the fractional ablative pulse modes – possible because of PSD Technology -- with non-ablative 1570nm in sequential and alternate mixed modes.
The various modes provide more options for combining the energies so treatments can be tailored by skin type and skin concern, controlling the amount of ablation, coagulation, and the % of each to help manage the downtime. Sequential mode delivers CO2 and 1570nm energy in the same scan spot during the same scan. Alternating mode delivers CO2 and 1570 nm energies in different scan spots based on selected ratio (1:1, 1:2, 1:3, 3:1 or 2:1) within a single scan.
While other skin resurfacing technologies may offer methods to combine ablative with non-ablative treatments, only HELIX's FUSION can achieve this using DEKA’s proprietary CO2 PSD™ technology. Mixed modes are selected based on treatment targets, severity and skin types. Acne scars, which have been difficult to treat, respond extremely well to the exclusive mixed protocols.
The unique heat profile created by the addition of 1570nm likely induces more coagulation and a more significant healing response. This has been shown to reduce healing time, while also delivering enhanced results.
Overall, Fusion’s combination of ablative and non-ablative lasers offers the best of both worlds: superior clinical outcomes with a better overall experience than traditional ablative laser treatments alone.
How Is Helix Different from Tetra?
For providers familiar with Tetra, there are a few distinct features in the HELIX CO2 laser system that sets it apart. The HELIX system boasts a higher power output operating at up to 70 watts, compared to the Tetra units, which are available in 30- to 50-watt options. Additionally, the HELIX system introduces the ability to combine fractional ablative treatments with 1570nm non-ablative treatments, allowing for a wider range of treatment options.
The HELIX system also features a new ergonomic handpiece design with a chilled tip, enhancing user comfort and maneuverability during treatments. The HELIX system incorporates a new graphical user interface (GUI) that provides an intuitive and user-friendly control panel and simplifies treatment setup and navigation for practitioners. These differences make the HELIX CO2 laser system a unique and innovative option for practitioners seeking advanced capabilities and an improved user experience.
And for providers that own a Tetra, there are compelling reasons to either upgrade to the HELIX CO2 laser system or choose to keep the Tetra system while adding the HELIX to their arsenal of devices. The main reason to consider both is that the award winning CoolPeel treatment is available on both platforms.
The demand for CoolPeel has continued to grow, so adding the Helix would double your potential CoolPeel business alone. Then by upgrading to HELIX or adding it to their existing Tetra unit, providers expand their treatment options to offer a broader range of services – including the FUSION which has given CoolPeel enthusiasts something to get excited about.
Expertly Tailored Ablative & Non-Ablative Treatments
HELIX stands out in the industry because there is really nothing else in the market that includes the benefits of both ablative and non-ablative resurfacing in one impressive, effective system. Consider broadening your practice to include more skin types and treatments by choosing HELIX.
Cartessa Aesthetics provides end-to-end fulfillment to help leading providers deliver safe, stunning results, with cutting-edge technology. To learn more about enhancing your practice with unique skin resurfacing laser technology, contact us today.
