Longer wavelength allows deeper penetration into the dermis and partially spares melanin.

Target dermis without a specific chromophore

Not very effective for epidermal signs of photoaging, such as dyschromia

1320 nm, long pulses

One of the earliest lasers used for nonablative resurfacing

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  Early applications did not include a cooling device, and this resulted in a high rate of scarring, hyperpigmentation, and pain.

Newer models include a cryogenic cooling spray, which keeps the epidermis temperature around 40°-48° C, while the dermis is heated to 60°-70° C. ^{1 , 2}

Effective in resurfacing atrophic acne scars ^{3 , 4}

1064 nm, very short pulses

Coupled with a cryogenic cooling device

Very effective at treating tatoos ⁵

1450 nm

Has not demonstrated a significant effect on rhytids ⁶

Effective in resurfacing atrophic acne scars ⁷

Fraxel (Solta Medical)

1550 nm

The most frequently used nonablative laser and has multiple applications, such as dyschromia, ^{8 , 9} fine rhytids, ^{8 , 9} acne scars, ¹⁰ burn scars, ^{8 , 9 , 11} striae distensae ¹²

Treatment of dyschromia: Same effectiveness as nonablative, nonfractionated lasers ^{13 , 14}

Treatment of rhytids: More effective than nonfractionated, nonablative lasers, but less effective than ablative fractional or fully ablative lasers ^{13 , 14}

Requires three to six treatments, spaced at 2- to 4-week minimum intervals

Other fractional lasers include the Lux 1540 fractional laser (1540 nm, Cynosure) and the Affirm laser (1320 nm + 1440 nm, Cynosure). ¹⁵

Pulsed dye laser

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  585-595 nm

  
  
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  Of limited use in dark skin types because of high affinity for melanin

  
  
  
  
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    Risk of hypopigmentation and hyperpigmentation

  
  
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  Shown to increase the quantity of collagen and elastin in the dermis ¹⁶

  
  
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  Photodynamic therapy: Effect can be potentiated by topical application of a photosensitizer, such as 5-aminolevulinic acid. ¹⁷

  
  
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  For aging treatment, fluencies used are below those typically used for the treatment of vascular lesions, and pulse width durations are longer than those used to treat port-wine stains to minimize purpura.

  
  
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  Best used for signs of hypervascularity and dyschromia

  
  
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  Most effective laser for port-wine stain treatment

Not a laser. Intense polychromatic light including multiple wavelengths from 500-1200 nm. ¹⁸

Filters can be added to allow only certain wavelengths, thus targeting specific chromophores.

Of limited use in dark skin types (IV–VI) because of affinity for melanin

Excellent in the treatment of hypervascularity, such as rosacea and telangiectasia ¹⁹

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  Very good in the treatment of dyspigmentation, such as solar lentigines ¹³

  
  
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  Broadband light (BBL) is a form of IPL and has proven to be effective in genetic transcription to a more youthful genomic expression with multiple frequent treatments at least three times per year for several years ²⁰

Photodynamic therapy: Effect can be potentiated by topical application of a photosensitizer, such as 5-aminolevulinic acid. ²¹

ThermaCool (Solta Medical)

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  Radiofrequency waves cause collagen denaturation when heated to 55°-62° C, and the amount of collagen in the skin increases over time. ²²

  
  
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  Amount of tissue heating and the placement of that heating zone can be controlled by modifying the fluence of the radiofrequency waves and the intensity of the cryogenic cooling spray.

  
  
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  Heat is delivered at high fluence (70–150 J/cm²) for short pulses (<2.3 seconds) (flash heating).

  
  
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  Because radiofrequency does not target melanin, it can be used safely in patients of all skin phenotypes.

  
  
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  Used in patients with mild skin laxity

  
  
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  Does not address underlying structural ptosis

  
  
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  Several studies analyzing the efficacy of monopolar radiofrequency showed measurable improvement in skin laxity.

  
  
  
  
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    However, most studies were not blinded, randomized, or comparative. ^{12 , 23}

    
    
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    Overall, results were modest and inconsistent. ^{24 , 25}

  
  
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  Can be painful to the patient

  
  
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  Low risk of complications, although multiple reports have described fat atrophy from heat damage to adipose tissue early in the treatment’s evolution. ²⁶ Current treatment protocols greatly minimize or eliminate this risk.

Nonablative lasers are not as painful as ablative lasers in general, but can vary depending on the depth; i.e., a deep, nonablative laser treatment could possibly cause more pain than a superficial ablative laser treatment.

Topical anesthesia, typically with EMLA (2.5% prilocaine/2.5% lidocaine) or LMX (4% or 5% lidocaine), is usually sufficient.

It must be applied at least 1 hour before treatment, covered with an occlusive dressing, and wiped off just before treatment.