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Nonablative skin resurfacing for skin rejuvenation

Macrene Alexiades, MD, PhD
Section Editor
Jeffrey S Dover, MD, FRCPC
Deputy Editor
Abena O Ofori, MD


Over time, chronic sun exposure and chronologic aging contribute to changes in the skin, such as dyschromia, rhytides (wrinkles), telangiectasias, textural alterations, and skin laxity (table 1). Although ablative laser resurfacing and surgical procedures are effective for improving features of cutaneous aging, concern regarding potential adverse effects and required recovery times deter many patients from proceeding with these procedures.

Nonablative lasers and light sources are therapeutic options for skin rejuvenation that demonstrate low risks for serious adverse effects and nonexistent or abbreviated recovery periods. Certain nonablative procedures are highly effective for the treatment of the dyschromia (eg, intense pulsed light [IPL] and fractional lasers) and vascular changes (eg, vascular lasers and IPL) seen in photoaged skin.

Significant improvements in rhytides and skin laxity require the induction of dermal collagen remodeling and are relatively more difficult to achieve with nonablative technology. Infrared lasers, radiofrequency devices, and fractional lasers are typically used for these indications. Picosecond lasers are a newer form of laser technology introduced for nonablative skin rejuvenation. Since the degree of improvement achieved with nonablative technology is often modest, patients with mild to moderate rhytides or skin laxity are better candidates for nonablative procedures than individuals with more severe manifestations of these features.

The modalities of nonablative skin resurfacing utilized for skin rejuvenation, including vascular lasers, IPL, infrared lasers and light sources, radiofrequency, photodynamic therapy, and nonablative fractional lasers, will be reviewed here. The basic principles of laser and light therapy for cutaneous lesions and ablative laser skin resurfacing are discussed separately. (See "Principles of laser and intense pulsed light for cutaneous lesions" and "Ablative laser resurfacing for skin rejuvenation".)


Restoration of a youthful appearance to the skin is dependent upon the ability to remove or improve features characteristic of photodamage (cutaneous damage induced by ultraviolet light) and chronologic aging, such as irregular skin pigmentation, telangiectasias, and cutaneous erythema. Chronic exposure to ultraviolet light also promotes damage to the dermis, which manifests clinically as rhytides and skin laxity and histologically as disorganized collagen fibrils and abnormal elastotic material [1]. Because collagen is the major structural component of the skin, treatments that successfully restore collagen to a condition that resembles collagen in youthful skin are beneficial for the reversal of these features. (See "Photoaging".)

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Literature review current through: Oct 2017. | This topic last updated: Aug 15, 2017.
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  1. Kim KH, Geronemus RG. Nonablative laser and light therapies for skin rejuvenation. Arch Facial Plast Surg 2004; 6:398.
  2. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58:719.
  3. Goldberg DJ. Full-face nonablative dermal remodeling with a 1320 nm Nd:YAG laser. Dermatol Surg 2000; 26:915.
  4. Goldberg DJ. Non-ablative subsurface remodeling: clinical and histologic evaluation of a 1320-nm Nd:YAG laser. J Cutan Laser Ther 1999; 1:153.
  5. Jørgensen GF, Hedelund L, Haedersdal M. Long-pulsed dye laser versus intense pulsed light for photodamaged skin: a randomized split-face trial with blinded response evaluation. Lasers Surg Med 2008; 40:293.
  6. Nymann P, Hedelund L, Haedersdal M. Long-pulsed dye laser vs. intense pulsed light for the treatment of facial telangiectasias: a randomized controlled trial. J Eur Acad Dermatol Venereol 2010; 24:143.
  7. Seirafi H, Fateh S, Farnaghi F, et al. Efficacy and safety of long-pulse pulsed dye laser delivered with compression versus cryotherapy for treatment of solar lentigines. Indian J Dermatol 2011; 56:48.
  8. Galeckas KJ, Collins M, Ross EV, Uebelhoer NS. Split-face treatment of facial dyschromia: pulsed dye laser with a compression handpiece versus intense pulsed light. Dermatol Surg 2008; 34:672.
  9. Kono T, Chan HH, Groff WF, et al. Long-pulse pulsed dye laser delivered with compression for treatment of facial lentigines. Dermatol Surg 2007; 33:945.
  10. Kono T, Groff WF, Sakurai H, et al. Comparison study of intense pulsed light versus a long-pulse pulsed dye laser in the treatment of facial skin rejuvenation. Ann Plast Surg 2007; 59:479.
  11. Goldberg D, Tan M, Dale Sarradet M, Gordon M. Nonablative dermal remodeling with a 585-nm, 350-microsec, flashlamp pulsed dye laser: clinical and ultrastructural analysis. Dermatol Surg 2003; 29:161.
  12. Bjerring P, Clement M, Heickendorff L, et al. Selective non-ablative wrinkle reduction by laser. J Cutan Laser Ther 2000; 2:9.
  13. Zelickson BD, Kilmer SL, Bernstein E, et al. Pulsed dye laser therapy for sun damaged skin. Lasers Surg Med 1999; 25:229.
  14. Rostan E, Bowes LE, Iyer S, Fitzpatrick RE. A double-blind, side-by-side comparison study of low fluence long pulse dye laser to coolant treatment for wrinkling of the cheeks. J Cosmet Laser Ther 2001; 3:129.
  15. Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med 2010; 42:93.
  16. Hedelund L, Due E, Bjerring P, et al. Skin rejuvenation using intense pulsed light: a randomized controlled split-face trial with blinded response evaluation. Arch Dermatol 2006; 142:985.
  17. Weiss RA, Weiss MA, Beasley KL. Rejuvenation of photoaged skin: 5 years results with intense pulsed light of the face, neck, and chest. Dermatol Surg 2002; 28:1115.
  18. Goldberg DJ. New collagen formation after dermal remodeling with an intense pulsed light source. J Cutan Laser Ther 2000; 2:59.
  19. Dover JS, Bhatia AC, Stewart B, Arndt KA. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch Dermatol 2005; 141:1247.
  20. Carruthers J, Carruthers A. The effect of full-face broadband light treatments alone and in combination with bilateral crow's feet Botulinum toxin type A chemodenervation. Dermatol Surg 2004; 30:355.
  21. Goldberg DJ, Cutler KB. Nonablative treatment of rhytids with intense pulsed light. Lasers Surg Med 2000; 26:196.
  22. Bitter PH. Noninvasive rejuvenation of photodamaged skin using serial, full-face intense pulsed light treatments. Dermatol Surg 2000; 26:835.
  23. Sadick NS, Weiss R, Kilmer S, Bitter P. Photorejuvenation with intense pulsed light: results of a multi-center study. J Drugs Dermatol 2004; 3:41.
  24. Ruiz-Rodriguez R, Sanz-Sánchez T, Córdoba S. Photodynamic photorejuvenation. Dermatol Surg 2002; 28:742.
  25. Paithankar DY, Clifford JM, Saleh BA, et al. Subsurface skin renewal by treatment with a 1450-nm laser in combination with dynamic cooling. J Biomed Opt 2003; 8:545.
  26. Lupton JR, Williams CM, Alster TS. Nonablative laser skin resurfacing using a 1540 nm erbium glass laser: a clinical and histologic analysis. Dermatol Surg 2002; 28:833.
  27. Fournier N, Dahan S, Barneon G, et al. Nonablative remodeling: clinical, histologic, ultrasound imaging, and profilometric evaluation of a 1540 nm Er:glass laser. Dermatol Surg 2001; 27:799.
  28. Dahan S, Lagarde JM, Turlier V, et al. Treatment of neck lines and forehead rhytids with a nonablative 1540-nm Er:glass laser: a controlled clinical study combined with the measurement of the thickness and the mechanical properties of the skin. Dermatol Surg 2004; 30:872.
  29. Ruiz-Esparza J. Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients. Dermatol Surg 2006; 32:601.
  30. Carniol PJ, Dzopa N, Fernandes N, et al. Facial skin tightening with an 1100-1800 nm infrared device. J Cosmet Laser Ther 2008; 10:67.
  31. Chan HH, Yu CS, Shek S, et al. A prospective, split face, single-blinded study looking at the use of an infrared device with contact cooling in the treatment of skin laxity in Asians. Lasers Surg Med 2008; 40:146.
  32. Lee M-W C. Comparison of radiofrequency vs. 1100-1800 nm infrared light for skin laxity. Amer Soc Derm Surg Abst, Atlanta, GA, October 27, 2005.
  33. Goldberg DJ, Hussain M, Fazeli A, Berlin AL. Treatment of skin laxity of the lower face and neck in older individuals with a broad-spectrum infrared light device. J Cosmet Laser Ther 2007; 9:35.
  34. Bunin LS, Carniol PJ. Cervical facial skin tightening with an infrared device. Facial Plast Surg Clin North Am 2007; 15:179.
  35. Alexiades-Armenakas M. Assessment of the mobile delivery of infrared light (1100-1800 nm) for the treatment of facial and neck skin laxity. J Drugs Dermatol 2009; 8:221.
  36. Khetarpal S, Desai S, Kruter L, et al. Picosecond laser with specialized optic for facial rejuvenation using a compressed treatment interval. Lasers Surg Med 2016; 48:723.
  37. Ge Y, Guo L, Wu Q, et al. A Prospective Split-Face Study of the Picosecond Alexandrite Laser With Specialized Lens Array for Facial Photoaging in Chinese. J Drugs Dermatol 2016; 15:1390.
  38. Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review. J Am Acad Dermatol 2016; 74:931.
  39. Wu DC, Fletcher L, Guiha I, Goldman MP. Evaluation of the safety and efficacy of the picosecond alexandrite laser with specialized lens array for treatment of the photoaging décolletage. Lasers Surg Med 2016; 48:188.
  40. Fitzpatrick R, Geronemus R, Goldberg D, et al. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med 2003; 33:232.
  41. el-Domyati M, el-Ammawi TS, Medhat W, et al. Radiofrequency facial rejuvenation: evidence-based effect. J Am Acad Dermatol 2011; 64:524.
  42. Hsu TS, Kaminer MS. The use of nonablative radiofrequency technology to tighten the lower face and neck. Semin Cutan Med Surg 2003; 22:115.
  43. Dover JS, Zelickson B, Atkin D, et al. A multi-specialty review and ratification of standardized treatment guidelines for optimizing tissue tightening and contouring with a non-invasive monopolar radiofrequency device. Amer Soc Derm Surg Abstracts October 28, 2005.
  44. Kist D, Burns AJ, Sanner R, et al. Ultrastructural evaluation of multiple pass low energy versus single pass high energy radio-frequency treatment. Lasers Surg Med 2006; 38:150.
  45. Bogle MA, Ubelhoer N, Weiss RA, et al. Evaluation of the multiple pass, low fluence algorithm for radiofrequency tightening of the lower face. Lasers Surg Med 2007; 39:210.
  46. Alster TS, Tanzi E. Improvement of neck and cheek laxity with a nonablative radiofrequency device: a lifting experience. Dermatol Surg 2004; 30:503.
  47. Nahm WK, Su TT, Rotunda AM, Moy RL. Objective changes in brow position, superior palpebral crease, peak angle of the eyebrow, and jowl surface area after volumetric radiofrequency treatments to half of the face. Dermatol Surg 2004; 30:922.
  48. Paasch U, Bodendorf MO, Grunewald S, Simon JC. Skin rejuvenation by radiofrequency therapy: methods, effects and risks. J Dtsch Dermatol Ges 2009; 7:196.
  49. Gold MH, Goldman MP, Rao J, et al. Treatment of wrinkles and elastosis using vacuum-assisted bipolar radiofrequency heating of the dermis. Dermatol Surg 2007; 33:300.
  50. Sadick NS, Trelles MA. Nonablative wrinkle treatment of the face and neck using a combined diode laser and radiofrequency technology. Dermatol Surg 2005; 31:1695.
  51. Hammes S, Greve B, Raulin C. Electro-optical synergy (ELOS) technology for nonablative skin rejuvenation: a preliminary prospective study. J Eur Acad Dermatol Venereol 2006; 20:1070.
  52. Kulick M. Evaluation of a combined laser-radio frequency device (Polaris WR) for the nonablative treatment of facial wrinkles. J Cosmet Laser Ther 2005; 7:87.
  53. Sadick NS, Alexiades-Armenakas M, Bitter P Jr, et al. Enhanced full-face skin rejuvenation using synchronous intense pulsed optical and conducted bipolar radiofrequency energy (ELOS): introducing selective radiophotothermolysis. J Drugs Dermatol 2005; 4:181.
  54. Bitter P Jr, Stephen Mulholland R. Report of a new technique for enhanced non-invasive skin rejuvenation using a dual mode pulsed light and radio-frequency energy source: selective radio-thermolysis. J Cosmet Dermatol 2002; 1:142.
  55. Sadick NS. Combination radiofrequency and light energies: electro-optical synergy technology in esthetic medicine. Dermatol Surg 2005; 31:1211.
  56. Doshi SN, Alster TS. Combination radiofrequency and diode laser for treatment of facial rhytides and skin laxity. J Cosmet Laser Ther 2005; 7:11.
  57. Choi YJ, Lee JY, Ahn JY, et al. The safety and efficacy of a combined diode laser and bipolar radiofrequency compared with combined infrared light and bipolar radiofrequency for skin rejuvenation. Indian J Dermatol Venereol Leprol 2012; 78:146.
  58. Alexiades-Armenakas M. Rhytides, laxity, and photoaging treated with a combination of radiofrequency, diode laser, and pulsed light and assessed with a comprehensive grading scale. J Drugs Dermatol 2006; 5:731.
  59. Kim JE, Chang S, Won CH, et al. Combination treatment using bipolar radiofrequency-based intense pulsed light, infrared light and diode laser enhanced clinical effectiveness and histological dermal remodeling in Asian photoaged skin. Dermatol Surg 2012; 38:68.
  60. Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar versus bipolar radiofrequency treatment of rhytides and laxity using a mobile painless delivery method. Lasers Surg Med 2008; 40:446.
  61. Hruza G, Taub AF, Collier SL, Mulholland SR. Skin rejuvenation and wrinkle reduction using a fractional radiofrequency system. J Drugs Dermatol 2009; 8:259.
  62. Brightman L, Goldman MP, Taub AF. Sublative rejuvenation: experience with a new fractional radiofrequency system for skin rejuvenation and repair. J Drugs Dermatol 2009; 8:s9.
  63. Lee HS, Lee DH, Won CH, et al. Fractional rejuvenation using a novel bipolar radiofrequency system in Asian skin. Dermatol Surg 2011; 37:1611.
  64. Alexiades-Armenakas MR, Geronemus RG. Laser-mediated photodynamic therapy of actinic keratoses. Arch Dermatol 2003; 139:1313.
  65. Alam M, Dover JS. Treatment of photoaging with topical aminolevulinic acid and light. Skin Therapy Lett 2004; 9:7.
  66. Touma D, Yaar M, Whitehead S, et al. A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage. Arch Dermatol 2004; 140:33.
  67. Alexiades-Armenakas M. Laser-mediated photodynamic therapy. Clin Dermatol 2006; 24:16.
  68. Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med 2006; 38:142.
  69. Wanner M, Tanzi EL, Alster TS. Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium-doped fiber laser. Dermatol Surg 2007; 33:23.
  70. Manstein D, Herron GS, Sink RK, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004; 34:426.
  71. Narurkar VA. Nonablative fractional laser resurfacing. Dermatol Clin 2009; 27:473.
  72. Geraghty LN, Biesman B. Clinical evaluation of a single-wavelength fractional laser and a novel multi-wavelength fractional laser in the treatment of photodamaged skin. Lasers Surg Med 2009; 41:408.
  73. Leyden J, Stephens TJ, Herndon JH Jr. Multicenter clinical trial of a home-use nonablative fractional laser device for wrinkle reduction. J Am Acad Dermatol 2012; 67:975.
  74. Saedi N, Petrell K, Arndt K, Dover J. Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments. J Am Acad Dermatol 2013; 68:113.
  75. Rubenstein R, Roenigk HH Jr, Stegman SJ, Hanke CW. Atypical keloids after dermabrasion of patients taking isotretinoin. J Am Acad Dermatol 1986; 15:280.