Although generally not as strong as a CO2 laser, an erbium laser is capable of creating significant change in the skin, which necessitates some downtime. The most common side effects include generalized discomfort and mild swelling. Some patients may experience redness that may remain for the duration of the healing period. This first stage of skin healing after erbium laser resurfacing generally lasts 1-2 weeks, followed by some peeling or flaking as new tissue is generated. It is very important that patients keep the skin moisturized and do not scratch or pull at any peeling areas, which may damage the skin and increase the risk of scarring or infection. The complete healing process after an erbium laser treatment will take from 5 to 21 days depending upon the laser used and the nature of the treated condition. During this erbium laser recovery period, some patients may experience persistent redness in the treated area which may be covered with makeup generally one week after erbium laser resurfacing.

Because the energy produced by an erbium laser is readily absorbed by water in the skin cells, an erbium laser works instantly to vaporize target tissue. Afterwards, it is just a matter of allowing the skin to heal and generate new replacement cells. Some treatments may include multiple passes to achieve deeper resurfacing. For this grade of erbium laser resurfacing, the full results may take 4 to 6 months to realize as new collagen and elastin is formed.

Erbium laser resurfacing may be ablative or non-ablative depending upon the erbium laser used and the goals of treatment. Generally, an ablative laser will be more painful because it removes, or ablates, the top layer of skin. Therefore, there is a range of potential discomfort that may accompany erbium laser resurfacing. Thankfully, an erbium laser resurfacing is performed with the use of a topical or local anesthetic to thoroughly numb the area to be treated by the erbium laser. After the erbium laser session, different levels of discomfort may be experienced depending on the patient’s wound response and individual pain threshold. Pain medications or other pain management strategies may be prescribed to mitigate patient discomfort after an erbium laser.

The primary difference between an erbium laser and Fraxel is the lasing medium used. Although a bit simplistic, a lasing medium can be thought of as the source of a laser’s power and determines the depth that the laser can reach in the skin. An erbium laser is a solid-state laser using a crystal and a rare earth element, erbium, to create specific wavelengths. Erbium laser is quite active on the upper layers of the skin, which is why it is a popular choice for tattoo removal. Conversely, Fraxel® is a gas state laser using carbon dioxide or CO2 to produce light energy. In general, gas state lasers are more “powerful” and can reach deeper layers of the skin. The strongest lasers for skin resurfacing are all CO2 lasers.

Another key difference between Fraxel® and an erbium laser concerns how the energy is delivered into the skin. As suggested by the name, Fraxel® is a fractional laser, where the energy beam is divided into thousands of microscopic treatment zones without harming the surrounding skin. Erbium laser, on the other hand, may be either fractional or non-fractional depending upon the model used. To summarize, while Fraxel® may achieve a greater depth in the skin, an erbium laser presents more diversity as it can resurface an entire area or just fractions of an area.

Depending on what is being treated, follow-up sessions of erbium laser may or may not be needed. Because of the high-precision of an erbium laser, treatment may be limited to specific areas of scarring or discoloration which most likely will not require an additional session. For more generalized sun damage or signs of aging, additional erbium laser resurfacing treatments will likely be recommended. How soon the additional erbium laser treatments are performed will depend in part on the reaction and healing speed of the skin. In general, the skin needs about 21 days to completely heal after erbium laser resurfacing. Once a patient’s goals have been achieved, maintenance sessions will likely be needed once or twice a year to maintain the erbium laser results.

Healthy and nourished skin will not only heal more quickly, but also achieve a better final result from any esthetic procedure. This explains why professional skin care clinics often “prescribe” facial treatments such as gentle massage, LED or microcurrent both before and after a more intense procedure such as erbium laser resurfacing. The proper pre and post-treatment care has a huge impact on the final results of an erbium laser. But there are many ways to prep the skin for an erbium laser at home. If possible, the months preceding erbium laser resurfacing should include daily use of a retinoid to boost cellular turnover and vitamin C to aid collagen formation and prevent collagen degradation activated by free radicals. However, retinoids and any exfoliating acids should be discontinued 5-7 days before the erbium laser resurfacing, while the vitamin C may be used up to the day before. Both retinoids and vitamin C are too irritating to use immediately after an erbium laser, but may be resumed after the initial healing period (generally 1-2 weeks after erbium laser).

Similar to other procedures that generate a controlled wound in the skin, such as erbium laser, UV exposure should be avoided for at least 4 weeks before erbium laser resurfacing. If a patient has a history of cold sores, a cycle of Acyclovir or Valacyclovir may be prescribed before and after erbium laser. Since every individual is different, it’s best to consult with a trusted clinician on how to prepare for an erbium laser.