Nonablative Resurfacing

Updated: Jan 14, 2021
  • Author: Omobola Onikoyi, DO, MSc; Chief Editor: Dirk M Elston, MD  more...
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Nonablative resurfacing is a technique in which lasers are used to resurface the skin to improve pigment and texture without physical injury to the skin surface. Similar to ablative resurfacing lasers, nonablative lasers can be one of two types, fractionated (most common) or nonfractionated. Changes in patient preferences and improved laser technology have led clinicians to prefer nonablative laser resurfacing techniques over older and more destructive ablative techniques.

Nonablative nonfractionated lasers create uniform thermal damage to the dermis while sparing the epidermis. They are best for the treatment of mild-to-moderate photodamage and early signs of skin aging. Fractionated lasers deliver energy through a process called fractional photothermolysis, in which an array of small laser beams create many microscopic areas of thermal injury within the range of 100-400 um in width and 300-700 um in depth. These areas, referred to as microscopic treatment zones, are columns of thermal damage surrounded by areas of normal skin that serve as a source of healthy tissue and stem cells for remodeling and effective rejuvenation and allow for safe and rapid healing. [1] Nonablative fractionated lasers combine the best of the gentle and safe aspects of both fractionated and nonablative technologies and are ideal for patients seeking moderate improvement with minimal postrecovery time. [2]

The most common uses of nonablative resurfacing lasers include the treatment of photoaging, rhytides, scars, skin pigmentation, and overall skin rejuvenation. A report from 2017 looked at the use of these devices to assist in drug delivery. [3]


History of the Procedure

The desire for facial rejuvenation dates as far back as ancient Egypt. The Egyptians used sour milk and lactic acid to perform chemical peels. Since then, there has been significant experimentation and advancement in order to achieve the optimal balance between skin damage and skin improvement.

The use of fractional lasers in medicine was first introduced in 2004 by dermatologist Dieter Manstein and has since revolutionized the field of laser resurfacing and rejuvenation. These specific devices use varying wavelengths, with the goal of improving skin appearance with minimal downtime and adverse effects.



The key problem in assessing evaluations of nonablative resurfacing in the last 5 years has been understanding its ability to induce objective clinical improvement.

Investigators using nonablative lasers have noted that the induction of new collagen creations are not specific to a wavelength. That is, identical alterations of collagen can be histologically demonstrated using the Er:glass laser, Nd:YAG laser, and diode lasers. The primary effects appear to be thermal injury to the dermis, inducing collagen remodeling and formation instead of vascular injury. What may be occurring is dermal remodeling or toning in a parallel fashion to the healing response elicited by an injury that initiates collagen regeneration, turnover, and deposition. [4]

Histological alteration does not exactly mirror clinical enhancement of skin. Results vary, and studies even of the same lasers with similar (but almost always slightly different) settings and parameters report different results (ie, some with clinically significant change and some without objective alterations in the skin).

Studies have been performed on pulsed-dye, 585- to 595-nm lasers; Er:glass, 1540-nm lasers [5] ; Nd:YAG, 1320-nm lasers; diode, 1450-nm lasers; and intense pulsed-light, 560- to 640-nm lasers with a cutoff filter. [6]

It might be best understood that nonablative laser treatments are likely not the most effective treatments for rhytid reduction. However, they seem to be effective and useful modalities for amelioration of scars and superficial dyschromias. Obviously, for minimal facial damage, they allow patients to pursue their regular activities and thus are useful and important treatment options. [7]

Trellas et al noted that no single nonablative laser can achieve all the specific effects needed for effective skin rejuvenation, [8] and they suggest that combinations of treatments are the most useful modes of treatment. Fractional resurfacing has largely replaced other ablative technologies, and nonablative techniques have become more widespread.

Although nonablative treatments are useful, they are still not as effective as ablative treatments. This was highlighted in a study by Ong and Bashir [9] ; ablative fractionated laser induced an improvement range of 26-83%, whereas nonablative fractionated laser had an improvement range of 26-50%.



Nonablative lasers work by stimulating collagen synthesis, thereby promoting improved skin texture and tone. This type of laser may be used to improve the appearance of acne scars, fine lines, wrinkles, melasma, and much more. The fast postprocedural recovery time is what makes it a highly desired cosmetic technique. While nonablative nonfractionated lasers are best for treating mild-to-moderate photodamage and dyschromia, nonablative fractionated lasers are considered superior for rejuvenation and retexturizing.

A study from 2017 reports on the effective use of nonablative laser resurfacing for a wide array of dermatological conditions seen specifically in skin of color. [10]


Relevant Anatomy

Nonablative laser techniques have mainly been used to treat areas on the facial skin; however, interest is increasing in the role of these techniques on the neck, the hands, and other areas of the body.

The use of lower wavelengths in nonablative laser resurfacing techniques allows for the restoration of damaged collagen without causing disruption to the stratum corneum (epidermis), the outermost layer of the skin. The underlying dermis is disrupted via light energy, eliciting an inflammatory response and further initiating collagen repair. Fractionated nonablative lasers create microscopic columns of thermal injury interspersed with normal tissue, which allows for quicker and more efficient recovery.



Contraindications to skin resurfacing with lasers include active psoriasis and lichen planus, active bacterial or fungal infections, and active neoplastic disease. Individuals who are unable to give proper informed consent should not receive laser treatment, and those with unrealistic expectations should be cautioned. [11]