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Laser Skin Resurfacing Evolving Options– Part 2 of a 3 part series

Laser skin resurfacing has been refined significantly since it was first introduced. Early problems such as pigment loss in the treated areas are nearly unheard of these days. The way that laser energy is delivered to the skin with modern devices allows for excellent clinical results with decreased healing time and overall decreased risks.

Laser skin resurfacing is categorized in different ways, and to someone not familiar with the different options, it can be confusing and overwhelming. Adding to the confusion is the fact that there are many different laser manufacturers, each of them marketing their particular device as “the best” for wrinkles, pigment, sun damage, etc. I want to try to simplify this by reviewing the basic categories of laser resurfacing. Remember that each category will have many different devices on the market, all with similar functions. This review should help you to narrow down your options when deciding on a laser resurfacing procedure.

The first categories to review are ablative versus non-ablative laser resurfacing.

Ablative laser resurfacing of the face for sun damage and aging was first performed with a Carbon Dioxide (CO2) laser in 1989. The target of ablative lasers is water contained in the skin; when heated by laser energy the skin tissue is vaporized and removed from the skin surface. A wound healing response is initiated by the body to replace the lost tissue with new collagen, elastin, and skin cells. In this way textural abnormalities, wrinkles, and pigment can be erased. However, the treatment goals must be balanced by the risk of scarring, which was more common with the original devices and with more aggressive treatment settings.

Non-ablative laser resurfacing was first introduced under the name “Fraxel” laser which came out in the early 2000’s. It was developed to provide a way to improve tone, texture, and wrinkles with minimal downtime. “Non-ablative” refers to the fact that there is no vaporization of the skin tissue. Instead, the laser energy heats the skin and creates columns of coagulated tissue called microscopic treatment zones (MTZs). Only a fraction of the skin surface is treated with each session, therefore multiple sessions (average of 5) are required for maximal improvement. The advantage is short recovery time, usually 3-5 days of moderate erythema and swelling, but without oozing or crusting.

The next category to review is fully ablative versus fractional laser resurfacing (Figure 1).

Fully ablative resurfacing removes the entire top surface of the skin to a depth determined by the settings chosen by the physician.   Healing time increases with the depth of treatment. Superficial depth treatments, helpful for fine textural changes and pigment, are called “microlaser peels” and heal within a few days.   Deeper treatments, particularly helpful for etched in lines around the mouth, take up to 2 weeks to heal.

Ablative fractional resurfacing was developed to improve healing time and minimize risks of scarring and pigment alteration. Columns of tissue are vaporized, often to depths greater than can be achieved safely with fully ablative lasers. Vaporized columns are quickly healed by the surrounding unaffected tissue. New collagen and elastin deposition and elimination of pigment in these columns contribute to the cosmetic result of decreased lines, diminished texture, and improved tone. Because only a fraction of the surface is treated each time, a series of 3-5 treatments is required for maximal improvement.

Laser Skin Resurfacing Categories
Laser Skin Resurfacing Categories

Lastly, the new hybrid fractional laser resurfacing (HALO) delivers ablative vaporization and non-ablative coagulation to the same tissue column (microscopic treatment zone). The result is improved healing time with less pain than traditional resurfacing lasers. Pigmentation, wrinkles, and pores are significantly improved over the course of 1-3 treatments.

HALO Laser Image
HALO Laser Image

AboutSkin Dermatology physicians provide patients with a full array of laser resurfacing options in all of the categories reviewed in this blog post. (See below)



  • Fully ablative Erbium resurfacing (TRL)
  • Ablative fractional Erbium resurfacing (ProFractional)
  • Erbium Microlaser Peel

Palomar Icon

  • Ablative fractional Erbium resurfacing
  • Non-ablative fractional resurfacing (1540nm XF and XD)

Often, laser resurfacing devices are combined in the same treatment session depending on specific patient needs. For example, a single treatment session could consist of the following:

  • Erbium fully ablative resurfacing around the mouth and eyes for etched in lines
  • CO2 fractional resurfacing for the rest of the face
  • HALO hybrid fractional resurfacing on the neck and chest
  • Microlaser peel on the top of the hands

** Stay tuned for part 3 of this laser resurfacing blog series in which I will explain how to choose which laser is right for you.

Whatever your particular treatment goals are, we have the knowledge and technology to help you achieve them. Call our cosmetic coordinators at AboutSkin Dermatology at two Denver area locations (Greenwood Village and Lone Tree) to schedule your laser resurfacing consultation. 303-756-7546 (SKIN).


Sunscreen – Friend or Foe?

By Dr. Samantha Stoler

Suncreen at AboutSkin DermatologyHave you read articles declaring that sunscreen is dangerous?

The media has tricked people into questioning the safety and benefits of sunscreen and claim there is “The sunscreen dilemma” – it’s not really a dilemma at all.

Ultraviolet light is a proven carcinogen.  Daily use of zinc or zinc and titanium based sunscreens effectively reduce exposure to the damaging effects of Ultraviolet Light.

What we know from scientific data:

  • UV exposure undoubtedly increases the risk of basal cell and squamous cell carcinoma. These are skin cancers that can occur in cosmetically devastating areas.  They often need to be surgically removed.  Melanoma causes are multi-factorial.  UV exposure is included and tanning beds increase the risk of melanoma tremendously.  Melanoma can kill.
  • Sunscreen definitively reduces the amount of sun damage to skin cells.  DAILY use with reapplication minimizes the effects of photo-aging.  These signs include: hyperpigmentation (sun spots), wrinkling and thinning of the skin, and broken blood vessels.  You do not need to be getting burned to be damaging and mutating your DNA.  The damage is cumulative.
  • Chemical sunscreens may stimulate estrogen receptors and cause more skin cancer if you are a rat and are force-fed hundreds of times the amount of sunscreen that humans apply to their skin over a lifetime.
  • Physical blockers are better anyway.  As single agents they offer a broad spectrum of coverage against both UVA and UVB.  They do not absorb into the cells and negate the chemical “fear.”  Zinc oxide and titanium dioxide (physical blockers) are also more hypo-allergenic.  These are the best sunscreens for both kids and adults!

Take oral Vitamin D.  There is no “safe” 10 minutes a day.  This is especially true in Colorado living at high altitude and enjoying many sunny days.

An Introduction to Laser Skin Resurfacing – Part 1 of a 3 part series


Laser Resurfacing for Lines on Lips“What can we do about the lines on my lips? I’ve never been a smoker, but they are just getting deeper.”



Laser Skin Resurfacing for Lines Under eyes“I found this cream at the store that covers the lines under my eyes pretty well – but, is there something better we can do for this?”



Bumpy Texture on Cheeks“I’m starting to notice these lines and bumpy texture on my cheeks.  I used to only see them when I smile, but now they are there all the time.  Can we just do some Botox here?”


All of these questions were posed to me earlier this year by my mom, who I’ve treated over the past 12 years with various combinations of botulinum toxin, fillers, and chemical peels (she is 63).  Like most of the patients I see, she regrets all the time she spent as a young woman laying out on the lawn in the Minnesota sun.  When I first started treating my mom she had decent skin texture and minimal lines at rest.  The volume changes, folds, and lines that she did have responded well to injectable filler and botulinum toxin; her pigmentation evened out nicely with chemical peels and intense pulsed light (IPL).

A few years later, as she began to develop etched in lines, I performed a series of fractionated laser skin resurfacing procedures with nice reversal of these mild early changes.

Laser Resurfacing Procedure
“After a single fully ablative Erbium laser resurfacing procedure, she was able to reverse the clock by a few years and is very pleased with her results.”

Later, the inevitable signs of aging, particularly loss of elasticity and collagen, caught up to her, and the etched in lines and texture changes became more prominent.  For her to see the degree of improvement she wanted, I explained she would have to consider a more aggressive laser resurfacing procedure, the fully-ablative Erbium laser.  She certainly wasn’t excited about laying low for nearly 2 weeks (and she even had some regrets 3-4 days into her recovery – it’s not easy), but she now says she’s so pleased with the results and is so happy she did it.


As winter approaches, this is the perfect time to consider a laser resurfacing procedure;  lower temperatures and decreased sunlight exposure make for a more comfortable recovery and improved outcome.  In the next three blog posts I will be reviewing the latest technologies and applications of laser resurfacing.

Achieving flawless, smooth skin is the holy grail of any skin rejuvenation program.  Unfortunately, perfect skin will always be as elusive as the holy grail itself.  Fortunately, though, we live in a time when there are new technologies and devices entering the marketplace, each one inching us closer in our quest for youthful skin.  Laser resurfacing is usually a critical component in a person’s skin rejuvenation regimen.

Laser devices have been used for the improvement of the signs of aging and sun damage since 1989.   Nothing is more effective than laser resurfacing for all-around improvement in fine lines and wrinkles, texture, pigment, pores and scars due to acne or surgery.

So, how does laser skin resurfacing work?

During the laser resurfacing procedure laser energy is absorbed by water in the skin leading to either vaporization or heat damage within the superficial and deeper skin layers.  Collagen and elastin, damaged over years of sun exposure and normal skin aging, is removed and replaced by the body’s wound healing response with new, healthier collagen and surface epithelium.   The result is smoother, brighter, and overall younger-looking skin.

Many patients considering laser resurfacing on the face express concern that their face will appear white compared to their neck.  It is true that many patients undergoing this in the 1990’s experienced this—when the fully ablative CO2 laser was first widely used.  Today, with the advent of newer laser technologies like Erbium fully ablative laser, fractional ablative, fractional nonablative, and hybrid fractional laser, there is speedier recovery and greatly reduced risk of pigment change and scarring.

Laser skin resurfacing is just one component of a complete rejuvenation plan.  Fillers, chemical peels, microdermabrasion, botulinum toxin, laser resurfacing, skin resurfacing products, and topical products (especially daily sun protection, nightly retinoid, and daily antioxidants) all focus on unique features of aging and combine to give a natural and optimal results.

In part two of this blog series I will review the different types of laser skin resurfacing.  At Aboutskin Dermatology we have acquired the latest technologies from each of the laser resurfacing categories.  What that means for you is a broad-array of options and a personalized approach to your skin rejuvenation goals.



Introducing HALO Hybrid Fractional Laser Resurfacing

AboutSkin Dermatology is excited to announce the addition of HALO Hybrid Fractional laser skin resurfacing (http://halobysciton.com/).  What’s great about this technology is the ability to tailor the treatment to the length of downtime and level of treatment desired.

HALO has been shown in clinical studies and in our office to improve the signs of sun damage and skin aging – tone, texture, wrinkles, and pore size with an average of 5 days of downtime (series of 3 treatments recommended for optimal results).

This is an ideal choice for somebody looking for significant results but cannot afford to take more than a few days off for recovery.

Watch Dr. Cohen in action with Halo on Colorado’s Best Fox31 news segment…

Call our Cosmetic Department at AboutSkin Dermatology to schedule your consultation at 303-756-7546.

Greenwood Village Newsletter Feature – AboutSkin Ribbon Cutting!

After a year of design and planning the AboutSkin team is proud to unveil our beautiful new clinical space. We wanted a space that is bright and welcoming with attention to making the patient experience comfortable and easy.  Our office is located just off of I-25 (near corner of Belleview and Quebec), and parking is conveniently located right outside the building.   With plenty of waiting space (with option for smaller, more private waiting), table tops, and wifi access we wanted to enhance the patient experience.  We have also added a AboutSkinCare Stop where patients can learn from our educated staff about a comprehensive skin care regimen that is right for their skin.

Read the full Greenwood Village Spotlight article here!

Want to reduce your risk for skin cancer? Take your vitamins!!

Nicotinamide (vitamin B3) has been shown to have protective effects against damage caused by UV radiation and to reduce the rate of new premalignant actinic keratosis and non-melanoma skin cancers.  Here are the numbers from the Study published in the New England Journal of Medicine:

  • 386 participants who had had at least two non-melanoma skin cancers in the previous 5 years received 500 mg of nicotinamide twice daily or placebo for 12 months.
  • The number of actinic keratoses at 4 months was 29% lower among those who received 500 mg of nicotinamide administered orally once daily and 35% lower among those who received 500 mg of nicotinamide twice daily than among those who received placebo.
  • Patients taking nicotinamide twice daily experienced a 25% decrease in non-melanoma skin cancer rates.

AboutSkin now has nicotinamide available for your convenience.  It retails for $29.50 + tax for 100 tablets.  We advise taking one table twice daily to maximize the health benefits.

If you want to read the entire study, here is the link:


For additional information, including interesting new research on how eating too much grapefruit may increase your risk for melanoma, read the following article:



Proven: Botox improves self perception of age and appearance

In a study of patients injected with botulinum toxin (Botox, Dysport, or Xeomin) into the frown lines (between the eyebrows), data shows 28% improved patient satisfaction with their overall appearance.    Patients reported they looked almost 6 years younger after their cosmetic botulinum injection.

Read the full article here.

Watch Dr. Cohen describe effective use of botulinum toxins for aesthetic improvement with natural results.


Dr. Cohen on ABC News – Get your skin checked!

Summertime is a great time to remember to have your skin checked.  Self exams are helpful in identifying spots that may have unusual shape or color, or symptoms like itching, bleeding, or pain.  Seeing a board-certified Dermatologist with expertise in identifying worrisome lesions can catch cancer at it’s earliest stages when chance of cure is high.

Dr. Cohen reviews the types of skin cancer and signs and symptoms to be aware of on ABC News in Denver.

Denver7News June 2016

Call AboutSkin to schedule with one of our 6 Dermatology providers at 303-756-7546 (SKIN).

Dr. Cohen New York Times – Plumper Cheeks

Volumizing as opposed to wrinkle filling – Dr. Cohen spoke to the New York times about the evolution of fillers in “New Beauty Goal: Plumper Cheeks”.   When fillers were first introduced more than 2 decades ago, the most commonly treated area was the nasolabial folds, more commonly known as the “smile lines” or “parentheses” extending from the nose to the corners of the mouth.

While this was effective in reducing the depth of the lines, it did not address at all the deflation and flattening of the cheeks. Therefore, the lines looked smoother, but patients did not necessarily look younger. Over years of injectable filler experience, Dr. Cohen notes that by replacing the areas of lost volume, the smile lines are indirectly improved and with a much more natural cosmetic result. He explains this can also provide a subtle lift to the corners of the mouth.

Volume loss is due to a combination of factors including loss of fat associated with aging or rigorous exercise, loss of skin collagen, genetics, gravity, and loss of underlying bony support. Products with the ability to lift such as Restylane Lyft, Radiesse, and Voluma are most often used to achieve a natural-looking result. It is important to trust a physician with years of experience and up-to-date injection technique to maintain a balanced, subtle, and natural rejuvenation.


Screen Shot 2016-03-20 at 9.53.32 AMMicroneedling popularity is growing at a rapid rate. Doris Day, MD shares how she uses microneedling in practice. Beyond the benefits she’s seen for acne scars, she explains how and why she’s using it to treat melasma. While more evidence-based data is needed, she says it has the potential to become a standard-of-care option for melasma.

Click here to view video