Erbium Laser versus Fractional CO2 Laser

Erbium laser vs CO2 Laser: Which is more suitable for you?

Both of these lasers are commonly used for skin rejuvenation and resurfacing.

In this article, we are going to talk about the differences between erbium laser (also known as Erbium:yag laser) and fractional CO2 laser to help you to understand more about the uses, effectiveness, side-effects, recovery time and treatment prices before you undergo the treatments.

How do Erbium laser and CO2 laser work?

Erbium laser being the newer technology claims to have improved safety profile for patients of darker skin type. This however has not replaced the use of fractional CO2, which is still the gold standard today for treating acne scars.

Compared to the older generations of CO2, improvements has been made to newer generation fractional CO2 devices – pulsed CO2 laser, which aims to match the downtime and improve safety profile to compete with what erbium:yag has to offer.

These ablative lasers works by absorbing water in your skin cells. The absorption causes vapourisation of the cell, which induces microscopic injury to the epidermis to initiate the process of skin remodeling with the production of collagen.

Fractional CO2 laser delivers high-speed laser pulses at a wavelength of 10640m, whereas Er:yag laser emit light with a wavelength of 2940nm. With a higher Rayleigh length, it means that fractional CO2 is able to penetrate deeper into the skin, which is may be more beneficial for treating deeper acne scars.

What do Erbium lasers and CO2 lasers treat?

Although Erbium laser and Fractional CO2 lasers are both classified as ablative lasers, they have different uses.

Fractional CO2 lasers are generally used to treat scars, warts, wrinkles and deeper skin flaws. Erbium laser tends to target more superficial problems like fine lines, wrinkles and skin laxity.

Erbium versus CO2 Laser: Which is more effective?

In the treatment of rhytides (wrinkles), fractional CO2 has slightly better improvements compared to Erbium:yag laser, but multiple passes of Erbium laser can mimic the effects of fractional CO2 in the treatment of rhytides.

In the treatment of acne scar however, the effects of fractional CO2 cannot be reproduced with Erbium. CO2 Laser is more effective than Erbium laser for improving deeper skin textural issues like acne scars.

Histologically, the effects of the laser has been studied and the depth of changes to collagen and elastic fibres ranged from 50-200 µm in the CO₂-treated specimens (average, 90 µm) compared with 30 to 50 µm (average, 45 µm) for specimens from Er:yag-treated sites. This proves that Erbium:yag laser despite multiple passes is unable to remodel scarring tissue at the same level as fractional CO2. Studies also prove that the effects of collagen stimulating last longer in fractional CO2.

For the treatment of especially bigger discrete lesions such moles, warts and skin tags, the use of CO2 may be more appropriate as the ability to coagulate and stop bleeding is higher than that of Er:yag.

Is Erbium laser more painful than CO2 laser?

With the use of numbing agents, the pain for both treatments is manageable. The severity of your skin problem, the intensity and he number of passes required to achieve the desired effect will be the determining factor of how much pain you feel!

What is the downtime of Erbium laser compared to CO2 Laser?

Redness

Erythema or redness after laser is very common. For most patients the degree of redness experienced will be more in patients doing fractional CO2 laser.

Skin peeling

Skin peeling for erbium is more noticeable as the superficial layers of skin physically sheds. For fractional laser the peeling happens when the microscopic ‘scabs’ of shriveled skin come off.

Duration of recovery

The duration of downtime is more versatile for fractional CO2 ranging from 1-3 weeks depending on the indication of use. The duration of downtime for erbium laser is generally 1 week as the light does not penetrate as deep into the dermis.

How are the side effects of Erbium and CO2 lasers different?

Swelling

There is no significant difference in incidence of swelling for all time intervals between the two treatments.

Post-inflammatory Hyperpigmentation

Conventional CO2 lasers are known to have higher risk of PIH as the area of damage is bigger. However to stratify this risk, the newer generation fractional CO2 lasers, like Edge, allow changes to the density, the pulse duration, pulse energy to allow better precision and control over the amount of ‘damage’ required for the desired effect. Studies have shown that the risk of PIH is comparable for Erbium laser and fractional CO2 when used to treat fine lines and that the resolution of PIH for both fractional CO2 and Erbium laser are the same.

In the treatment of deeper skin issues such as acne scars, the risk of PIH may be higher as the nature of the treatment requires a more aggressive approach.

Infection and scarring

For both fractional CO2 and erbium laser, these side effects are extremely uncommon.

How often can I do Erbium laser treatments?

Generally, both procedures can be performed every 4-6 weeks safely. However, depending on your skin recovery and skin condition, you may not necessarily require such as aggressive regime.

How much does Erbium and CO2 Laser treatment cost?

The cost of erbium laser and fractional CO2 are comparable ranging from $300 -$1000/session. 

In general, the fractional CO2 laser is a more versatile machine that enables it to treat more skin problems effectively. Erbium is a good alternative for patients who wants to target more superficial skin problems and for individuals with darker skin type.

As these laser machines, when done at different setting can mimic the effects of one another, it is important that you go to someone with good understanding and experience in performing skin resurfacing treatments!

Please consult your doctor before undergoing any of these treatments.