Benefits of Erbium Laser

Erbium laser is similar to the CO2 lasers in that they are classed as ablative lasers, which act to precisely remove the outer layers of the skin using controlled pulses of laser energy. Laser resurfacing is also referred to as a laser peel and has many advantages over more traditional methods of resurfacing, such as chemical peels and CO2 lasers. Erbium YAG lasers have more precision compared with CO2 laser and cause less bleeding, and are more suitable for the removal of superficial skin lesions. Compared with older laser resurfacing methods, the Erbium YAG laser carries a shorter downtime. Many patients often recover in less than half the time it takes with CO2 laser treatment. Erbium YAG laser causes less thermal injury to the skin and, therefore, virtually no risk of skin burns of surrounding tissues. This means less risk of hyperpigmentation and permanent scarring. Common side effects of erbium laser include swelling, redness and superficial crusting, which lasts for a week at most. Erbium laser resurfacing perfectly complements the results of facial rejuvenation procedures like Morpheus8, blepharoplasty and facelift, and the results can last for up to five years or more.

Erbium laser for skin lesion removal

Erbium YAG laser is ideal for superficial skin lesion removal due to its excellent absorption in water. This gives the erbium laser great accuracy in being to remove superficial facial skin lesions completely and with a low risk of hyperpigmentation and scarring.

What does Erbium laser involve?

Treatment with erbium laser is a very quick and simple procedure and is carried out as an outpatient treatment under local anaesthetic. The procedure involves laser energy being applied to the target to vaporise the lesion layer by layer until the skin lesion is fully removed. Treatment often takes less than 5 minutes per skin lesion, depending on the size and thickness of the skin lesion. After treatment, a protective scab often forms, taking about 2 weeks to come off naturally. You should avoid picking at the scab. Some skin lesions may need more than one treatment for adequate clearance.

Erbium laser can be used to treat a wide variety of superficial skin lesions that are benign in nature but can also be used to treat pre-malignant skin lesions such as actinic keratosis.

Viral warts

A wart is a very common skin lesion caused by the skin becoming infected by human papillomavirus or HPV. Viral warts are prevalent in young children, people with chronic skin conditions like eczema and patients with immunosuppression such as diabetes and HIV. Warts can affect people of all ages and are most commonly spread by direct contact with the skin. Wart removal is effectively carried out with an erbium laser.

There are a number of different types of warts, including warts found on fingers, planter warts, also known as verruca, flattened warts and cauliflower-like warts.

Seborrhoeic keratosis

Seborrhoeic keratosis, also known as senile warts, is a very prevalent type of harmless skin growth found in older people who have spent significant amounts of time in the sun and have subsequently developed extensive photodamage to the skin. These skin lesions often have a brown or black colouration and are raised above the surrounding skin. They most commonly have a crusty and wart-like surface texture and normally have a rounded shape.  Seborrhoeic keratosis is not a pre-malignant skin lesion and therefore has no potential to develop into skin cancer. Most of these skin lesions course have no symptoms whatsoever. They are most commonly removed when patients view them as a cosmetic nuisance or when they catch on items of clothing and become uncomfortable.

Actinic keratosis

Actinic keratoses are skin lesions most commonly found on areas of photo-damaged skin. They often resemble a rough, scaly skin patch with an overlying crust. Actinic keratosis is caused by abnormal cellular processes often as a result of repeated exposure to ultraviolet radiation from the sun. The most commonly occur on son exposed areas of skin such as the forehead, ears, lower lips and balding areas of the head in men. Actinic keratosis is a pre-malignant condition and, in certain cases can go on to develop into a type of skin cancer called squamous cell carcinoma or SCC. It is important to have treatment for actinic keratosis to prevent progression to potential skin cancer. Localised lesions can be effectively treated with an erbium laser. If you have diffuse actinic keratosis, full-face erbium laser skin resurfacing is a very effective treatment.

• Skin tag removal
• Milia removal
• Mole removal
• Xanthelasma removal
• Age spot removal

Erbium Laser Resurfacing

All lasers are not created equal. The Erbium YAG laser at Centre for Surgery is one of the most powerful lasers in its class. Erbium YAG laser is ideal for the elimination of mild, moderate and severe wrinkles caused by extensive exposure to the sun. Wrinkles that are caused by repeated facial movements are better treated with anti-wrinkle injections and dermal fillers. Acne scarring, surgical scars and age spots are all amenable to treatment with Erbium laser as well as Morpheus8. Skin lesions, whether epidermal (superficial) or dermal (deep), also respond well to treatment with Erbium laser. Unlike CO2 laser, our Fotona laser works great for darker skin types with less risk of causing pigmentary changes or skin lightening, which would be more obvious in darker skin. Laser resurfacing works best for the face region in particular because facial skin contains many accessory glands. These glands include both sweat glands and sebaceous glands and it is these cells that help to regenerate skin after laser resurfacing. Laser resurfacing of the neck must be performed with caution as this area lacks the accessory glands and so there is a higher risk of scarring if Erbium YAG laser is not used correctly. Erbium laser treatment is performed as an outpatient, meaning you get to recover in the comfort of your own home soon after having your laser treatment. Our Baker Street clinic in central London is well placed to serve patients from all over London and the southeast and further afield. Many of our patients travel down from Scotland to receive state-of-the-art erbium laser skin resurfacing in London. Erbium YAG laser resurfacing is performed very comfortably with a local anaesthetic with or without oral sedation for maximum comfort.

Erbium laser resurfacing is excellent for the removal of superficial fine lines and wrinkles and the effects of chronic sun damage, which lead to an uneven skin texture, solar lentigo, seborrhoeic keratosis and actinic keratosis. Laser resurfacing is a more effective resurfacing treatment when compared with chemical peels. Chemical peels can be unpredictable in the depths to which they penetrate, increasing the risk of hyperpigmentation and scarring. Erbium laser resurfacing can be fractional or fully ablative. Fractional laser resurfacing is excellent for anti-ageing and treating facial acne scarring. The microcolumns generated by fractional laser can penetrate deeply into the tissue, which facilitates deep collagen remodelling. The collagen remodelling leads to the thickening of the dermal layer of skin, leading to a more youthful, rejuvenated look. The same mechanism is also very useful for acne scarring where scar remodelling is induced by the laser leading to the reduction of the deep pitted scars which characterise acne scarring.

Erbium laser causes its effects as the laser makes contact with the skin surface. Skin contains a high percentage of water and the Erbium laser is strongly absorbed in water. The extra heat generated by the erbium laser results in collagen contraction and stimulates the production of new collagen, leading to a skin-tightening effect. With laser resurfacing, the aim is to cause a controlled thermal injury just enough to promote healing. The thermal injury is enough to cause a superficial burn and the skin will undergo oozing and weeping as part of the healing response. Erbium laser is used at higher settings for deeper wrinkles and often requires more treatment sessions. Superficial lines and wrinkles may only need one treatment for optimal results.

Good candidates for Erbium laser

• Those with lighter skin types, Fitzpatrick types 1-3
• Reduction of fine lines around the periocular or perioral region
• Tightening of loose skin of the upper and lower eyelids as an alternative to a blepharoplasty
• Reduction of hyperpigmentation, age spots or freckles
• Acne scar treatment
• Can tolerate 1-2 weeks of downtime
• Non-smokers

1. An Erbium:YAG laser wavelength is optimal for skin ablation.

Erbium:YAG lasers are optimal for skin ablation primarily because of the wavelength this technology generates. Erbium:YAG is emitted at 2,940 nm, while CO₂ has a much longer wavelength at 10,600 nm. Chromophore absorption curves show a significant bump in the water absorption coefficient between 2,500-3,500 nm and a drop down at 7,500-20,000 nm.

Erbium:YAG lasers have a very efficient beam to target water and relatively limited haemoglobin absorption. Because water is such a critical component in the epidermal and dermal tissue, the 2,940 nm wavelength produced by Erbium:YAG lasers can rapidly vaporise water residing in the skin. This unique wavelength delivers an almost instant skin ablation while limiting heat damage in the surrounding area.

This thermal damage is the biggest difference between Erbium and Carbon Dioxide lasers. Carbon Dioxide lasers have been used to treat and ablate the skin since the 1970s. However, because the absorption in skin tissue is relatively low compared to Erbium lasers (in both water and haemoglobin), their result is substantial excess heat in the surrounding tissue. The consequences of that are localised necrosis (tissue death that leads to slower recovery time), more post-treatment discomfort, and greater instances of post-inflammatory hyperpigmentation (PIH), all while not necessarily allowing for better results when compared to Erbium lasers.

2. Erbium:YAG lasers can vary their treatment depths (full skin resurfacing vs. light Celebrity Peel). 

Again, the varied treatment depths of Er:YAG lasers are mostly credited to the significantly greater absorption in water found in the epidermal and dermal tissue. This significant water absorption allows practitioners to reduce the pulse duration to make the treatment “colder” (i.e., pulse duration at 100 microseconds), or extend the pulse duration for a warmer therapy (up to 1000 microseconds).

A “cold laser” treatment performs laser therapy that doesn’t cause significant thermal damage to the tissue. CO₂ technology can’t provide the same treatment because the thermal damage inherent in the wavelength of 10,600 nm makes it incredibly difficult (or impossible) to treat a patient without heating the tissue. Practitioners using Er:YAG lasers are afforded the option to cater treatments to each patient better and can elect to build thermal damage by increasing the pulse duration, or keeping those thermal effects limited.

3. Erbium:YAG laser treatments create less thermal damage and are less painful.  

Er:YAG users can very intentionally create treatment protocols specialised for each patient because they have greater control over the thermal damage delivered. By controlling thermal damage, practitioners can administer popular, more superficial treatments with little-to-no downtime, such as the “Hollywood Peel” or “Celebrity Peel.” A Hollywood Peel is a light dermabrasion that aims to correct epidermal pigmentation and dull skin. Practitioners typically set pulse duration at only 100 microseconds for “super-cold” ablation. Depending on the treatment style and speed, Er:YAG practitioners can create more or less heat in the skin for added short-term collagen tightening.

Thanks to the greatly limited thermal effects of Erbium lasers, Er:YAG treatments are notably less painful than CO₂ lasers, and patients do not require any anaesthesia when receiving treatment for small lesions. These safety features make Er:YAG lasers the superior choice for treating delicate areas such as the peri-orbital region, neck, chest, and hands.

4. Erbium:YAG laser treatments have a lower risk of side effects, including hyperpigmentation or skin bleaching, compared to CO₂ treatments. 

Hyper-pigmentation and hypo-pigmentation are mainly due to thermal damage and collagen stimulation. Melanin can only absorb wavelengths between about 300-1,000 nm, so CO₂ and Er:YAG do not directly cause pigmentation issues. One study found that hypo-pigmentation is more likely with CO₂ while also finding that treatment depth is related to an increased chance of hyperpigmentation.

While it’s well established that CO₂ lasers penetrate deeper in the dermis than Erbium lasers, given constant fluence or energy settings, that doesn’t always correlate with improved patient outcomes. Erbium:YAG lasers deliver impressive results with very few if any, side effects.

5. Erbium:YAG treatments require a shorter recovery time compared to CO₂ lasers. 

Er:YAG lasers require a shorter recovery time compared to CO₂ lasers because of the shallow depths of wounds they create. Furthermore, Er:YAG lasers deliver reduced thermal damage to the surrounding skin tissue, allowing for much faster healing compared to the deeper injuries and extensive thermal damage that CO₂ lasers produce.

Although Er:YAG lasers do not penetrate as deeply as CO₂ lasers, they’re able to mimic the effects of CO₂ lasers by increasing pulse duration while limiting the risk of unwanted side effects. However, a CO₂ system can not replicate the same success as an Er:YAG system without increasing the risk of harm to the patient. The flexibility of an Er:YAG laser’s pulse formats and energy capabilities make it a desirable and safer alternative to the time-tested CO₂ laser for ablative and fractional treatments.

Erbium Laser Skin Tightening

Using Fotona’s unique Smooth mode, the Erbium YAG laser can work in a fully non-ablative mode with the transfer of thermal energy to intact skin for minimal downtime. The unique ‘Smooth’ mode works great to improve skin quality through the production of new collagen and the remodelling of existing collagen. Laser skin tightening is one of our leading treatments for treating skin laxity and is applicable to most parts of the body, including the face, neck, abdomen, thighs and buttocks. The treatment is fully non-invasive, with no requirement for anaesthesia.

Fotona 4D uses an Erbium laser to tighten the nasolabial folds and perioral lines from within the mouth – completely unique for a laser system. Fotona 4D is an excellent treatment for non-invasive skin tightening and can be used instead of or can complement facial injections such as dermal fillers. For those looking to improve the laxity of the eyelids, SmoothEye is a highly effective non-invasive treatment which tightens eyelid skin over the course of 5-6 treatments. The results can match the results of surgical blepharoplasty in many cases.

An Erbium laser peel can treat specific areas of the face, such as the peri-ocular (eye region) or peri-oral (mouth region) area, and this takes approximately 30-45 minutes to perform. Full-face erbium resurfacing takes between one to two hours to perform. It is important to keep the skin moist after laser treatment and the application of a topical emollient is normal practice. The downtime from Erbium laser peels is about one week. However, the skin begins to return to normality by day four or five with some residual redness of the skin, which often looks similar to a fresh sunburn.

Erbium YAG Laser for Laser Snoring Treatment

Erbium laser, when used in Fotona’s unique non-ablative Smooth mode, is able to effectively address mild, moderate and severe degrees of snoring with no anaesthesia or surgery required. Laser snoring treatment is a very straightforward procedure performed as an outpatient with minimal downtime. The impact on quality of life can be enormous, with many patients reporting the laser snoring treatment to have transformed relationships, and improved energy levels through improved quality of sleep.

Fotona SMOOTH® erbium laser treatment

Centre for Surgery is one of the few providers in London and the UK to specialise in non-surgical laser gynaecology treatments. Fotona SMOOTH^® erbium laser treatments offer gentle solutions to vaginal problems such as involuntary leakage during coughing and sports activities, loss of vaginal firmness and vaginal dryness and irritation. They are based on a specially engineered, patented laser mode using the award-winning SP Dynamis laser that works by delivering gentle heat pulses to the vagina, strengthening and improving the tissue quality through the production of new collagen and elastin.

Is erbium laser painful?

Erbium laser is a very well-tolerated procedure. Your doctor will first inject a local anaesthetic into and around the skin lesion for maximum comfort.

Any mild discomfort experienced after treatment can be easily treated with mild oral painkillers for the first 24 hours after treatment.

What are the potential risks and complications of erbium laser?

Erbium laser carries minimal risks when treatment is carried out by a highly trained dermatologist. Potential side-effects include residual pain, bruising and swelling, skin blistering and infection.

Your doctor may apply paraffin jelly to the area of laser treatment or may apply a sterile dressing if the area is at risk of being knocked or rubbed upon by clothing.

It is very important not to pick at any scabs that form as a protective layer over the area of treatment, as this may then lead to scarring.

Does erbium laser give permanent results?

Erbium laser can permanently treat skin lesions. By precise vaporisation of superficial skin lesions, they will then not re-occur.

This does not, however prevent the development of skin lesions on other parts of the skin.