Indication
Skin quality improvement
Enlarged pores, rough texture, fine lines and uneven skin tone sit mainly in the upper layers of the skin, and superficial fractional treatment resurfaces those layers with little downtime. Non-ablative options are the LaseMD Ultra and the Mosaic 3D; the UltraClear and the eCO2 3D at a shallow depth resurface ablatively. For firmness and deeper wrinkles, see skin rejuvenation.
LaseMD Ultra
What changes at the surface
With age, the epidermis renews itself more slowly. Dead cells linger on the surface, the skin feels rougher and reflects light less evenly. UV exposure drives the melanocytes to produce mottled pigment and damages the collagen in the upper dermis, which also supports the pore walls. In oily skin, sebum production keeps the pores enlarged as well. Sun and time keep acting on the skin, so even after successful treatment these changes gradually return.
Sharply defined pigmented lesions and visible vessels need light that specifically targets pigment or blood. These are covered under pigmentation and vascular lesions.
Treating superficially: non-ablative or ablative
How deep a fractional laser works depends on the wavelength, the energy and the handpiece. The LaseMD Ultra, a thulium laser (1927 nm), treats superficially, down to the upper dermis, which also makes it suitable for dull skin with fine, superficial pigmentation. According to Cynosure Lutronic, the skin absorbs the active ingredients of a topical product more readily straight after treatment.
In its standard mode, the Mosaic 3D (Er:glass, 1550 nm) reaches deeper. Its Thermal Mode uses a higher density and less energy, so more of the heat stays near the surface. The manufacturer lists enlarged pores and fine lines among the indications for this mode.
Ablative treatment can be superficial too. Alongside Laser-Coring™ for deep resurfacing, the erbium fibre laser UltraClear (2910 nm) has the lighter 3DMIRACL™ mode, and the CO₂ laser eCO2 3D can be set anywhere from subtle skin renewal to intensive resurfacing. Even at light settings, these treatments involve more downtime than a non-ablative one. Darker skin can respond to any treatment with post-inflammatory hyperpigmentation (PIH); the risk is lower with a light, non-ablative treatment.
Building results and keeping them
Downtime per session is short, and results build over a series of treatments. Sun protection between sessions, and maintenance treatments later on, help the results last.
If scarring or laxity lies beneath a rough texture, a superficial treatment does not reach deep enough. RF microneedling with the Genius works in the dermis and is covered under acne scars. The XERF tightens the skin with monopolar RF, without needles; see skin tightening.
If many of your patients want fresher-looking skin without spending days at home, we would be glad to show you the LaseMD Ultra or the Mosaic 3D in a demo.
Technologies for this indication
CO₂ laser (10,600 nm)
Skin quality improvement addresses texture, pores, fine lines and uneven skin tone, with as little downtime as possible. Fractional CO₂ can also be used superficially, so that mainly the epidermis and upper dermis are treated. For such a superficial treatment with the eCO2 3D, Cynosure Lutronic cites redness lasting 6 to 48 hours. After three sessions of fractional CO₂, pigment on the cheeks and around the eyes was more evenly distributed, a prospective study measured [1]. In dark skin, post-inflammatory hyperpigmentation (PIH) remains a risk, including after fractional CO₂ [2].
Erbium
Skin quality improvement concerns fine lines, a dull or rough texture and superficial pigment. A superficial, fractional ablative erbium treatment mainly renews the epidermis, with little downtime [3][4]. In a randomised comparison in Asian patients, pigment, uneven skin tone and redness improved more with fractional Er:YAG, and wrinkles and overall appearance more with non-ablative 1550 nm Er:glass [5].
Monopolar RF
RF microneedling
Rough texture and enlarged pores are partly linked to the dermis beneath. RF microneedling renews the collagen there without damaging the entire epidermis. In a study of 30 patients with acne scars and enlarged pores, the pores and scars improved in more than 70% of patients. Skin surface roughness and dermal density also improved [7].
Devices for this indication
XERF
UltraClear
Elite iQ
Genius
LaseMD Ultra
Mosaic 3D
eCO2 3D
Which device suits your practice?
Schedule a consultation and we will help you make the right choice.
References
- Kohl E, Meierhöfer J, Koller M, Zeman F, Klein A, Hohenleutner U, Landthaler M, Hohenleutner S. Fractional carbon dioxide laser resurfacing of rhytides and photoageing: a prospective study using profilometric analysis. Br J Dermatol. 2014;170(4):858–865. doi:10.1111/bjd.12807
- Chan NP, Ho SG, Yeung CK, Shek SY, Chan HH. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med. 2010;42(9):775–783. doi:10.1002/lsm.20974Nine patients, one treatment.
- Bernstein EF, Sanzo JF, Wang JY, Cotsarelis SM, DiLeonardo M. Low-fluence treatment with a novel fractionated 2,910-nm fiber laser improves photodamage. Lasers Surg Med. 2023;55(1):35–45. doi:10.1002/lsm.23624
- Selim MM, Lowery JA, Maredia HS, Zelickson BD. Clinical evaluation of a new fractional ablative 2910 nm erbium laser on photodamaged skin: a pilot study. Lasers Surg Med. 2023;55(8):715–723. doi:10.1002/lsm.23714
- Moon HR, Yun WJ, Lee YJ, Lee MW, Chang S. A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin. J Dermatolog Treat. 2015;26(6):551–557. doi:10.3109/09546634.2014.999020
- Erlich G, Dahan E, Wolf Y. Objective and subjective retrospective evaluation of XERF, a novel single-shot dual-frequency non-invasive monopolar radiofrequency. Lasers Med Sci. 2026;41(1):194. doi:10.1007/s10103-026-04996-0The lead author is a trainer for Cynosure Lutronic; the manufacturer performed the statistical analysis.
- Cho SI, Chung BY, Choi MG, Baek JH, Cho HJ, Park CW, Lee CH, Kim HO. Evaluation of the clinical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores. Dermatol Surg. 2012;38(7 Pt 1):1017–1024. doi:10.1111/j.1524-4725.2012.02402.xNo control group.
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