Indication
Skin rejuvenation
Skin rejuvenation targets the dermis, where collagen and elastin are lost over the years and the skin becomes thinner and less firm. Fractional lasers and RF microneedling deliver controlled heat or injury to the dermis, prompting the skin to produce new collagen. Ablative lasers such as the UltraClear and the eCO2 3D vaporise narrow columns of tissue through the epidermis, which gives the strongest effect, but also the most downtime. The non-ablative Mosaic 3D leaves the skin surface intact, and the Genius delivers radiofrequency energy into the dermis through microneedles; both work more gradually, with less downtime. If the concern is mainly pores, texture and tone, see skin quality improvement.
eCO2 3D
Sun damage across a whole area
Years of sun exposure mark the skin of the face, neck, décolletage and the backs of the hands across the entire surface, not just in individual lines. Thickened, disorganised elastic material accumulates in the dermis, a change known as solar elastosis, while the amount of functional collagen declines. The skin becomes thinner and less resilient, with a finely wrinkled, sometimes leathery surface. On the neck and décolletage, this often comes with redness and brown discolouration. On the hands, tendons and veins show through the thinner skin.
The redness and discolouration are often treated with IPL, for example with the ReClear IPL or the IPL SQ handpiece for the Etherea MX. Individual lines and folds are covered under wrinkles.
Rebuilding collagen
Each of the laser and RF treatments below sets off controlled wound healing in the dermis. Damaged collagen is broken down and replaced by new collagen and elastin. This remodelling continues for months after the last session, and the skin keeps improving over that time.
Of the ablative lasers, the CO₂ laser eCO2 3D acts most strongly on the tissue around each column, and tightens the skin in the process. According to Cynosure Lutronic, a deep treatment means more than a week of redness. The erbium fibre laser UltraClear works at 2910 nm, close to the absorption peak of water, and heats the surrounding tissue less; you set the coagulation separately. After a deep treatment, the skin recovers in about five days. For practices working with an Etherea MX, the DualMode handpiece (Er:YAG, 2940 nm) offers an ablative option in which a single pulse both vaporises and coagulates. According to Vydence, this approaches the results of CO₂ with a shorter recovery.
All of these lasers target water, not pigment. In darker skin, the risk of post-inflammatory hyperpigmentation (PIH) depends mainly on how much the epidermis is damaged and inflamed. The non-ablative Mosaic 3D leaves the epidermis intact, and in RF microneedling with the Genius, the energy is released only below the surface. Both therefore carry a lower risk of PIH than an ablative laser.
A single session or a series
An ablative laser achieves a great deal in one or a few sessions, at the cost of a longer period of redness and peeling. The Mosaic 3D and the Genius build results over more sessions, each with short downtime, and suit patients who would rather not clear their diary. Where laxity of the jawline or cheeks is the main concern, see skin tightening.
If you already offer ablative or non-ablative treatment, we would be glad to work out with you which device would add the other, and show it to you in a demo.
Technologies for this indication
Alexandrite (755 nm)
With picosecond pulses and a fractional lens. In a histological study, small zones formed in the epidermis and the author described new collagen and elastic tissue in the dermis [1].
CO₂ laser (10,600 nm)
Skin rejuvenation addresses advanced photoageing, in which wrinkles, lax skin, rough texture and pigment occur together. Fractional CO₂ treats the epidermis and the dermis in the same session. In one study, 56 Asian patients received a single treatment. In the 30 who were followed up for five years, the photoageing score at five years was still better than before treatment [2]. An international consensus of 21 dermatologists and plastic surgeons regards fractional CO₂ as a standard treatment for skin rejuvenation [3].
Erbium
Skin rejuvenation concerns changes deeper in the dermis, such as wrinkles and advanced photoageing. An ablative erbium laser works there with fractional channels that reach into the dermis. In a study with the 2910 nm erbium fibre laser, patients with advanced photoageing received three treatments of the face and neck. The 15 participants who completed the study improved moderately to markedly, according to the authors, with five to seven days of redness, swelling and crusting. There was no control group [4].
Monopolar RF
Within skin rejuvenation, monopolar RF covers the tightening component: a lax jawline, cheeks or skin around the eyes, without opening the skin [5][6]. Pigment is not a target of monopolar RF: in one of the two clinical studies of XERF, pigment did not change [7]. The technologies for pigmented lesions are covered under pigmentation.
Nd:YAG (1064 nm)
Nd:YAG is used for skin rejuvenation in two ways. Picosecond pulses at 1064 nm, often through a fractional handpiece, concentrate the energy into a grid of small points in the skin. A systematic review describes fractional picosecond Nd:YAG as a well-supported application for skin rejuvenation [8]. In addition, long pulses at 1064 nm heat the dermis non-ablatively.
RF microneedling
Skin rejuvenation is about laxity, wrinkles and texture, but also about pigment and redness. RF microneedling acts mainly on the dermal component. In a study with Genius on the lower face and neck, hyperpigmentation improved only in the group that also received a 1927 nm fractional thulium laser (LaseMD Ultra). Submental volume decreased comparably in both groups. The groups were not randomised: the group with RF microneedling alone came from an earlier study [9]. The technologies for pigmented lesions are covered under pigmentation.
Devices for this indication
XERF
Etherea MX
UltraClear
Clarity II
FlexSys Laser
Hollywood Spectra
Healite II
PicoSure Pro
ReClear IPL
ZYE – 1064 nm Nd:YAG laser platform
DermaV
Genius
LaseMD Ultra
Mosaic 3D
PicoPlus
eCO2 3D
Handpieces for this indication
DualMode
ProDeep
IPL SQ
handPICO
LongPulse
Which device suits your practice?
Schedule a consultation and we will help you make the right choice.
References
- Tanghetti EA. The histology of skin treated with a picosecond alexandrite laser and a fractional lens array. Lasers Surg Med. 2016;48(7):646–652. doi:10.1002/lsm.22540
- Tan J, Lei Y, Ouyang HW, Gold MH. The use of the fractional CO2 laser resurfacing in the treatment of photoaging in Asians: Five years long‐term results. Lasers Surg Med. 2014;46(10):750–756. doi:10.1002/lsm.22304
- Levy T, Lerman I, Waibel J, Gauglitz GG, Clementoni MT, et al. Expert Consensus on Clinical Recommendations for Fractional Ablative CO2 Laser, in Facial Skin Rejuvenation Treatment. Lasers Surg Med. 2025;57(1):15–26. doi:10.1002/lsm.23850Consensus of 21 experts via questionnaires; according to the authors, focused on one specific device.
- Murray TN, Hu JK, Friedman PM. Full-face and neck resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser for advanced photoaging. Lasers Surg Med. 2024;56(3):249–256. doi:10.1002/lsm.23764
- Fitzpatrick R, Geronemus R, Goldberg D, Kaminer M, Kilmer S, Ruiz-Esparza J. Multicenter study of noninvasive radiofrequency for periorbital tissue tightening. Lasers Surg Med. 2003;33(4):232–242. doi:10.1002/lsm.10225
- Kushikata N, Negishi K, Tezuka Y, Takeuchi K, Wakamatsu S. Non-ablative skin tightening with radiofrequency in Asian skin. Lasers Surg Med. 2005;36(2):92–97. doi:10.1002/lsm.20136
- 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.
- Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med. 2021;53(1):9–49. doi:10.1002/lsm.23244
- Nguyen L, Blessmann M, Schneider SW, Herberger K. Radiofrequency microneedling with 1927 nm thulium laser versus radiofrequency microneedling monotherapy for rejuvenation of photoaged skin. J Cosmet Dermatol. 2026;25(1):e70685. doi:10.1111/jocd.70685With Genius and LaseMD Ultra, provided by Cynosure Lutronic; not randomised.
Looking for a treatment yourself?
We supply equipment to clinics and practices. Ask a practice near you which devices they use.