Er:YAG Lasers

Er:YAG Fractional Resurfacing on Cheek

Er:YAG and CO2 Lasers are the systems of choice for ablative laser skin resurfacing. Er:YAG Lasers are commonly used to repair skin damage, including acne scars and melasma (excess pigmentation). Er:YAG lasers are also routinely used to cut bone and tissue. They are used in laser dentistry and other surgical applications.

How do Er:YAG Lasers Work?

Resolution of Erythema After ErYAG Laser Resurfacing (Ko)
Resolution of Erythema After ErYAG Laser Resurfacing (Ko)

 Er:YAG Lasers utilize Erbium-doped Yttrium Aluminium Garnet as the lasing medium. Er:YAG Lasers generate a laser beam with a very long wavelength (~2940 nm). This wavelength is in the infra-red spectrum and is strongly absorbed by water. The longer wavelength of the Er:YAG laser beam helps it to penetrate deeply into the skin tissue.

ErYAG Ablative Skin Resurfacing
ErYAG Ablative Skin Resurfacing

Er:YAG Lasers work by ablating (vaporizing) the surface layer of the skin. Each pass with the Er:YAG laser removes approximately 10 micrometers of skin tissue (1/100th of a millimeter). This type of technology is the basis for the procedure known as a “laser peel”. Some systems are can be tuned to produce laser peels of varying depth.

ErYAG Laser Resurfacing at a Cellular Level (Jeong)
ErYAG Laser Resurfacing at a Cellular Level (Jeong)

Er:YAG Lasers primarily target the surface of the skin, and are not as effective as CO2 lasers at remodeling the collagen matrix underneath the skin. As a result, Er:YAG lasers are excellent options for repairing minor to moderate scarring and other superficial skin damage, but are less effective for severe scarring, especially pitted acne scars. Because Er:YAG lasers primarily affect the surface of the skin, the recovery times are faster and the side effects are generally milder than more invasive laser resurfacing techniques, such as CO2 Laser resurfacing.

Er:YAG Lasers, Active Acne and Acne Scars

ErYAG Laser Resurfacing (Jeong)
ErYAG Laser Resurfacing (Jeong)

Er:YAG Lasers are primarily used as a treatment for acne scars. They are rarely used for the treatment of active acne. Er:YAG Lasers have a good efficacy profile against mild to moderate acne scarring. Er:YAG Lasers are generally considered to be more effective for the treatment of acne scars purposes than many other light and laser treatment modalities, including as Nd:YAG, Pulsed Dye Lasers (PDL) and Intense Pulsed Light (IPL).

ErYAG Improvement of Acne Scarring for Different Regions of the Face (Tay)
ErYAG Improvement of Acne Scarring for Different Regions of the Face (Tay)

The (relatively) mild side effects of Er:YAG Lasers, combined with decent efficacy and generally positive patient response has made Er:YAG lasers a popular treatment option for superficial acne scars. The biggest limitation of Er:YAg lasers is their inability to effectively treat the extensive and deep scarring that is common in those who have suffered from severe inflammatory and cystic acne. For the treatment of moderate to severe acne scars, C02 Lasers generally provide better improvement. However, CO2 Lasers tend to generate more severe side effects and the recovery period can be significantly longer.

How and Where is Er:YAG Laser Treatment Administered?

Fractional Photothermolysis Cellular Image and Diagram (Geronemus)
Fractional Photothermolysis Cellular Image and Diagram (Geronemus)

Er:YAG treatment is administered in cosmetic surgery clinics, dermatology offices and hospitals. Er:YAG Laser treatment can be done as a complete or fractional ablation technique. Complete ablation treats all of the skin in a given region, but fractional treatment leaves small areas of untreated skin in between (like a checkerboard). Recovery times from fractional treatment tend to be substantially shorter than from complete ablation treatments.

The cost of Er:YAG treatment varies greatly depending on the area being treated, the number of passes (how many times they go over a particular area during a single treatment), the number of treatment sessions, and the general costs of laser surgery in your market. Generally speaking, the cost ranges from $200 to $700 dollars per treatment session for treatment of facial acne scars. In many cases, multiple treatments are necessary to achieve significant results. A complete Er:YAG treatment plan for facial acne scars often costs in excess of $2000.

Common Er:YAG Laser Systems

Alma Pixel, Contour TRL, Fotona, FRAXEL RE:STORE (fractional Er:YAG laser system), Sciton Profractional, Venus.

Er:YAG Laser Images

References

Resurfacing of Pitted Acne Facial Scars with a Long Pulsed Er:YAG Laser. Jeong, et al. 2001.
Resurfacing of Pitted Facial Acne Scars Using Er:YAG Laser with Ablation and Coagulation Mode. Jeong, et al. 2003.
Treatment of Atrophic Acne Scars with a Dual Mode Er:YAG Laser. Tanzi, et al. 2002.
Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study. Tay, et al. 2008.
Cutaneous Laser Resurfacing, Erbium-YAG @ Emedicine
Er:YAG laser @ Wikipedia

Er:YAG Fractional Resurfacing on Cheek