Efficacy and safety of fractional CO2 laser versus fractional Er:YAG laser in the treatment of facial skin wrinkles

Lasers Med Sci. 2017 Feb;32(2):283-289. doi: 10.1007/s10103-016-2111-8. Epub 2016 Nov 24.


Ablative fractional lasers were introduced for treating facial rhytides. Few studies have compared fractional CO2 and Er:YAG lasers on cutaneous photodamages by a split trial. The aim of the present study was to compare these modalities in a randomized controlled double-blind split-face design with multiple sessions and larger sample size compared to previous studies done before. Forty patients with facial wrinkles were enrolled. Patients were randomly assigned to receive three monthly treatments on each side of the face, one with a fractional CO2 and one with a fractional Er:YAG laser. The evaluations included investigating clinical outcome determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of cheeks using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, possible side effects and patients' satisfaction have been recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. Clinical assessment showed both modalities significantly reduce facial wrinkles (p value < 0.05), with no appreciable difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to the baseline in both laser groups. There was no serious long-standing adverse effect after both laser treatments, but the discomfort was more pronounced by the participants after CO2 laser treatment. According to the present study, both fractional CO2 and fractional Er:YAG lasers show considerable clinical improvement of facial skin wrinkles with no serious adverse effects, but post-treatment discomfort seems to be lower with Er:YAG laser.

Keywords: CO2 laser; Erbium:YAG laser; Fractional laser; Laser resurfacing; Skin aging; Skin wrinkles.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Biomechanical Phenomena
  • Cheek
  • Double-Blind Method
  • Face / radiation effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Lasers, Gas / adverse effects*
  • Lasers, Gas / therapeutic use*
  • Lasers, Solid-State / adverse effects*
  • Lasers, Solid-State / therapeutic use*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Safety
  • Skin Aging / radiation effects*
  • Treatment Outcome