Laser treatments are more popular and effective than ever, so knowing what to expect is critical to meeting your expectations. Different lasers can be used for facial rejuvenation, as well as for scar treatment and resurfacing. Cosmetic lasers have an array of indications and different mechanisms of action.
So, how painful are laser treatments? The answer is dependent on which laser treatment you are considering! Most lasers come with some discomfort, but several more aggressive technologies are painful enough that a local anesthetic should and likely will be used. We control pain levels during therapy, mainly through cooling with air or ice, topical numbing medications, local anesthetics, or injectable numbing agents.
So, which lasers are most painful? And what, if anything, can be done to prepare?
Let’s jump right into some different lasers and the levels of pain associated with their use.
Pulsed Dye lasers are used to treat a wide range of vascular issues. The indications for Pulsed Dye laser range from telangiectasis to hemangioma, as well as hypertrophic scars and keloids. Pulsed Dye laser treatment is not very painful. It is described more as startling or uncomfortable than actual pain. An ice pack for cooling the skin before and after the treatment is usually sufficient for making the procedure more comfortable.
Nd YAG lasers are used for pigmentation, tone, wrinkles and fine lines, firming, rosacea, and vascular defects. It is considered a mildly painful treatment and has been compared to a rubber band snapping against the skin. Topical numbing medication like lidocaine may be a good idea.
Erbium lasers can resurface and treat shallow scars, sun damage, wrinkles, and skin cancers. Erbium lasers are not considered very painful, although the energy they transmit is heat, so warming sensations or even a burning feeling is possible. This can be controlled within the device’s settings and with cooling mechanisms. It is important to have this type of treatment from a physician who is well-trained in using the device.
Fraxel lasers are like Erbium, although they can penetrate the skin more deeply. The sensation is discomfort; some have called it hot and prickly but not painful. A cooling agent is used, and topical numbing cream can help if you are sensitive.
CO2 lasers are used for more aggressive interventions. They are ablative, and their mechanism involves destruction of the upper layers of the skin. When the skin regrows, it is free from unwanted scars and lesions. CO2 lasers are often used for cosmetic purposes, including scars and skin tightening, and for destroying moles, warts, seborrheic keratosis, actinic keratosis, and even some skin cancers. The CO2 laser is considered one of the more painful and aggressive options. CO2 typically requires injectable numbing medication to make the procedure more tolerable, though many providers have had success with a strong topical anesthetic. Due to the aggressive nature of CO2, additional medicines, such as an oral sedative, are sometimes used to help relax you.
With new lasers coming to market every year, it is hard to keep track of which offers the best results. For pain control, regardless of the mechanism of the laser, the approaches are similar. For less aggressive, i.e., non-ablative lasers, topical numbing, and cooling is usually sufficient. For more aggressive lasers like ablative lasers, sometimes topical medication is all you will need, but an injectable medication might also be an option for more painful treatments. If a local injectable anesthetic is used, the skin will be completely numb, meaning that deeper and more extreme treatments can be administered for more dramatic results.
Pain control is an essential aspect of any skin procedure, and there are so many new lasers for skin care that each has distinctive mechanisms causing varying pain levels. Since there is no clear answer to – “How painful is a laser?” you may have to take “It depends” as a final answer! Feel free to talk about pain with Dr. Boger during the initial consultation, especially if you are particularly sensitive. This is also an excellent opportunity to address any anxieties about the procedures or results.