For some, the most telltale (and unsettling) sign of aging is the crepe-paper quality that their skin begins to develop in later years. Over the years, I’ve had many patients ask me whether Fraxel restore—a non-ablative laser treatment—would be effective in tightening the skin and eliminating the creping (especially on the face). While Fraxel lasers can have some positive effect upon skin creping, the improvements are only mild to moderate. To truly see results from laser treatments, you would need to undergo treatment by an ablative laser, such as the CO2 laser.

The basic difference between ablative (CO2 laser) and non-ablative (Fraxel laser) treatments is that ablative lasers remove the top layer of skin, while non-ablative lasers work by heating up your skin tissue so your body can lay down collagen. With Fraxel lasers, you have to undergo multiple treatments, spaced 2 to 3 weeks apart—and since it’s a milder, slower process, you won’t see results for several months.

Ablative laser treatments are certainly more invasive; they create a raw surface that takes time to heal, and the downtime is 3 to 4 weeks. However, there’s a reason that ablative CO2 laser resurfacing is considered the gold standard laser treatment: only one treatment is necessary (vs. the multiple treatments non-ablative lasers require), and it will be much more effective in eliminating the creping that’s bothering you. Another plus on the side of ablative lasers is cost—since you only have to do it once, an ablative treatment will generally be less expensive than non-ablative treatments.

Both ablative and non-ablative laser treatments have their advantages—and ultimately, it’s something that you should discuss with your plastic surgeon and then make your own decision about. If you want to truly get rid of that crepe-paper skin, though, ablative lasers are probably what you’re looking for!