Skin Resurfacing in Charleston and Mt. Pleasant, SC

Reviewed by Ashley Harwyn, PA-C, ABAAHP  |  A4M Board Certified  |  Updated October 4, 2026

Remove the surface or heat beneath it? Here is how ablative and non-ablative laser resurfacing differ in results, recovery, and safety for your skin tone.

The choice comes down to what you want to change, how many days you can step away from work, and your skin tone. If loose skin is your main concern, read our skin tightening page. If it is spots, redness, or small veins, start with skin rejuvenation. This page is about the surface: lines, rough texture, sun damage, and scarring.

• Ablative resurfacing removes the top layers of skin so new skin can grow in. Non-ablative resurfacing heats the deeper layer and leaves the surface whole.[3]
• Ablative treatment brings the biggest change per session but needs time off: healing takes 3 to 10 days depending on depth, and dermatologists describe about 5 to 7 days at home.[2][1]
• Non-ablative treatment has little or no downtime, but it often takes 3 to 5 sessions, and results build slowly over 2 to 6 months after the last one.[1]
• Fractional treatment, which works in tiny columns and spares the skin between them, sits in the middle for both results and recovery.[3]
• Lasers can be used on darker skin, but darker skin is more prone to burns and dark marks afterward, so the settings, the timing, and sometimes the treatment itself change.[4][6]
• Resurfacing can make wrinkles and scars less visible. It cannot erase a scar, and it cannot do what a facelift does.[5][1]

Two ways to resurface: removing the surface or heating beneath it

Every kind of laser resurfacing injures the skin in a controlled way so it repairs itself. What separates the two families is where that injury happens. An ablative laser vaporizes the outer layers. Erbium lasers were developed for this job because the first carbon dioxide (CO2) lasers caused a high rate of side effects, including scarring, and erbium removes skin in a more precisely controlled way.[3] The American Society for Dermatologic Surgery (ASDS) notes that erbium causes fewer side effects than CO2.[2]

A non-ablative laser takes the opposite route. It heats the dermis, the deeper layer where collagen lives, while the epidermis on top stays intact.[3] With no open skin to heal, recovery is easy. The cost is that each session does less, so you need more of them and wait longer to see a change.[1]

There is also a middle path. Fractional resurfacing treats the skin in a grid of tiny columns and leaves untouched skin between them, which helps it heal faster. A review in the Journal of the American Academy of Dermatology describes fractional work as more effective than non-ablative treatment and quicker to recover from than full ablative resurfacing.[3] The Fotona platform we use has an erbium mode for ablative and fractional work and an Nd:YAG mode for non-ablative heating, so one consult can cover all three options.

The same review makes a point that is easy to miss. Neither non-ablative nor fractional treatment matches the results of full ablative resurfacing. They became more popular anyway, because their risks are limited and the improvement is acceptable to many people.[3] That trade is fine, as long as you make it knowingly.

Results versus recovery: comparing the depths

The rule of thumb: the more skin a laser removes or heats, the more it can change, and the longer and riskier the recovery. Here is how the three approaches compare.

Treat the recovery column as a range: healing depends on treatment depth and the laser used.[2] After full ablative work, the ASDS describes soaking the area, applying ointment, and re-dressing it every day while it heals.[2] Non-ablative sessions usually mean some redness and swelling for a few days rather than raw skin, which makes them easier to fit around a normal work week.

If you have a wedding or a trip on the calendar, the results column matters as much as the recovery one: ablative results arrive within weeks of healing, while non-ablative results take months.[1]

Erbium is also not the strongest tool that exists. A 2026 pooled analysis compared fractional CO2 lasers with erbium-based fractional lasers for acne scars across five studies and 130 people. Erbium was linked to a lower chance of more than 50 percent improvement, though the gap was no longer statistically clear when only randomized trials were counted. CO2 brought more pain and about three and a half extra days of downtime, and rates of dark marks afterward did not differ significantly.[7] In plain terms, erbium trades some strength for an easier recovery.

What resurfacing can improve, and where it stops

Resurfacing is used for wrinkles, crow's feet, sun-damaged skin, age spots, acne scars, and other scars.[2] Erbium in particular is used for superficial and moderately deep lines on the face, neck, chest, and hands.[2] These are surface and texture problems, and that is where resurfacing earns its place.

Scars deserve a straight answer. A laser can make a scar less noticeable, but it cannot remove it, and the change can take months to show, with little visible at first.[5] For acne scars specifically, the comparison studies are small and measure success in different ways, so even the best evidence comes with wide error bars.[7] Sometimes another option, such as microneedling, is the better first step. Our acne and acne scars page covers that wider picture.

Loose skin is the other common question. The American Academy of Dermatology (AAD) calls laser resurfacing the most effective procedure for tightening loose skin, yet it is also clear that no nonsurgical option gives the results of a facelift, eyelid surgery, or neck lift.[1] People with a lot of sagging skin may not see much benefit.[1] If firmness is what you are after, our skin tightening page explains the heat-based approach in detail.

Some problems belong elsewhere. Stretch marks have their own plan on our scars and stretch marks page. Melasma and other stubborn pigment are covered under hyperpigmentation, because pigment that keeps returning needs more than a laser. For a brighter surface with almost no downtime, a lighter laser facial may be enough.

Skin tone, timing, and reasons to wait

Lasers can be used on every skin tone, but the AAD notes that darker skin is more prone to burns and dark marks afterward, and advises choosing a clinician experienced with darker skin.[4] The ASDS goes further for full resurfacing and says people with very dark skin usually are not good candidates.[2] Non-ablative fractional lasers have been reviewed specifically for darker skin. That review found them a favorable option for darker skin types, with the strongest evidence for acne, stretch marks, and rejuvenation, though high-quality studies in the darkest skin types are scarce.[6] For many patients with darker skin, that points toward fractional or non-ablative settings and a cautious start.

Timing matters in the Lowcountry, where strong sun is part of daily life. You cannot be treated over a tan or a sunburn, and treated skin needs protection from the sun until it heals.[5] After that, daily broad-spectrum, water-resistant sunscreen with SPF 30 or higher helps protect the result.[4] We ask patients to avoid direct sun for at least a week after resurfacing, so plan it for weeks without beach days or boating.

Active acne is a reason to hold off.[2] So are pregnancy, a skin infection, and certain medications.[1] Some medicines make skin more sensitive to laser light, so bring a full list of what you take, including supplements.[4] Before treatment, the AAD advises stopping retinoid or glycolic acid products for 2 to 4 weeks, quitting smoking for at least 2 weeks, and taking medicine to prevent cold sores if you get them.[5]

Not sure which depth fits your skin and your schedule? Call 843-981-0870. Ashley will weigh your skin tone, your goals, and your calendar, then lay out the ablative, fractional, and non-ablative options side by side, with the recovery each one asks of you.

Your resurfacing visit, from numbing to the first week

Every plan starts with a consult. Ashley Harwyn, PA-C, board certified in anti-aging and functional medicine (A4M, ABAAHP), looks at your skin, asks about past reactions, scarring, cold sores, and medications, then recommends a mode based on your goals and your calendar. Laser results depend largely on the skill of the person doing the treatment, so that planning matters.[4] Visits are available at our Mount Pleasant office on Bramson Court and at The Longevity Club on Rutledge Avenue in downtown Charleston.

On treatment day, we numb the skin with a topical cream or cool it with cold air, depending on the depth. Most sessions take 15 to 30 minutes. Expect redness and swelling for several days afterward. The most aggressive ablative treatments can mean up to about 5 to 7 days of downtime, which lines up with the AAD's guidance on full resurfacing.[1] You go home with written aftercare and ALASTIN recovery products for the healing skin.

Some people see a difference after one session. Dermatologists often schedule laser work as a series to get the most improvement, and we usually plan the same way.[5] Resurfacing can be combined with a chemical peel or with platelet-rich plasma (PRP), an add-on with limited evidence for facial aging that our laser facial page discusses. At your consult, you can also ask to see before-and-after photos of our resurfacing patients.