Which Laser Is Best for My Skin? What a Dermatologist With 35 Lasers Wants You to Know
New lasers and energy devices seem to launch every month, and most of them find you on social media before you ever see a dermatologist. So how do you know which one is right for you?
On this week's Facially Conscious episode, Which Laser Is Best for My Skin?, board-certified dermatologist Dr. Vicki Rapaport, esthetician Trina Reneá, and consumer advocate Julie Falls welcomed back Dr. James Wang, a Harvard- and UCLA-trained, double board-certified dermatologist who also holds an MBA in healthcare policy. He has more than 35 lasers across the five California locations of his practice, Metropolis Dermatology, and does his own laser treatments every day. You can read more about Dr. Wang on our website.
The laser business, and why it's marketing to you
Dr. Vicki opened with the business side. A handful of large U.S. companies lead the laser market, with many more worldwide, and the competition is fierce. That's why so much of the marketing goes straight to patients: if enough people walk in asking for a device by name, practices feel pressure to buy it. Dr. Wang put it plainly later in the episode: a doctor's job is to offer things they can stand behind, not a marketing ploy.
How a laser-heavy practice chooses its devices
Dr. Wang stays current by talking to dermatologists across the country, to the companies and to users abroad, so he can tell which devices are truly innovative and which are copycats or existing solely on marketing. He demos devices before he buys them, waits for data on new technology, and gets rid of lasers he no longer uses, because a device he hasn't used in a year is one he won't be good at.
Dr. Vicki asked whether the rest of the world is ahead of the U.S. because of stricter FDA rules. Dr. Wang said somewhat, and that's not necessarily bad. Regulation means devices are tested, complications are reported, and someone is accountable.
It's not the laser. It's who's doing your laser.
This was the theme of the episode. "It's not what laser you have," Dr. Wang said. "It's who's doing your laser." The best results come from a provider who understands your skin, the technology and how to combine treatments, not from the brand on the machine.
Part of that is presets. Manufacturers set conservative starting points so devices don't hurt anyone. Trina has seen it at trainings with Dr. Wang: the company teaches very low settings, then leaves it to the doctor to learn how to safely push further. Dr. Wang agreed, and said the providers worth seeing are the curious ones who adjust thoughtfully, with your consent, after explaining the pros and cons.
He also said experience alone isn't enough. "You can do the wrong thing for 20 years," he said. A newer provider who keeps asking how to do better may be the best choice of all.
The biggest red flag
Julie asked whether the bargain laser place at the mall is a mistake. Dr. Wang didn't want to paint with a broad brush. He's seen great providers at budget clinics and poor ones charging $5,000 a session. His red flag is different. It's the provider who tells you nothing could ever go wrong. Complications can happen to anyone, he said, and a good provider counsels you about them before they happen.
Can energy devices cause facial fat loss?
Julie raised the reports of facial fat loss linked to some energy devices. Dr. Wang said overheating facial fat is something everyone wants to avoid, since facial fat is what keeps the face from looking gaunt. Fat loss happens over months to years, so new devices need time and reported data before anyone knows their long-term safety. He has never had a case in his own practice, which he credits to knowing the right depths, the energy and where the fat pads sit. He also noted that some devices display depths that aren't fully accurate, so the provider's knowledge matters.
The new skin-tightening devices
Julie brought the two devices she's asked about constantly: Sofwave and XERF. Dr. Wang said skin tightening has improved enormously. It's more effective, less painful and less expensive than it was.
Sofwave: he had one in his practice for a while and saw a lot of results. It can be painful, and he believes patient comfort is becoming more important, because people need maintenance.
XERF: a newer radiofrequency device from Korea, made by Cynosure Lutronic. He enjoyed using it and said patients can see results, but because it's so new, he wants more data on how results hold up over months and how deep the energy goes. He was clear that he isn't saying it causes fat loss. For his own patients, he currently prefers a combination approach that keeps energy away from the fat layer.
His most important point: skin tightening is a lifelong effort. "Gravity doesn't ever stop," he said. Two sessions aren't the end; maintenance is.
Why one device rarely does it all
When a patient asks for a "snatched" jawline, Dr. Wang starts with questions, not a package. His approach usually combines several tools, like a biostimulator, filler in anchoring areas, and radiofrequency, so the result doesn't rely on any one device.
Dr. Vicki shared how she explains this to patients: a flip book from Galderma that shows, page by page, how collagen, fat pads and bone change at 40, 50 and 60. When patients understand why their face has changed, they understand why one laser may not be enough.
Trina wanted that book for her own treatment room, and explained why. As an esthetician, she's the first point of contact for her clients. She sees them monthly and can counsel them on all their laser questions as well as prep and treat their skin before and after different procedures. She can also steer her patients to the correct provider for their needs.
Lasers and skin of color
About 70% of Dr. Wang's patients have skin of color. "Any laser can be really safe, and any laser can certainly be very dangerous," he said. Knowing which Fitzpatrick skin type helps, but it doesn't always predict who will darken after treatment, so a real skin evaluation and experience matter. He uses many devices developed and tested in Asia on skin of color.
He also pushed back on the idea that pico lasers are automatically safe for every skin type. Because people are told they're safe, some providers treat them as risk-free, and he's seen pigment problems as a result. He described a patient who darkened after a laser, then was given more of the same, and darkened more. The fix isn't repeating the same treatment. It's having the right tools and the judgment to choose between them.
What happens to old lasers?
Trina asked what practices do with a $200,000 laser when something newer arrives. (She also asked about the black market. She was joking.) Dr. Wang sells his to reputable resellers who refurbish them. Some offices keep what he called "laser graveyards." He doesn't, because he'd rather be excellent with the devices he actually uses.
The plan is the point
Dr. Wang says he spends half his consults asking questions. People arrive full of information, and need help making decisions. Often, he goes home at the end of the day, thinks about a patient, and sends them a written plan. The patient then has a clear treatment plan from which to make decisions.
Trina said that's what turns someone into a long-term, trusting patient. When people expect one laser to fix everything and it doesn't, they leave the practice. A realistic plan, with a timeline and a budget, keeps them coming back.
Keep going
Listen to the full episode, Which Laser Is Best for My Skin?
Join the Facially Conscious Substack for extended content and deeper dives
Read Trina's personal take on the episode, as the esthetician in the room, on her Substack
Links
The Skin Master
Co-host | When Trina Renea became an esthetician she realized the key to success was lifelong learning - a goal that sets her apart from most skin care practitioners.
For over 30 years, she’s explored the fields of cosmetic chemistry, medical esthetics, dermatology, and plastic surgery, becoming an expert in a wide expanse of professional skin care brands, equipment, and treatments. She is a member of the Society of Cosmetic Chemists with three certifications in cosmetic sciences from UCLA and continues to attend spa, medical, esthetic, and scientific conferences worldwide.
Now considered a skin master due to her broad expertise, Trina is a consultant to the Southern California beauty industry and medical esthetic community, selecting and training staff, developing treatments, guiding product selection, and helping professionals best serve their clients.
In 2004, she founded the Facial Bungalow, a clinical spa offering advanced skin care technologies where she continues to work one-on-one with clients to this day. In 2008 she created Trina Renea Skincare.
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