What the research shows
Two kinds of erbium laser. The 2940 nm Er:YAG is ablative: it vaporizes the surface, either across the whole area or in a grid of tiny columns (fractional). Erbium glass lasers at 1540 to 1550 nm are nonablative and leave the surface intact (Modena 2020). An early report used Er:YAG on shallow wrinkles around the mouth, eyes and forehead, with redness gone within two weeks (Teikemeier 1997).
Erbium against CO2. In side-by-side faces, CO2 smoothed wrinkles more, while the Er:YAG side healed faster, stayed red for less time and rarely lost pigment, which happened on many CO2 sides (Khatri 1999). Comparative studies taken together agree: CO2 is more effective for wrinkles and Er:YAG has fewer complications (Chen 2017). On upper lip lines, erbium crusted for about 3 days instead of about 8, with a smaller improvement (Newman 2000). When both lasers were set to injure the skin to the same depth, healing and results matched (Ross 2001, Tanzi 2003a). Depth, more than the type of laser, sets both the result and the recovery.
Recovery after full Er:YAG resurfacing. New skin covered the face in about five days and redness lasted a few weeks. About two in five patients developed temporary dark patches lasting two to three months on average; none lost pigment or scarred (Tanzi 2003b).
Fractional and nonablative treatment. One fractional session around the eyes gave a real but limited improvement with either laser, and several sessions may be needed, which cancels much of the shorter downtime (Karsai 2010). Three nonablative 1550 nm sessions improved sun damage by half or more on about three in four faces at nine months, with only short-lived redness and swelling (Wanner 2007). Three erbium glass sessions equaled one fractional Er:YAG session (Borges 2014), and pooled randomized trials found ablative lasers no better or safer than nonablative ones for skin rejuvenation (Seirafianpour 2022).
Darker skin. Darker skin types had more pain and more dark patches after treatment (Mahmoud 2010), and every patient treated for stubborn melasma darkened for a time before improving (Manaloto 1999). A gentle nonablative Er:YAG protocol treated wrinkles around the eyes in Asian patients without any dark patches (Wu 2026).
Where surgeons disagree
- CO2 against erbium. Pooled comparisons say CO2 does more for wrinkles (Chen 2017); matched-depth trials say the two lasers do the same work when used the same way (Ross 2001).
- Ablative against nonablative. Nonablative treatment needs more sessions but matched ablative results in trials (Borges 2014, Seirafianpour 2022); the trials are small, and the authors of the pooled analysis asked for larger ones before the question is settled.
- Laser or needling for acne scars. Fractional Er:YAG clearly beat microneedling in a split-face trial (Osman 2017), while most comparisons in a review found no difference (Nobari 2023).
What is new
- A 2910 nm erbium fiber laser treats the full face and neck; after three sessions, blinded doctors picked the after photo almost every time, crusting lasted five to seven days and no one scarred (Murray 2024).
- Erbium settings for darker skin now have trial data showing wrinkle reduction without dark patches (Wu 2026).
- A woman with an undiagnosed hole between the upper chambers of the heart had a stroke after straining in pain during full Er:YAG resurfacing; the authors advise good pain control to prevent straining (Levy 2026).
What is still unknown
- How long results last and whether late side effects appear. Erbium looks good in the short term, but long-term data are limited (Modena 2020).
- The right number of fractional sessions for a full result (Karsai 2010).
Key papers
- Teikemeier 1997: early report of Er:YAG for wrinkles, with quick healing.
- Khatri 1999: CO2 smoothed more; erbium healed faster with less pigment loss.
- Ross 2001: matched depth gave matched results.
- Tanzi 2003b: the recovery a patient can expect after Er:YAG resurfacing.
- Wanner 2007: nonablative 1550 nm treatment improved sun damage with little downtime.
- Karsai 2010: one fractional session has a limited effect.
- Chen 2017: pooled comparison of CO2 and Er:YAG.
- Murray 2024: a new erbium fiber laser for face and neck.