When a patient asks me for «the laser», the first thing I do is ask her which one. That word covers instruments that act at different depths, on different tissues, with different recovery times and risks. Understanding the difference helps you choose, and keeps you from being swayed by a fashionable word.
The common principle: fractional treatment
Almost all lasers used today for skin rejuvenation are fractional. The beam does not treat the whole surface, but divides it into many microscopic columns of heat, separated by healthy tissue. It is precisely that intact surrounding tissue that heals the micro-injuries quickly: an idea first described in 2004 and since then the basis of almost all aesthetic laser technologies.
The heat stimulates fibroblasts, the cells that produce collagen and elastin. The result builds up slowly, over the following weeks and months.
Ablative and non-ablative: the difference
In one sentence: an ablative fractional laser vaporises micro-columns of tissue, opening tiny channels in the skin or mucosa, while a non-ablative fractional laser heats the dermis deep down, leaving the surface intact.
| Ablative | Non-ablative | |
|---|---|---|
| What it does | Vaporises micro-columns of tissue, opening tiny channels in the surface | Heats micro-columns in the dermis, leaving the surface intact |
| Examples | CO2 laser, erbium laser | Lasers with wavelengths absorbed by tissue water, for example between 1,400 and 1,550 nm |
| Recovery | A few days of redness and small scabs | Usually redness and swelling for a few hours or days |
| Sessions | Fewer sessions, each more intense | More sessions, each lighter |
| In the intimate area | Vaginal CO2 laser is the most studied, for dryness and fragility of the mucosa (genitourinary syndrome of menopause) | Almost no studies on the external genitalia |
The laser I use for the vaginal mucosa is a fractional CO2 laser, so it is ablative: I discuss it on the vaginal CO2 laser page. Radiofrequency microneedling is yet another technology, delivering heat into the dermis through very fine needles: I describe it on its dedicated page.
What the studies say
On the face and body, fractional lasers have been studied for twenty years. In short, ablative lasers achieve more per session but need a few days of recovery; non-ablative lasers are lighter, but more sessions are needed for a comparable result.
In the intimate area the picture is even less certain. In 2018 the FDA, the US agency that authorises medicines and medical devices, stated that the safety and effectiveness of laser and radiofrequency devices for «vaginal rejuvenation» have not been established. On the skin of the external genitalia, studies with non-ablative lasers are practically non-existent.
What I am evaluating in my practice
For a few months I have been evaluating a 1,470 nm non-ablative fractional laser on the skin of the labia majora and mons pubis. It is a wavelength absorbed mainly by tissue water, which heats the dermis without opening the surface.
I want to be clear on three points:
- It is an off-label use. The device is certified for face and body treatments, not for the genital area. Every patient knows this and accepts it in writing.
- There are no published studies yet on this application, and the patients I have treated so far are few, with follow-up of only a few months.
- I am collecting the data systematically, with standardised photographs, a record for each session and check-ups at 3 and 6 months, so that I can assess them rigorously and, if the results deserve it, share them with the scientific community.
Until I have solid data I do not consider it an established treatment, and I cannot tell you what results to expect. When the data are there, I will report them here in the same spirit: numbers, limits and risks, without promises.
How to find your way today
- Dryness, burning, fragile vaginal mucosa: vaginal CO2 laser or biorevitalisation with hyaluronic acid.
- Lax or marked external skin (labia majora, mons pubis, groin): radiofrequency microneedling.
- Deflated labia majora: filler or fat grafting, because the problem is volume, not skin.
- Excess skin or tissue: surgery, for example monsplasty or labiaplasty.
Often the answer is a combination. And that is why the consultation comes before any laser.
Frequently asked questions
Is a non-ablative laser safer than an ablative one?
Not necessarily. It does not open the skin and recovery is shorter, but a review of 34 studies with over a thousand patients (Mirza, 2021) found side effects in 12.2% of patients treated with non-ablative lasers and in 8.3% of those treated with ablative lasers. Less invasive does not mean risk-free.
Is vaginal CO2 laser an ablative laser?
Yes. Fractional CO2 laser creates micro-columns of vaporisation in the vaginal mucosa and is used mainly for dryness and fragility after menopause. It is a different treatment from those on the skin of the external genitalia.
How many sessions does a non-ablative laser need?
Generally more than with an ablative laser, because each session is lighter. On the face, several sessions are usually done a few weeks apart; for the intimate area there are no validated protocols yet.
Do you perform non-ablative laser on the external genitalia?
I am evaluating it in a small number of patients, as an off-label use and with systematic data collection. I do not yet consider it an established treatment: at the consultation I also explain the alternatives that have more studies behind them.
Scientific bibliography
-
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR – Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury
Source: Lasers in Surgery and Medicine, 2004 – Wiley
What it covers: It describes for the first time the idea of treating the skin with many microscopic zones of heat, separated by intact tissue that speeds up healing.
Why it matters: It is the study from which all fractional lasers, ablative and non-ablative, originate.
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Alexiades-Armenakas MR, Dover JS, Arndt KA – The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing
Source: Journal of the American Academy of Dermatology, 2008 – JAAD
What it covers: A review of laser technologies for skin rejuvenation, from non-ablative to ablative, with the advantages, limits and recovery times of each.
Why it matters: It explains well the trade-off between effectiveness per session and recovery time.
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Mirza HN, Mirza FN, Khatri KA – Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: a systematic review of 1093 patients
Source: Dermatologic Therapy, 2021 – Wiley
What it covers: A review of 34 studies with 1,093 patients: side effects in 9.7% of cases, 12.2% with non-ablative lasers and 8.3% with ablative ones; hypertrophic scars very rare.
Why it matters: It shows that a less invasive laser is not automatically free of side effects.
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U.S. Food and Drug Administration – FDA warns against use of energy-based devices to perform vaginal "rejuvenation" or vaginal cosmetic procedures
Source: FDA, July 2018 – Medsafe (copy of the warning)
What it covers: The warning states that the safety and effectiveness of laser and radiofrequency devices for "vaginal rejuvenation" have not been established, reporting burns, scarring and pain.
Why it matters: It is the context in which any energy-based technology in the intimate area should be read.
Further reading:
Non-surgical intimate rejuvenation: the guide →
Medically reviewed by Dr Giulio Maria Maggi, Plastic Surgeon — last reviewed:
Article written by Dr Giulio Maria Maggi
Aesthetic Plastic Surgeon – Turin, Asti and Alessandria
Medical Director – Aesthetic Clinic (Turin)
Turin Medical Council (Ordine dei Medici di Torino) no. 20595
Member of AICPE – Italian Association of Aesthetic Plastic Surgery
Expertise and areas of interest
Dr Maggi trained internationally, completing advanced training with Prof. José Guerrero Santos (Guadalajara) and with Prof. Andrew A. Jacono (New York) in the Deep Plane facelift technique.
He focuses in particular on:
- Deep Plane facelift
- Blepharoplasty
- Functional and aesthetic intimate surgery
- Liposculpture and fat grafting (lipofilling)
- Breast surgery
- Body contouring
Clinical approach
Combines scientific rigour with natural results, applying advanced protocols focused on morphological well-being.
