While most doctors agree that the stronger carbon dioxide (CO2) laser is best avoided on Asian skin, weaker non-ablative laser peels can be employed with caution on the Asian face.
The main concern is the debilitating complication of loss of pigmentation caused by excessive heat penetratation into the skin's dermis (see skin anatomy).
Some surgeons have found that Asian facial skin resurfacing using radio-frequency energy can generate results not unlike that from the carbon dioxide lasers with minimal risk of permanent and patchy skin lightening.
RF energy interacts with the skin in a very different manner than does the laser where tissue is essentially vaporized by heat from focused light. With radiofrequency resurfacing, saline solution is instead vaporized by several electrodes in a wand-like handpiece into what has been termed a "plasma" of ions. It is the energized movement of this plasma against the skin rather than heat that removes, or "cold ablates," the epithelium.
Even with multiple passes of the machine's handpiece, the plasma is unable to produce deep dermal injury, and heating in the superficial dermis is kept to a much lower level than with the more powerful lasers.
While the synthesis of new collagen is still stimulated, so-called "collateral damage" is not extensive enough to cause spotty pigment loss.
The skin's appearance after radio-frequency resurfacing can be just as extreme as with the CO2 laser or deep phenol chemical peels. Intense redness can last three months or more. In some cases, inflammation causes a temporary over-pigmentation that eventually disappears.
The major advantage, however, is that permanent loss of pigment is rare, a major benefit in very susceptible Asian skin.
The level of skin rejuvenation with radio-frequency resurfacing can be far superior to results after treatment with intense pulsed light or newer non-ablative lasers.