Why Interior Dermatology Chose Erbium Over CO2 for Deep Laser Resurfacing
When patients begin researching deep laser resurfacing, they almost always arrive at the same question: CO2 or erbium?
It is a reasonable place to start. Both are ablative lasers - meaning both work by removing controlled layers of skin to stimulate collagen remodeling and reveal healthier tissue beneath. Both have decades of evidence behind them. Both can produce meaningful improvement in deep wrinkles, structural skin changes, acne scarring, and cumulative sun damage.
So why does Interior Dermatology Centre use erbium for deep resurfacing?
The answer is not that CO2 does not work. It is that when it comes to resurfacing, we believe precision and predictability matter more than depth of injury alone - and erbium gives us more of both.
What Makes These Two Lasers Different
Both CO2 and erbium are ablative resurfacing lasers - they remove skin tissue layer by layer to trigger the body's healing and collagen-remodeling response. The distinction lies in how much thermal energy each delivers to surrounding tissue in the process.
CO2 creates more residual thermal effect in tissue beyond the treatment zone. That thermal spread contributes to collagen stimulation, but it also means less precision in controlling exactly how deep treatment goes and how much surrounding tissue is affected.
Erbium produces significantly less collateral thermal injury. The result is a cleaner, more controlled ablation - meaning the treating dermatologist can assess tissue response more clearly in real time, and judge treatment endpoints with greater confidence.
In resurfacing, that distinction has real clinical consequences.
Why Precision Matters in Resurfacing
Resurfacing is not simply about removing as much skin as possible. It is about improving the skin while remaining within the limits of what that tissue can heal from safely.
As treatment becomes deeper and thermally more aggressive, the risk profile changes. Potential complications include prolonged erythema (lasting redness and inflammation), delayed healing, post-inflammatory pigmentation changes, and - in cases where treatment exceeds what the tissue can recover from - permanent textural change or scarring.
That risk is not hypothetical, and it is not the same for every patient. Skin thickness, tone, barrier health, cumulative sun damage, and healing history all influence how a given patient will respond to a given depth of treatment. Even within the same person, different areas of the face carry different margins for error.
This is why experienced resurfacing requires respect for variability - and why the ability to calibrate treatment precisely, assess response in real time, and stop at the right endpoint is clinically meaningful.
"The art of resurfacing is going deep enough to improve the skin, but not so deep that you injure structures the skin needs for normal healing."
Erbium's lower collateral thermal profile supports that kind of disciplined approach. With less thermal spread, the dermatologist has a clearer signal at each layer - which supports more precise depth targeting, cleaner endpoint assessment, and a more predictable healing trajectory.
What Erbium Allows That Shapes Our Approach
At Interior Dermatology Centre, the choice of erbium for deep resurfacing reflects a specific set of clinical priorities:
Precise depth targeting: erbium can be calibrated from lighter fractional treatments to more comprehensive resurfacing depending on the concern, area, and patient
Clearer intraoperative assessment: less thermal scatter means tissue response is easier to read in real time
More controlled endpoint evaluation: the dermatologist can make more confident judgments about when to stop at each layer
A more predictable healing process: lower collateral thermal injury supports a more controlled recovery trajectory
This does not mean erbium is the right choice for every patient or every concern. Treatment selection - like all clinical decisions at IDC - begins with evaluation, not with a device.
Factors including skin tone, thickness, sun damage history, healing profile, downtime tolerance, and treatment goals all inform whether deep resurfacing is appropriate, and which approach makes the most sense. In Kelowna's climate, timing also matters: resurfacing is generally better planned for fall and winter months, when UV exposure and outdoor activity during recovery are easier to manage.
How We Think About Deep Resurfacing at IDC
Interior Dermatology does not start with a device. We start with diagnosis, anatomy, tissue behaviour, and clinical judgment.
When deep resurfacing is appropriate - when structural collagen loss, deep scarring, or significant cumulative sun damage has reached a point where surface treatments no longer create meaningful change - we want the tool we are using to support that judgment, not work against it.
Erbium's precision profile aligns with that standard. We chose it not because it is the most aggressive option, but because it allows us to treat as effectively as needed while reducing the risk of going beyond what the skin can heal from cleanly.
That reflects a broader philosophy at IDC: we do not choose treatments based on hype or marketing. We choose them based on how skin behaves, how tissue heals, and how reliably we can treat without creating avoidable problems.
BEFORE / AFTER | 4 months post 1 tx | courtesy of Jacque LeBeau, MD
BEFORE / AFTER | Four months post 1 tx | courtesy of Stanley J. Kovak, MD
Is Deep Resurfacing Right for You?
Deep resurfacing is not appropriate for every patient, and it is not the right starting point for every concern. It is considered when structural changes in the skin - deep wrinkles, significant scarring, or advanced cumulative damage - are no longer responding meaningfully to less intensive approaches.
A thorough consultation is where that assessment happens. We will evaluate your skin properly, discuss your goals and history, and help you understand whether resurfacing - and which approach - makes sense for your anatomy and your life.
Individual results vary. Treatment selection depends on careful clinical evaluation.
Ready to book your consultation at Interior Derm? Click here to contact us today.
Meet Dr. Dianne Burrows, MD, FRCPC
Dr. Burrows is the Medical Director at Interior Dermatology Centre and a leader in dermatology, combining her clinical expertise with a passion for education and research.
As the founder of the Interior Dermatology Centre in Kelowna and a Clinical Instructor at UBC’s Department of Dermatology and Skin Science, she is dedicated to advancing skin health and training the next generation of dermatologists.
Her commitment to innovation extends to conducting clinical trials, keeping her at the forefront of dermatological advancements.
