Laser Resurfacing with

An Overview

We are excited to offer treatments with the Hybrid laser by Alma. This laser combines both CO2 and 1570 nm lasers to allow for a wide range of ablative, non-ablative, and thermal treatments. This combination creates a uniquely synergistic effect that delivers exceptional results without the pain and downtime of a traditional CO2 laser.

The Science

An ablative laser removes (or vaporizes) the thin outer layer of skin (epidermis) and a portion of the dermis as well as creating a coagulative and thermal injury to the adjacent epidermis and dermis. This ablative, coagulative and thermal injury to the skin stimulates the production of collagen resulting in improvement of skin firmness and texture. As the epidermis heals, the treated area appears smoother and tighter. Carbon dioxide (CO2) and erbium lasers are two types of ablative lasers.

A non-ablative laser creates a coagulative and thermal injury to the epidermis and dermis without removing the epidermis. This coagulative and thermal injury also stimulates the production of collagen. It is a less aggressive approach than an ablative laser and has a shorter recovery time, however the results are not as significant. Types of non-ablative lasers include pulse-dye, erbium (Er:YAG), and 1570 nm laser. Intense pulsed light (IPL) is also considered a non-ablative treatment, but it is not a laser.

Both ablative and non-ablative lasers can be delivered with fractional technology. This means that when the laser is fired, there are microscopic columns of untreated tissue throughout the treatment area instead of causing damage to the entire surface of the skin. Fractional lasers were developed to shorten recovery time and reduce the risk of side effects, such as scarring, hyperpigmentation, and hypopigmentation. CO2 lasers have been available for years to treat wrinkles, photodamaged skin, scars, warts, linear epidermal nevi (birthmark) and rhinophyma (enlarged oil glands on the nose). The next generation CO2 lasers use very short-pulsed light energy (ultrapulsed) or continuous light beams that are delivered in a scanning pattern. Laser resurfacing can reduce the appearance of fine lines and wrinkles, increase skin tone, and improve complexion, however it cannot eliminate excessive or sagging skin.

The Alma Hybrid laser utilizes revolutionary technology that combines both CO2 (ablative) and 1570 nm (non-ablative) fractionated lasers to allow for an optimal blend of ablative, coagulative and thermal effects on the skin in a customized and highly precise treatment. The HyGrid technology within the Alma Hybrid laser allows our providers to customize your treatment based on your skin type, aesthetic goals, and expected downtime you will experience to achieve your desired results.

What to Expect

Prior to your treatment with the Alma Hybrid laser, you will need a consultation with one of our medical providers or cosmetic nurses to determine if this is the best treatment to meet your aesthetic goals and customize a treatment plan. A topical anesthetic will be applied prior to the treatment. Due to the combined CO2 and 1570 nm laser technology, the procedure is better tolerated than a pure CO2 laser. Nerve blocks and oral sedation are not needed. The Pro-Nox Nitrous Oxide Delivery System is available to manage any discomfort or anxiety if requested by the patient. With the use of a topical anesthetic, there will be minimal to no pain during the treatment.

Pre-Treatment Information

To optimize your treatment results it is important to hydrate. Moisturize the treatment area in the morning and evening and drink at least 8 glasses of water per day.

If you have a history of Herpes Simplex (cold sores), you will be provided a prescription for anti-viral medication the day of the procedure to avoid an outbreak. Please let your provider know if you have a history of cold sores during your consultation.

Topical retinoid therapy should be discontinued 3-4 days prior to treatment. Discontinue any irritant topical agent 2-3 days prior to treatment.

Avoid any prolonged direct exposure to the sun 4 weeks prior to treatment. If you must be in the sun, use sunscreen with at least SPF 30. Avoid tanning beds for 4 weeks prior to the treatment.

Arrive for the treatment with clean skin. Do not apply lotion, make-up, perfume, powder, or bath/shower oils on the treatment area prior to the procedure.

To avoid infection, the treatment area will be thoroughly cleaned prior to the procedure, including topical anesthetics, hairspray, gel, makeup, lotions, deodorants, self-tanning products, and ointments.

Skin types IV-VI can be treated with the Hybrid but are at increased risk of post-treatment resurfacing hyperpigmentation. Pre-treatment with topical hydroquinone for skin types III – VI are recommended to prevent any hyperpigmentation. Central Minnesota Dermatology has a prescription strength hydroquinone compound available to purchase the day of your consultation.

Post-Treatment Information

Depending on the combination of CO2 and 1570 nm laser, as well as the amount and intensity of the treatment, the downtime can vary from a few days to two weeks. After the treatment is completed, you will have redness, swelling, and a mild to moderate sunburn sensation that may last a few days. You may take over the counter pain relievers (Tylenol, ibuprofen, etc.). You may relieve the sunburn sensation and swelling by applying cool washcloths. Avoid ice packs for the first few hours after treatment as the skin may still be numb and you do not want to create a cold injury. Expect a down-time of one week, though most patients can return to work within 2-3 days. A more aggressive treatment will result in more significant results but will also cause more post-procedure redness and swelling that will take longer to resolve. Consider your downtime when scheduling your procedure.

After treatment, a calming serum (Cool, Calm and Luminous) and a barrier balm (Bounce Back Skin Restoring Gel) will be applied to the treatment area(s). Apply the calming serum 2-3 times a day until the redness has improved, which will be 1-3 days. We recommend applying the Bounce Back Skin Restoring Gel 2-3 times a day until all crusting and scabbing has resolved, which is typically around 5-7 days. This ointment-based squalene gel helps keep the skin hydrated and moist, as well as protected. Once the epidermis has healed you may apply moisturizer, sunscreen, and makeup. You will be sent home with a bottle of the Cool, Calm and Luminous as well as a bottle of the Bounce Back Skin Restoring Gel after your first treatment. 

Treat the skin gently. Avoid scrubbing the treated area or exposing it to trauma. Avoid washcloths or sponges and use water or a gentle cleanser for the first 3 days to clean the skin. Using a dilute white vinegar soak/compress 2-3 times a day for the first week is recommended. Keep the dilute vinegar solution in the fridge and when applied it will cool and sooth the skin. It can help with swelling for the first few days. Vinegar has both antibacterial and antiviral properties and will help to prevent infection. You may wash your face with a gentle cleanser. You will be sent home with a bottle of CeraVe Cream to Foam cleanser to use.

It is recommended that you sleep in a semi-recumbent position for at least the first 24 hours. A more aggressive treatment will result in more swelling; therefore, you may need to sleep elevated for the first 1-3 days.

Keep hydrated. The Hybrid laser treatment damages the epidermis; therefore, you will experience water loss through the skin. Drink lots of water.

Do not exercise for 2-3 days after your treatment. Exercising will increase your risk of bleeding, swelling and infection. Once the epidermis has healed, then you can resume your normal exercise routine.

Itching is common as the skin heals and typically resolves within one week. The skin may also feel tight and may peel. The topical ointment that you were given will help with these symptoms.

Post-procedure hyperpigmentation is expected. It is essential that you protect the treatment area from the sun with sunscreen. We recommend the use of a physical sun block that contains zinc oxide or titanium dioxide with SPF 30 or higher once the epidermis has healed. We can treat the hyperpigmentation with our 4-hexylresorcinol lightening gel and/or our prescription strength hydroquinone compound. For skin types IV – VI, we often prescribe a topical steroid for the first 2-3 days after the procedure to help prevent inflammation that could cause post-procedure hyperpigmentation.

Textural changes can be observed between weeks 2 and 12 postoperatively and will resolve with time. Milia, which are tiny cysts may develop in the treatment area postoperatively and will resolve with time or can be manually extracted.

Reactivation of herpes simplex can occur, especially if treatment occurs around the mouth. Taking prophylactic antiviral medication can prevent flares.

A topical retinoid may be resumed 4 weeks after the procedure.

Contact the office with any questions, concerns, or if there is any sign of infection such as excessive swelling, redness, purulent drainage, or pain. Take photos of the treatment area and send them to the nursing email address ( for review.

A 2 month follow up appointment will be scheduled before you leave.

Refund Policy

We do not offer refunds on services rendered. Results for aesthetic services can vary significantly from person to person. We will do our best to achieve your desired result, but outcomes cannot be guaranteed. Patients are responsible for any additional treatments that may be needed to achieve and maintain desired outcomes. If a package is purchased and the patient would like a refund for unused treatments, the refund amount will be calculated as the package price less the number of treatments used at the individual treatment price.