Do we have the best laser? Why we use different technologies
“We have the best laser” is a convincing advertising claim. But it leaves out the questions that matter to a patient: best for which concern, for which skin type, and by which measure?
There is no universal laser that outperforms every other device for every skin concern. One method may be preferable for a particular indication. However, a device suited to blood vessels may not be the best option for scar texture, pigmentation or tattoo removal. [1, 2]
Why we work with different lasers
At Dr Uskov Clinic in Tallinn, we have several laser systems: CO₂, Er:YAG, two Nd:YAG systems, picosecond and Q-switched technologies, Er:Glass, thulium and alexandrite lasers, as well as IPL and around ten other energy-based devices (EBDs). These devices use different forms of energy to act on tissue.
This range allows us to select a method for the clinical task. The number of devices alone does not guarantee a result: diagnosis, a sound reason for treatment, settings, practitioner training and follow-up all matter.
Laser light interacts differently with targets in the skin, such as haemoglobin, melanin and water. Wavelength, pulse duration and treatment settings are important. A device's name or maximum power therefore does not describe the treatment on its own. [1]
What the different technologies are used for
These are examples of treatment goals, rather than instructions for choosing your own procedure. Indications depend on the specific system, operating mode and skin condition. [2, 3]
CO₂ and Er:YAG: ablative methods, including fractional treatments, for skin texture and certain types of scars.
Nd:YAG: selected vascular concerns in long-pulsed mode; other indications with different pulse modes. Two devices labelled Nd:YAG can have substantially different capabilities.
Picosecond and Q-switched systems: tattoo pigment and selected pigmentary changes; some systems also offer fractional modes for other indications.
Er:Glass: non-ablative fractional treatment for certain atrophic scars and improvements in skin texture.
Thulium laser: selected concerns involving photodamage, superficial pigmentation and skin texture.
Alexandrite laser: hair removal and, with an appropriate operating mode, selected pigmentary concerns.
IPL: intense pulsed light for selected vascular and pigmentary changes. It is a light-based technology, not a laser.
The names in this list describe different features: Nd:YAG refers to the laser medium, “picosecond” to pulse duration, and Q-switching to how a pulse is generated. These categories can therefore overlap. Other EBDs, such as radiofrequency devices, also have their own indications and limitations.
A scar is a moving target
A scar is living tissue that changes as it matures. Its colour, vascularity, firmness, elasticity and symptoms can change over time. In a study following scars for one year, maturation progressed through successive stages, with the rate of change varying between individuals. [4]
When assessing scars, we therefore consider their origin and age alongside what needs attention now. Redness, a raised or depressed surface, itching and restricted movement are different concerns, even when they affect the same scar.
For example, the vascular component may initially be the main concern for one patient. As redness subsides, firmness or texture may become the priority. This is a possible treatment pathway, not a mandatory sequence for everyone. An actively growing keloid requires a distinct approach and often medication. A 2026 consensus on hypertrophic scars and keloids also emphasises the stage of the process and skin phototype. [5]
How we personalise combination treatment
At Dr Uskov Clinic, we use combination laser protocols when clinically indicated. The plan is tailored to each patient and reviewed in light of the skin's response. It may combine different laser methods, other devices, or non-drug and medical treatments.
When selecting a plan, we consider:
the diagnosis, scar type and location, colour, texture and activity;
skin phototype, susceptibility to pigmentation and healing characteristics;
previous treatment, health and contraindications;
the patient's goals, treatment tolerance and acceptable recovery time.
Combination treatment does not mean using more devices at every visit. Sometimes one method is enough. Sometimes treatments are better spaced over several stages, while observation or another type of treatment may be preferable in other cases. Every intervention should have a clear purpose.
Scientific evidence does not establish that every combination is always more effective than a single laser. For example, a 2024 randomised trial in burn scars reported encouraging findings in the combination group, but its overall advantage was not statistically significant. Expert recommendations help guide decisions; they do not replace evidence that a particular protocol is superior. [5, 6]
What results can you expect?
Scar treatment may aim to reduce visibility, firmness, redness, itching or tightness. Complete disappearance cannot be promised. For hypertrophic scars and keloids, a 2022 Cochrane review rated the certainty of available comparative evidence as low or very low. This limits categorical promises; it does not mean that every method is equivalent. [7]
Before treatment, we discuss expected changes, alternatives, recovery and risks. Depending on the method, risks can include prolonged redness, pigment changes, infection and worsening scarring. More energy or a more intensive procedure does not automatically produce a better result. [2]
Frequently asked questions
Which laser is best for scar removal?
There is no single answer. The first step is to identify the scar type and treatment goal. “Scar removal” is a common search term, but treatment usually aims to improve a scar's appearance and characteristics rather than make it disappear completely.
Should I choose CO₂ or Er:YAG?
Both are ablative lasers, but they affect tissue differently. The choice depends on the indication, operating mode, intended treatment depth, skin and acceptable recovery time. Their names alone are not enough for comparison. [2]
Is a picosecond laser better than all other lasers?
Picosecond pulse duration is useful for particular tasks. It does not make a device a universal replacement for vascular or ablative lasers. What matters is matching the method to the indication. [2]
Starting skin or scar treatment in Tallinn
During a consultation at Dr Uskov Clinic, we assess your skin, discuss your goals and explain which methods may help. You do not need to choose a device beforehand. It is more useful to understand what is realistically achievable and how treatment might work towards it.
Scientific references
Sources checked on 1 November 2026. Guidelines and expert consensus statements inform clinical practice; the strength of evidence varies between indications and methods.
