Thulium lasers and non-ablative fractional lasers: effect and uses
Non-ablative fractional lasers renew the skin without ablating its surface. This page explains what a thulium laser with 1927 nm does in the epidermis, what an erbium glass laser with 1550 nm achieves in the dermis and why the two together cover skin tone, pigment, sun damage, fine lines, pores and scars. You will find out how a session proceeds, how many are needed and how long redness and flaking last.
The focus is on the TULIX from SIACSKIN, which unites both wavelengths in one device and works without consumables. For comparison we draw on the FRACO CO2 XL and the DERMAFORCE BBL PRO.
What does a 1927 nm thulium laser do and why does it only act superficially?
A thulium laser at 1927 nm heats tiny points in the epidermis and renews it without opening the skin surface. The wavelength is absorbed very strongly by the water in the tissue. The energy is therefore already used up after about 0.2 mm, in other words in the epidermis and at the boundary with the dermis. That is exactly where pigment, sun damage and the dull, uneven surface are located. The heated microzones are shed as fine flakes within a few days. In between, untreated skin remains and speeds up healing.
In the TULIX from SIACSKIN, the 1927 nm thulium wavelength is responsible for the epidermis. The spot size is 50 to 200 µm, and the energy is adjustable from 0.5 to 300 mJ.
What does a 1550 nm erbium glass laser do in the dermis?
An erbium glass laser at 1550 nm places fine columns of heat in the dermis and stimulates the formation of new collagen there. Water absorbs this wavelength more weakly than 1927 nm, so the light penetrates deeper, depending on the energy to more than one millimetre. The epidermis remains closed, while at depth the tissue is heated at pinpoint sites and replaced by new connective tissue over weeks to months. Acne scars, surgical scars, stretch marks, wrinkles and enlarged pores benefit from this. The result builds up slowly and is often only fully visible around 3 months after the last session.
In the TULIX, the 1550 nm wavelength takes over the work in the dermis, with pulse durations of 1 to 25 ms and a scan field of up to 20 × 20 mm.
Why does combining 1927 nm and 1550 nm in one device make sense?
The combination makes sense because skin ageing rarely affects just one layer: 1927 nm works on pigment and surface, 1550 nm on collagen and structure beneath. Anyone who has sun spots usually also has fine lines and enlarged pores. With two separate devices, that would be two purchases and often two appointments. If both wavelengths are in one system, they can be used individually or combined in one session depending on the findings, for example deeper on the cheeks for scars and superficially over the whole face for skin tone.
The TULIX unites 1927 nm thulium and 1550 nm erbium glass in one device, usable individually or in combination, with 5 to 30 W of power. This makes the treatment plan flexible without a second system standing in the room.
What is a non-ablative fractional laser used for: glow, pigment, pores or scars?
A non-ablative fractional laser is used for all four: for skin tone and glow, pigment and sun damage, fine lines and pores, and for scars. Which wavelength comes into play depends on the depth of the problem. A dull complexion, age spots and sun damage on the face, décolleté and hands sit superficially and are the domain of 1927 nm. Acne scars, surgical scars, stretch marks and wrinkles need collagen to be built up in the dermis, in other words 1550 nm. Deep wrinkles and severely lax skin are more likely to require an ablative procedure.
The TULIX lists exactly these applications: melasma, pigment, sun damage and age spots, acne scars, surgical scars and stretch marks, fine lines, wrinkles and pores.
Can actinic keratoses be treated with the thulium laser?
Yes, the fractional thulium laser at 1927 nm is used by doctors to treat actinic keratoses, above all across whole areas of sun-damaged skin. Actinic keratoses are rough skin changes caused by UV light and are regarded as a precursor of non-melanoma skin cancer. They sit in the epidermis, in other words in the layer that 1927 nm reaches. The laser renews the damaged epidermis across the whole area, usually in several sessions. Diagnosis, indication and follow-up belong in medical hands, and suspicious lesions are investigated beforehand.
The TULIX lists actinic keratoses as a medical application. This is of interest to practices because the same device covers medical and aesthetic treatments.
What does melasma treatment with the thulium laser involve and are maintenance sessions needed?
Melasma treatment with the thulium laser runs as a gentle course and then moves into maintenance. The usual course is 3 to 6 sessions at intervals of about 4 weeks, with low energy and low density so that no inflammation triggers new pigment. In the first week the patches often look darker, then they flake off and lighten. Because melasma is chronic, it frequently returns without maintenance. What has proved effective is 1 to 2 top-up sessions a year, daily sun protection, ideally tinted, and accompanying skincare that slows pigment formation.
The TULIX lists melasma as an application. Its energy can be finely adjusted from 0.5 mJ, which matters with this sensitive skin.
Thulium laser or gentle CO2 mode: which is the better fit for dull skin and fine lines?
For dull skin, pigment and very fine lines the thulium laser is the better fit, and for noticeably rough texture, crêpey fine lines and shallow scars the gentle CO2 mode. Both are regarded as entry-level options with a short recovery time, but they work differently. The thulium laser leaves the surface closed, and the skin is red and rough for a few days. The CO2 laser ablates finely even in the gentle mode: the effect on texture is stronger per session, but in return the skin needs more care, and darker skin types and the summer call for more caution.
At SIACSKIN, the TULIX is the non-ablative option. The FRACO CO2 XL offers the CoolPeel mode, with which, according to SIACSKIN, healing takes 3 to 4 instead of 10 to 14 days.
Thulium laser, BBL or RF microneedling: which technology suits which skin concern?
The thulium laser suits pigment, sun damage and an uneven surface, BBL suits brown spots with redness and thread veins, and RF microneedling suits lax skin and deeper scars. The difference lies in the target: the laser at 1927 nm heats water in the epidermis and renews it regardless of skin colour. Broadband light is absorbed by melanin and haemoglobin, so it also treats redness, but it is restricted to fairer skin types. Radiofrequency delivered via needles acts at depth and leaves the pigment untouched.
At SIACSKIN this means: the TULIX for skin tone and texture in all skin types, the DERMAFORCE BBL PRO for pigment and vessels in skin types I to IV, the EUPHEUS M8 for tightening and scars.
What happens during a session with the thulium laser?
Including preparation, a session takes about 45 to 60 minutes, and the lasering of a face itself usually 15 to 20 minutes. After cleansing and photo documentation, a numbing cream is applied depending on the setting and left to take effect for 20 to 30 minutes. With gentle settings, cooling is often enough. Then the scanner places a grid of micro-dots on the skin field by field, usually in several passes. This feels like a warm, fine tingling. Cooling follows, and then soothing skincare and sun protection.
The TULIX works with a scan field of up to 20 × 20 mm and air cooling. Larger areas such as the décolleté or hands can be treated in the same appointment, and documentation runs via the device's cloud software.
How many sessions does a non-ablative fractional laser need and at what intervals?
The usual course is 3 to 5 sessions at intervals of 4 to 6 weeks. For skin tone and individual sun spots, 1 to 3 are often enough, while for melasma it is more like 3 to 6 at intervals of about 4 weeks. The reason for the difference: superficial changes are renewed with the epidermis within a few weeks. Collagen in the dermis builds up slowly, each session treats only part of the area, and the effects add up. A shorter interval brings no advantage, as the skin needs the time to regenerate. For maintenance, 1 to 2 sessions a year are often sufficient.
On the TULIX you can use 1927 nm and 1550 nm individually or in combination and so adapt the course to the findings.
How long is the downtime after the thulium laser and why does the skin flake?
The redness usually lasts 1 to 3 days, and the flaking follows roughly between day 3 and day 7. Directly after the session the skin is warm, red and slightly swollen, similar to sunburn. Because the laser does not ablate, the surface remains closed: nothing weeps and no crusts form. The heated microzones do, however, migrate upwards. The skin then feels rough like fine sandpaper, looks slightly tanned and flakes finely. This is shed old tissue together with pigment. Do not rub, cleanse mildly and apply rich skincare. Make-up is usually possible from the next day.
The TULIX works non-ablatively and with little downtime. For the days afterwards, SIACSKIN carries its own aftercare skincare, including the Sensitive Cream and the Suncream Sensitiv SPF50.
Is the thulium laser suitable for dark skin types and can the treatment be done in summer?
Yes, non-ablative fractional lasers are also suitable for darker skin types and are less dependent on the season than ablative lasers. Both wavelengths target water, not melanin, so skin colour hardly influences energy absorption. The risk lies elsewhere: in dark skin, heat can trigger pigment spots. For this reason, lower density, good cooling and longer intervals are used. Treatment is possible in summer if the skin is not freshly tanned and sun protection factor 50 is worn consistently afterwards. For melasma, autumn and winter remain the better time.
The TULIX is specified for all skin types. Its low downtime makes planning around holidays and sun easier.
Can serums or active ingredients be delivered into the skin more effectively after a fractional laser?
Yes, directly after a fractional treatment the skin absorbs active ingredients considerably better, and that is exactly why caution is needed. The microzones loosen the barrier for a few hours, even though the surface remains closed with the non-ablative laser. Whatever is applied now penetrates deeper than usual. Only products intended for this purpose are suitable: low-irritant, fragrance-free, without acids and without retinol. Soothing and moisturising serums are usual. Introducing medicinal products by this route is a medical decision.
After a session with the TULIX the rule is therefore: few, mild products and sun protection. Which skincare is suitable in the days afterwards is set out in the SIACSKIN aftercare guide.
Why are consumables and shot limits a cost factor with fractional lasers?
They are a cost factor because they are incurred with every treatment: disposable tips and shot quotas turn a purchased device into an item with fixed costs per session. With some fractional lasers, a tip has to be replaced for each client or a handpiece has to be repurchased after a certain number of pulses. This squeezes the margin, especially with large areas such as the décolleté, abdomen or back, and makes low-priced introductory offers hard to calculate. Without these items, the running costs that remain are essentially skincare products, electricity and maintenance.
The TULIX manages without consumables and without a shot limit. You can work through how this affects your costing in the SIACSKIN price calculator.
Who is a thulium laser worthwhile for as a complement to the CO2 laser?
A thulium laser is worthwhile for practices and institutes that achieve good results with the CO2 laser but lose prospective clients who cannot afford any downtime. Many want better-looking skin but not a week of healing. Others have darker skin, melasma or come in summer, all cases in which an ablative laser is only suitable to a limited extent. Then there is maintenance: between or after CO2 sessions, a non-ablative treatment keeps the result fresh.
SIACSKIN explicitly lists the TULIX as a complement to the FRACO CO2 XL. The FRACO CO2 XL takes on resurfacing, wrinkles and scars with an ablative effect, the TULIX pigment, skin tone and all treatments in which the skin is to remain closed.
