Laser and energy-based devices

Laser and energy-based devices act on tissue by different physical means; the same technology name does not describe the same result in every region.^1,2 This article assesses the claims made about skin appearance and laxity, the changes the research measures, the risks, and the authorisation framework in Türkiye. Uses aimed at reducing fat, medical peels and the aftercare timetable for skin resurfacing are separate subjects. The intervals from research given here are not a physician's personal treatment schedule.

What are laser and energy-based devices?

Are lasers, IPL, radiofrequency and ultrasound the same thing?

A laser produces light at a particular wavelength and with particular properties; its effect on tissue relates to that light being absorbed by a target.¹ Structures that absorb light, such as melanin, haemoglobin and water, are called chromophores.¹ Which of these is the target, the properties of the light used and the way the energy is delivered all matter.¹ Saying only "laser" therefore does not explain which tissue and which change are being aimed at.

IPL stands for intense pulsed light; it is not a laser.¹ Instead of a single wavelength it uses a broad spectrum of light that can be adjusted with filters.¹ That some areas of use overlap does not mean that IPL and every type of laser stand in for one another.¹ The effects of a laser on tissue are also not limited to heating; mechanical or chemical effects produced by light can matter depending on the purpose.¹

Radiofrequency (RF) generates heat through the electrical properties of tissue; it does not work by targeting a particular light-absorbing structure as a laser does.² Focused ultrasound uses sound waves rather than light and delivers energy into the area on which it is focused.² Even when they are described with the same word, "tightening", their physical effects and the applications studied differ.²

Methods in which RF is delivered from the surface of the skin also have to be distinguished from those in which it is delivered into the skin through microneedles.² In RF microneedling, small electrodes enter the skin and conduct energy within or beneath it.³ Appearing under the heading of non-surgical procedures therefore does not mean that every method is needle-free or leaves the skin intact.

What do ablative, non-ablative and fractional mean?

In ablative laser treatments tissue is removed; in non-ablative approaches the aim is to produce an effect without removing surface tissue in the same way.¹ The word fractional describes targeting small separated areas rather than treating the whole surface continuously.¹ A fractional method can be either ablative or non-ablative; these terms are not interchangeable names for the same classification.¹

This distinction explains how the name used is to be read. Choosing the depth suited to a person, comparison with medical peels and aftercare are matters for skin resurfacing. The word "fractional" on its own should not be read as a guarantee of short healing, of no scarring, or of a particular change in appearance.¹

What changes are expected, and what are not?

How are the target tissue and the claimed result distinguished?

Lasers are not used for aesthetic purposes alone; there are different dermatological uses, such as treating vascular and pigment problems, unwanted hair and some scars.^1,4 That these areas exist does not show that every device provides the same benefit for every problem. A reduction in the appearance of a vascular lesion and the assessment of skin laxity are different outcomes.^1,5

The change produced in tissue by energy and the change a person notices in their appearance are also assessed separately. An account of a mechanism showing change in collagen does not on its own say how much appearance will change, or for how long.² That has to be measured separately in a clinical study. An improvement on an appearance scale cannot be translated into a lifting distance measured in centimetres, or into all of a person's expectations being met.⁵

It helps for a reader to work out first which feature they want to change. When colour, surface irregularity and laxity are gathered under one heading, data belonging to one can be presented as evidence for another. The word "rejuvenation", used without stating the region of the research, the problem at baseline and the form of measurement, does not explain these distinctions. Nor does a study reporting a benefit create a reason for treatment for someone who does not want their appearance changed.

Where does the boundary with surgery begin?

The microfocused ultrasound and RF reviews considered below are not a shared comparison testing the equivalence of every energy method with surgical lifting.^5,6 Finding an improvement in appearance in research and showing the same change that surgery provides are separate claims. If a comparison with surgery is to be made, the region, the target and the measurement also have to be the same.

The comparison of non-surgical methods with surgery in the breast region is taken up in the breast lift article. Function, comparison with surgery and purpose-specific safety warnings in the genital region are the subject of the vaginoplasty and labiaplasty articles. The findings for those regions are not used here as a general result for facial or skin treatments.

Laser-assisted liposuction falls within the scope of the surgical liposuction article. Uses of cooling, RF and ultrasound aimed at fat are the subject of the non-surgical fat reduction heading. The skin-appearance data here cannot be read as an effectiveness rate for fat reduction.^5,6

What does the evidence on effectiveness show?

Microfocused ultrasound with visualisation

Forty-two studies were included in the systematic review and meta-analysis by Amiri and colleagues; 2 were controlled clinical trials, 9 were observational studies and 31 rested on before-and-after assessment.⁵ Regions other than the face and neck are also present.⁵ For that reason not all the results were calculated for the face alone.

The investigator's assessment of appearance and the participant's own assessment were pooled separately.⁵ Reporting at least some degree of improvement on the scales can count as a response; slight improvement can fall into this group as well.⁵ A pooled proportion is an estimate calculated from similar results across studies together. Here it describes the proportion of those giving the defined response, not the size of the change in appearance.⁵

Outcome measured	Studies	People	Pooled proportion	95 per cent confidence interval	I²
Improvement on the investigator's assessment	13	411	89 per cent	81-94 per cent	63 per cent
Improvement on the participant's assessment	13	312	84 per cent	73-91 per cent	64 per cent
Satisfaction	10	326	84 per cent	61-94 per cent	52 per cent

The results in the table are taken from the same meta-analysis; each row has its own denominator.⁵ 89 per cent does not mean that 89 per cent of the tissue was lifted. Satisfaction is also not the same measurement as an appearance scale. I² is an indicator that assesses how much variation there is between studies; the values here show that the results change from study to study.⁵

In the review, follow-up was 6 months or shorter in about 80 per cent of the studies.⁵ Evidence of publication bias was reported for improvement on the investigator's assessment and for satisfaction, and problems relating to confounding factors were identified in the non-randomised studies.⁵ The review received industry funding and the authors' conflicts of interest were disclosed.⁵ These do not cancel the favourable finding; they set the limit of what can be inferred about an individual result and about long-term persistence.

Radiofrequency

The abstract of the systematic review by Vassão and colleagues reports 21 articles and 354 participants.⁶ Different forms of RF and different treatment parameters were used in the studies, and findings of improvement in skin appearance are described.⁶ The abstract does not, however, give a pooled success percentage common to all participants.⁶ Only the findings of this source that can be verified in the abstract are used in this article.

This RF result does not form a ranking with the 89 per cent estimate for microfocused ultrasound. The methods, the participants and the way the results are presented differ between the two reviews.^5,6 That a number exists in one does not mean the other is less effective, and that a qualitatively favourable result was found does not mean the same size of effect was shown. Which device was assessed for which purpose comes before the number.

What change does the research measure?

In the same microfocused ultrasound review, the answer options of the satisfaction question were also examined.⁵ In assessments that included a neutral response option, pooled satisfaction among 172 people was 62 per cent, with a 95 per cent confidence interval of 37-82 per cent and I² of 3 per cent.⁵ In assessments without a neutral option, the proportion among 136 people was 91 per cent, with a confidence interval of 46-99 per cent and I² of 24 per cent.⁵

This comparison shows that the form of the question has to be known when a proportion is read; it is not an experiment proving that adding a neutral option on its own changes the result. The subgroups total 308 people, which does not match the 326 people in the overall satisfaction analysis.⁵ The subgroups cannot therefore be presented as a complete division of all the participants.

One person finding a small change sufficient and a large change being seen on a scale are not the same thing. In reading a result, who assessed it, the scale used, which answer counted as favourable and when it was measured have to be sought together. Where these details differ between outcomes given the same name, the percentages cannot be compared directly.⁵

How are authorisation and device suitability assessed in Türkiye?

Are a certificate and a facility's authorisation the same thing?

How health services for aesthetic and cosmetic purposes are to be provided in private outpatient diagnosis and treatment facilities is governed by the Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment, dated 19 April 2025.⁷

The provision in force requires three conditions together. Health services for aesthetic or cosmetic purposes may be provided within a medical centre, a polyclinic or a doctor's practice; within the competences physicians have acquired through their training curriculum or through a certificate; within the medical procedures permitted at the facility where they work; and provided that the physical space and minimum medical equipment defined for a polyclinic room are in place.⁷

The certificate referred to in the regulation is one registered under Ministry legislation.⁷

In the Ministry's Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications, dated 3 September 2025, laser treatments appear as headings in both the theoretical and the practical training.⁸ The principles of lasers and IPL, selection according to skin type, pigment problems, superficial acne scars, hair removal and the management of complications are among the theoretical content.⁸ A separate Laser Treatment Unit within the training centre is also required.⁸

The physician's competence and the facility's authorisation are separate things and both are required.⁷ A diploma alone, or any course certificate alone, does not show that all of these conditions are met. Nor is a training centre's authorisation to provide training the same thing as a physician's authorisation to carry out the procedure.^7,8

This provision covers private outpatient diagnosis and treatment facilities. A complete list of authorisation by profession and title, for every type of institution, cannot be derived from this text.⁷

What do a device's registration and intended use show?

The Communiqué of the Turkish Medicines and Medical Devices Agency dated 14 March 2024 concerns the non-medical-purpose product groups listed in Annex XVI of the Medical Device Regulation.⁹ Article 5(6) expressly covers high-intensity electromagnetic sources such as lasers and IPL intended for skin resurfacing, tattoo or hair removal, or other skin treatments.⁹ A device falling within that framework is not a conclusion that every claim about appearance has been demonstrated in clinical research.

The Ministry of Health's Product Tracking System (ÜTS) is a system for the registration and traceability of medical devices and cosmetic products.¹⁰ A product's registration information does not take the place of a physician's competence or a facility's authorisation. The traceability of a product and the benefit and risk expected in a particular person are also separate assessments.

The Ministry states that, through the ÜTS mobile application, both members of the public and health personnel can query information about the medical device or cosmetic product to be used.¹⁰ A registration that can be queried and the purpose for which that device is to be used have to be understood together. Naming the technology used does not take the place of explaining the benefit and the risk expected for a particular target.

The United States Food and Drug Administration (FDA) explains that registration or listing information is not the same as approval or marketing authorisation.¹¹ The conditions for physicians and facilities in Türkiye are likewise not met by a registration record in the United States.^7,11 The physical class, the place of the device in the legislation and the authorisation of the person applying it are separate questions; the answer to one cannot be used in place of another.

What are the risks and unwanted effects?

Burns, scarring and pigment change

Burns, scarring and darkening or lightening of the skin are among the problems reported with laser treatments.¹ The pigment properties of the skin, the target and the use of the device matter in the assessment.¹ Darker skin is stated to be more prone to burns and dark marks after laser treatment; this does not mean that no laser can be used on darker skin.⁴

The abstract of the RF review reports temporary discomfort, pain, redness, hyperpigmentation (darkening of colour), crusting, swelling, oedema, bruising and acne-like eruptions.⁶ The microfocused ultrasound review likewise describes effects such as redness, swelling, bruising and tenderness, and states that no serious events were reported in the studies examined.⁵ That no serious event was seen in the studies does not show that the risk is zero for every device and for every future treatment.

Pain is also one of the outcomes measured. In the same ultrasound meta-analysis the means below were calculated on a scale where 0 indicates no pain and 10 severe pain.⁵

Assessment	People	Mean pain score	95 per cent confidence interval	I²
All regions, 18 studies	785	4.85	4.35-5.35	97 per cent
Face and neck	536	4.62	4.01-5.24	97 per cent
Other regions	249	5.58	5.01-6.16	77 per cent

These means do not determine in advance the pain a person will experience; the variation between studies is particularly large.⁵ A pain score is also not the frequency of burns or nerve damage. Temporary discomfort and tissue damage have to be assessed as different outcomes.

The specific warning about RF microneedling

On 15 October 2025 the FDA announced reports of burns, scarring, fat loss, disfigurement and nerve damage with certain uses of RF microneedling.³ It is stated that some injuries required surgical repair or medical intervention.³ The warning does not mean that all RF devices are prohibited; the agency reports that its evaluation is continuing.³

These reports do not give a population frequency.³ On the other hand, describing microneedling as merely an ordinary care procedure does not match the scope of the warning either. The FDA describes it as a medical procedure and states that these devices should not be used at home.³ The unwanted fat loss reported here is not effectiveness data for other treatments that aim to reduce fat.

Eye injury and signs that should not be delayed

In light and laser treatments, eye protection is chosen according to the properties of the energy used and the area being treated.¹² Patients are generally given well-fitting protective goggles that are placed over the closed eyelids; where work is carried out close to the eye, a corneal shield may be used.¹² Which wavelength a protector guards against is confirmed from its label, which means it cannot be assumed that a single protector is suitable for every treatment.¹²

The abstract of the review by Flegel and colleagues reports 119 events; 59 were ectropion (outward turning of the lid) after resurfacing directed at the eyelid, and 60 were direct injuries to the eye.¹³ Among the direct injuries, improper eye protection was reported in 44 and continuing ocular complaints at follow-up in 31.¹³ These are not rates calculated from everyone who has had treatment but the characteristics of published events. Because the abstract does not give the follow-up period, a continuing complaint cannot be interpreted as lifelong permanent damage.¹³

If eye pain or a change in vision develops during or after treatment, assessment should not be delayed; a visual complaint is not waited out on the assumption that it is ordinary skin healing.¹² Since some signs of eye injury can appear with a delay, a complaint beginning later does not remove that requirement.¹²

How is the duration of the result assessed?

Does the follow-up period mean persistence?

When a person was assessed in a study and how long the effect lasted are different pieces of information. That follow-up was 6 months or shorter in about 80 per cent of the studies in the microfocused ultrasound review does not show that all results ended at 6 months.⁵ The same data also give no guarantee that the same result was maintained for longer. The date on which follow-up ended cannot be written as the date on which the effect ended.

Showing a change in tissue in mechanism research likewise does not on its own determine how long the change in appearance lasts.² A person wanting a repeat treatment is another question again. That wish cannot be used as a test measuring that the previous effect has disappeared completely. In reading a claim about duration, it has to be understood whether an appearance scale, a tissue finding or a request for repeat treatment was followed.

The RF and ultrasound reviews in this article contain different methods and assessments.^5,6 A repeat-treatment schedule common to all energy treatments cannot be built from these data. A number of months or years given next to a device name does not carry enough information for an individual result when the region, the target and the follow-up data it rests on are not explained.

Where is dermatological assessment needed?

Can a lesion be treated as a question of appearance alone?

A pigmented area, a vascular appearance and a scar are not the same diagnosis; the choice of laser relates to the properties of the target.¹ The American Academy of Dermatology describes lasers as usable for different skin problems.⁴ That the choice of technology comes first does not, however, make assessing the cause of the appearance unnecessary. A dermatological diagnosis and an aesthetic expectation are separate questions.

The Academy advises that a spot which is growing, changing or bleeding be examined by a board-certified dermatologist.¹⁴ This does not mean that every mark is a cancer; it is a reminder that a decision should not be made on appearance alone. Which examination is needed is decided from the findings; the same procedure or the same investigation is not advised for every mark.¹⁴

The diagnosis and treatment of skin diseases can require dermatological assessment; the scope of surgical tissue correction is taken up in the relevant surgical articles.⁴ This distinction is not a complete list of authorisation belonging to a single specialty for every device in Türkiye. Competence and facility authorisation are assessed together with the legislative framework given above.⁷ An account by an institution in the United States about choosing a specialist is not put in place of a legal provision on authorisation in Türkiye.

How should the marketing language be read?

Is the name of the technology evidence of a result?

In an advertisement, what the method does has to be understood first. Lasers, IPL, RF and ultrasound are not the same physical method, and the words "fractional" and "focused" do not on their own report the size of a result.^1,2 Where there is an unexplained gap between the name given to a technology and the change measured in research, the name cannot count as evidence for that gap.

To assess a claim of benefit, the region targeted, the feature measured, the comparison group and the follow-up period can be asked about together. Whether the participant's assessment and the investigator's assessment were separate also matters.⁵ A result reported for surface irregularity should not be presented as a measurement of tissue removal, nor a satisfaction rate as the amount of change in appearance.

Who the research covered also affects the result. The overall proportion from a meta-analysis in which the face and neck were examined together with other regions is not conveyed as the result for one particular facial area.⁵ Bringing together the favourable results of different studies to say that one device is suitable for every purpose removes the questions those studies each answered separately. Where treatments were used in combination, it also has to be explained which treatment the result belongs to.

What do "approved" and "non-surgical" not say?

The FDA states that a device being registered or listed is not the same as approval or marketing authorisation.¹¹ Rather than the word "approved" alone, therefore, which institution assessed which device for which intended use has to be understood. Registration with ÜTS in Türkiye, a physician's competence and a facility's authorisation are likewise not documents that stand in for one another.^7,10

The word "non-surgical" does not on its own explain which tissue is affected in a treatment or what risks exist. That the skin is entered in RF microneedling, and the reports of serious events with certain uses, make that distinction concrete.³ Conversely, the existence of risks does not require disregarding the research that reports benefit. The aim of an assessment is not to praise or reject the name of a technology but to understand how far a particular claim is met by evidence.

How should the numbers in this article be read?

The number of people in a study, the number of studies, a proportion showing improvement in appearance and a pain score are different quantities. A pooled proportion is not an individual result; nor is a confidence interval the range between the lowest and the highest value seen in individual studies. I² helps to assess the variation between the results of studies. Even where the same number appears in different measurements, it may not describe the same outcome.

The proportions in the ultrasound meta-analysis rest on particular scales and on separate groups of participants.⁵ The review of eye injuries, by contrast, gathers reports of events; its denominator is not everyone who has had treatment.¹³ These two kinds of number cannot be added together in one table of safety or success. The follow-up periods, mean pain scores and appearance assessments here are not given as a treatment schedule or a promise of results for any individual.

References

1. Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol. 2016;9:29-40. doi:10.2147/CCID.S69106 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸

2. Jia X, Feng Y. Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects. J Cosmet Dermatol. 2025;24(2):e16657. doi:10.1111/jocd.16657 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

3. U.S. Food and Drug Administration. Potential Risks with Certain Uses of Radiofrequency (RF) Microneedling: FDA Safety Communication. 15 October 2025. fda.gov ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

4. American Academy of Dermatology. Skin conditions that lasers can treat. aad.org ↩ ↩² ↩³ ↩⁴

5. Amiri M, Ajasllari G, Llane A, et al. Microfocused Ultrasound With Visualization (MFU-V) Effectiveness and Safety: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2025;45(3):NP86-NP94. doi:10.1093/asj/sjae228 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹ ↩²² ↩²³ ↩²⁴ ↩²⁵ ↩²⁶ ↩²⁷ ↩²⁸

6. Vassão PG, Balão AB, Credidio BM, et al. Radiofrequency and skin rejuvenation: a systematic review. J Cosmet Laser Ther. 2022;24(1-5):9-21. doi:10.1080/14764172.2022.2100914 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

7. Republic of Türkiye Ministry of Health. Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment. Official Gazette, 19 April 2025, no. 32875. Articles 4(1)(j) and 6(10). saglik.gov.tr ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

8. Republic of Türkiye Ministry of Health. Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications. 3 September 2025. saglik.gov.tr ↩ ↩² ↩³ ↩⁴

9. Turkish Medicines and Medical Devices Agency. Communiqué on the Determination of Common Specifications for the Groups of Products Without an Intended Medical Purpose Listed in Annex XVI of the Medical Device Regulation. Official Gazette, 14 March 2024, no. 32489. Article 5(6). resmigazete.gov.tr ↩ ↩²

10. Republic of Türkiye Ministry of Health. The Product Tracking System has come into operation. saglik.gov.tr ↩ ↩² ↩³

11. U.S. Food and Drug Administration. Are There "FDA Registered" or "FDA Certified" Medical Devices? How Do I Know What Is FDA Approved? fda.gov ↩ ↩² ↩³

12. Glover C, Richer V. Preventing Eye Injuries From Light and Laser-Based Dermatologic Procedures: A Practical Review. J Cutan Med Surg. 2023;27(5):509-515. doi:10.1177/12034754231191064 ↩ ↩² ↩³ ↩⁴ ↩⁵

13. Flegel L, Kherani F, Richer V. Review of Eye Injuries Associated With Dermatologic Laser Treatment. Dermatol Surg. 2022;48(5):545-550. doi:10.1097/DSS.0000000000003427 ↩ ↩² ↩³ ↩⁴

14. American Academy of Dermatology. Skin cancer: Symptoms, diagnosis, and causes. aad.org ↩ ↩²