Episode #30: Fotona Resurfacing Light and Fotona Resurfacing Max

Episode Title:
Fotona Resurfacing: Light vs. Max — A Smarter Alternative to CO2?

Episode Description:
In this episode of Just Laser It: All Things Cosmetic, Dr. Saluja and Kane break down one of the most powerful and versatile technologies in modern aesthetic medicine—the Fotona Dynamis Max—and how it is redefining skin resurfacing.

If you have ever wondered whether CO2 laser resurfacing is still the gold standard, this conversation offers a fresh, science-driven perspective. Dr. Saluja explains why erbium (2940 nm) technology is increasingly becoming her preferred approach for ablative resurfacing—delivering precise results with less downtime, reduced thermal damage, and lower risk of complications like post-inflammatory hyperpigmentation.

The episode introduces two signature treatment approaches used in practice:

• Fotona Resurfacing Light – A gentle yet effective option for patients seeking brighter, smoother skin with minimal downtime (approximately 2–3 days). Ideal for early aging, mild texture concerns, and maintenance. 
• Fotona Resurfacing Max – A more advanced, multi-layered resurfacing protocol designed for deeper lines, sun damage, and more significant skin remodeling, with a slightly longer recovery (approximately 3–4 days). 

You will also learn:

•  The key differences between erbium and CO2 wavelengths, and why water absorption matters in laser precision 
•  How collagen stimulation occurs at the cellular level (including activation of TGF-beta and heat shock proteins) 
•  Why erbium allows for customizable treatment depths—from micropeels to deep resurfacing 
•  How to safely treat a wider range of skin types with reduced risk 
•  Realistic expectations for downtime, healing, and treatment series 

Whether you are a patient exploring resurfacing options or a practitioner refining your laser approach, this episode delivers a clear, clinically grounded framework for choosing the right treatment.

Thank you for your listenership!

Transcript

Dr. Minni Saluja 0:12

Hi, everyone. I hope you're doing well. Thank you so much for joining Just Laser and All Things Cosmetic. Kane, how are you doing today?

Kane Rogers 0:18

great. I saw you just bust a move there with that opening music.

Dr. Minni Saluja 0:21

I saw you just plop the booth there- With that opening music. You know what? I'm gonna stand this time when I do this. It's a good thing we don't have video. Audio is much better in that regard. Well, today, Kane, what we're gonna talk about is still one of my favorite lasers in the office, and that is the Fotona Dynamis Max. But we're gonna talk about something that we call in the practice Fotona Resurfacing Max and Fotona Resurfacing Lite so we can coach patients on this.

Kane Rogers 0:46

Now just so people are aware, we do have another podcast episode for the Fotona 4D nonsurgical facelift,

Dr. Minni Saluja 0:56

another podcast episode for the Fotona 4D nonsurgical facelift, correct? Correct. So the 4D is something different. I'm gonna just talk about resurfacing today with the Fotona. And you know what's interesting is when I get patients that come in for consultation, come in asking

Kane Rogers 1:12

I don't know. I don't sit in the back room. I'm

Dr. Minni Saluja 1:13

Don't ask me. They always... Kane, they always ask about CO2 laser. Do I c- do

Kane Rogers 1:17

do CO2 laser?

Dr. Minni Saluja 1:17

laser? And the answer is

Kane Rogers 1:19

Which is very, very popular. Lots of people do it.

Dr. Minni Saluja 1:22

Lots of people do it. Correct. And we've done it for years and years and years as one of the first lasers to come into existence was a CO2 laser. And, you know, it has, in the recent years, CO2 will always be a part of our practice, but I think erbium is almost becoming a greater part of our practice. In fact, this year with my CO2 in our office and with our erbium, I've done zero CO2s. Everything I've done resurfacing-wise when within an ablative format was erbium,

Kane Rogers 1:51

Okay. Well, let me pause right there. So give us, like, a 30-second what is a CO2? What's it for? Just for people that maybe aren't familiar with it.

Dr. Minni Saluja 2:00

right there. So give us like a 30-second what is a CO2, what's it for, just for people that maybe aren't familiar with it. Okay. So fractional CO2 laser and fractional erbium. Let's talk about s- both of the commonalities and what the differences are. So the commonality is for resurfacing, we love these two wavelengths because it's ablative. It vaporizes the epidermis down to the dermis, so that starts a whole cascade of events that build collagen. I mean, the end game is we wanna build collagen. We wanna build structure in the skin. So we can do it with these two formats. The reason why... So CO2 is known more, so of course it's an older type of, of wavelength, so people know about it more. But the reason why I do erbium more than CO2 now is because erbium, Kane That wavelength it's absorbed highly by water in the tissue. So water in the dermis can absorb erbium s- that wavelength so quickly, the twenty-nine forty.

Kane Rogers 2:55

All right, so let me stop you. I was gonna s-- You keep saying that wavelength.

Dr. Minni Saluja 2:59

All right. Let me stop you. I was gonna...

Kane Rogers 3:01

which is different than the CO2

Dr. Minni Saluja 3:03

saying that wavelength. Erbium wavelength, the twenty-nine forty. Correct. Which is different than the CO2 wavelength. Ten thousand six hundred. Uh, so this... Let me, let me explain it. So it absorbs water highly, whereas CO2, ten thousand six hundred nanometer wavelength, is absorbed less, about fourteen to eighteen times less than erbium. So what happens is, think of it this way, this is probably the best way to explain it, is that CO2, when you ablate tissue, it only goes in hot, meaning that when you're trying to get deeper, there's even more lateral thermal spread of heat. So whereas erbium, I can go in cold, I can go in warm, I can go in hot based on my parameters. And the reason that's important is because you've heard of micro coring, right? Yes. With Ellacor that uses this. Well, you can use erbium because it can go in cold, but it can go in deep, and you can s-set certain parameters where you could actually just basically drill holes and micro core the tissue if you so choose to do it that way. Or you can create heat similar to a CO2, but with le-less downtime as CO2. So I can get to my goal of creating collagen, which again, is the end goal, without having as much downtime, as much risk of post-inflammatory hyperpigmentation, as much risk of flaring up rosacea, all these things that sometimes CO2 can do that erbium you can dial back

Kane Rogers 4:29

So why is it minimized with an erbium versus a CO2? Those things that you said, all those things that you mentioned, why is there a difference?

Dr. Minni Saluja 4:36

it minimized with an erbium versus a CO2? Those things that you said, the, the post, the PIA, the... All those things that you mentioned, why is there a difference? Because it doesn't cause as much lateral thermal diffusion of heat, so it's not as hot, so to speak. So some people might say,"Well, gosh, will it create the, as, much collagen?" Yes, it does. It still turns on something called TGF beta one, which goes into the cell to go to the nucleus to turn on the factors that stimulate collagen and elastin. It still, still turns on heat shock proteins, but it does it without creating as much of the burn aspect, so as much of the downtime with it. So it's just... And you know, my skin type is slightly darker and whereas I would never touch it with a CO2 because of risk of hyperpigmentation. And I've seen, I've seen it in Mediterranean patients. I've seen it where we have to really use, um, tranexamic acid with it or, or certainly hydroquinone and, and tretinoin. But with erbium, you know, it's... the risk is a lot, lot less.

Kane Rogers 5:29

Okay. So we, we just kinda took a little stroll down the science side of things, but I did wanna come back to one thing you were mentioning about the water. What was it about-- What was the differences between... One is

Dr. Minni Saluja 5:41

Erbium is absorbed much greater by the water molecule than CO2. So what that means is it creates ablation at a very precise level. I can, I can set my erbium and basically take off two to five microns at a time if I chose to, or I can set it with deeper, you know, with higher parameters and, and do a, a much deeper ablation. But the reason that's important is, let's say I've got someone with darker skin type that I just wanna give a micro peel to, I can set my erbium in a way that doesn't create as much heat, that won't flare up their melasma or won't create the PIH because it's so highly absorbed by water that it's very precise. It becomes a very precise tool when you're ablating tissue

Kane Rogers 6:23

yeah. So is--. if I'm hearing you correctly, the, a big difference between the two wavelengths of an erbium and a CO2 is that there's just more of a precision aspect. I mean, if I had to just summarize it, that sounds, that sounds like what the big difference is. You can be more precise with less downtime and similar or even better results.

Dr. Minni Saluja 6:43

You can. I mean, I think, uh, and I'm not poo-pooing CO2. It's got great results as well. I just can do the same thing with erbium with less risk of, some of the untoward side effects. So I will choose erbium all day long when it has the parameters, these parameters that the Fotona Dynamis Max has. The Dynamis Max has multiple handpieces, Kane, and that's what makes it so functional. So my three big workhorses when I c- when I ablate tissue with the Fotona Dynamis Max is the PSO 3X, which is a pixelated handpiece. That's more of a lighter type of a peel. That's what we use for micro peels.

Kane Rogers 7:19

Okay.

Dr. Minni Saluja 7:19

There's an R11, which is a little bit more. I use this with Fotona 4Ds, but I also use it with my FS01, which is the fractional handpiece that can go in deep. So oftentimes, I will do that, and then I'll go over it with my R11s, and you can do some really nice ablating with it. I know these are

Kane Rogers 7:40

You're saying a lot of letters and numbers that mean

Dr. Minni Saluja 7:43

has a device, they might know what that means. But, but let's go, let's go into what patients come in for. And when they're, getting a resurfacing procedure, I either say,"Okay, let's do a a Fotona Resurfacing Light or a Fotona Resurfacing Max." What do I mean by that? The Fotona Resurfacing Light has about a two-day, maybe a three-day downtime where they will be a little bit gritty. The skin might turn a little brawny, and when they're in the shower, maybe at about day three to five, they'll feel a little flaky. So that one just basically gets down to the epidermis, just maybe the beginning of the papillary dermis as far as depth of the resurfacing. And so what, what would a patient present with or a

Kane Rogers 8:25

And so what, what would a patient present with or a con- uh, what concern would they have that would make you say,"You know what? Let's do this"?

Dr. Minni Saluja 8:33

They might have fine lines and wrinkles. They just might wanna freshen and brighten their skin. But greater than, uh, what I would do with our Lace MD, with our thulium lasers. They want, might want something a little bit more aggressive. Maybe they've got some mild acne scarring. Then I w- might do the Fotona Resurfacing Light. And maybe they might say,"Oh, by the way, I don't have a lot of a downtime," or,"I've, I play tennis every other day," or, or whatnot. So then I might dial it down with that. So that's a Fotona Resurfacing Light. We, we love hypochlorous acid, so it comes in a little spray bottle. So they would still need to wash their face three times a day, spritz with the hypochlorous, and then use Aquaphor or some type of emollient. Now, if they have a lanolin allergy, which I had one patient that had a lanolin allergy, they can be allergic to Aquaphor, in which case Vaseline or some of the barrier protective balms afterwards.

Kane Rogers 9:19

And I'm assuming that this would require numbing or-

Dr. Minni Saluja 9:22

It does. Yes. Yes, they, they numb for one hour, with a BLT type of cream. And then the Fotona Resurfacing Max, that's where we do some combination, treatments with it. Fotona's got... So now I'm gonna kinda maybe confuse you, but I will do a little bit

Kane Rogers 9:39

Too

Dr. Minni Saluja 9:39

a s- I will do a little bit of a smooth mode, which means a non-ablative version of the erbium, only Fotona has this, where they have a very long pulse duration that's sub-ablative. I will lay that down in the skin first, especially around the perioral region where they have those hashtag type of, smokers lines. I like to call them sunshine lines. And I'll lay that down first. Then I'll go over it with a heavier FS01, with the fractional handpiece, and then I'll go over that with a full field light version just to blend everything together. And so that's my max. Now, that one has... You're gonna swell, especially around day one through three. By the end of day three to four, and again, these are just averages, some people swell more, some people swell less. But then around day three to four, you're starting to look more like yourself. It's not bad, though. It's not like my CO2 swelling. Gosh, my C- I think one time I did a CO2 around your eyes

Kane Rogers 10:38

Yeah.

Dr. Minni Saluja 10:38

a long

Kane Rogers 10:39

You did something.

Dr. Minni Saluja 10:40

and you thought for sure something had gone wrong. But I'm like,"Nope, that's the way you swell." But this, this you swell less. It's more manageable. But you get some nice results getting too

Kane Rogers 10:51

driving too deep into the weeds, why are you doing these three different layers?

Dr. Minni Saluja 10:56

Because I need to get deeper into the dermis, and oftentimes these really deep lines around patients' lips, you really need to get, deeper through that area. Now, Fotona does have an F runner or a different handpiece that can actually microcore as well. You can get some microcoring with the FS01, but that F runner can also microcore a little bit more, where you could really take out small 250 microns of tissue in, in pillar-like ways as well. That, that's called laser microcoring. Okay. So, and, and again,

Kane Rogers 11:26

Okay. So and, and again, similar to the question I asked with the light resurfacing, what concerns or what would a pra- patient present with that would make you think,"Let's do this version instead?"

Dr. Minni Saluja 11:38

asked with the light resurfacing, what concerns or what would a pres- patient present with that would make you think,"Let's do this version instead"? Deeper lines and wrinkles, more sun-damaged skin. You know, I have... You know that leathery, photo-damaged type of skin? Maybe they're athletes that have been runners all their life or whatnot. That's a type of skin that I'd wanna do it. And it's more than one treatment. Typically, I'll do a second one in about three to six months

Kane Rogers 11:54

was gonna be my next question. For both of these, are they more than one treatment or...?

Dr. Minni Saluja 11:58

the Fotona Resurfacing Light, I'd, I'd like to do around three treatments of that one. And the Max, probably about two treatments. And as we've gone along, we've gotten more and more aggressive with that one as well. Now, that's one that is... While someone can do it in the summer, I would really want them to sun protect for a good week post. And certainly you wanna protect before as well. So those might be patients, if they're really outdoorsy, I might say,"Hey, let's wait until the fall and do that

Kane Rogers 12:25

one." Okay. So f- just to summarize, so the, the resurfacing light, roughly two to three days, I

Dr. Minni Saluja 12:31

guess, Around about. Yep. Right. And this one about four, about four days. Again, it's not terrible. But it is definitely

Kane Rogers 12:38

Just to set expectations for everybody.

Dr. Minni Saluja 12:40

we do prescribe Valtrex because remember, 80 to 90% of us are exposed to herpes simplex type one, and anytime you're taking off the barrier, the epidermal layer, you do not wanna have a herpetic spread. So you just... We do a prophylactic dose of it, starting the day before, the day of, and the day after.

Kane Rogers 12:56

So let me ask you this. So earlier I heard you mention a micro peel. How is that different than what you just

Dr. Minni Saluja 13:04

Micro peels are easy. They basically need 24 hours of, of Aquaphor, if that. It's just a very light epidermal layer type of a peel, where at about day five when they're in, in the shower, they might feel like they have too much Retin-A on and it just flakes away. I do love that for pore size. Just a... It's just a very light rejuvenator of the skin. I really like that one too. But I also like, the thulium laser for that, non-ablative laser for that as well.

Kane Rogers 13:31

as well. Okay. So you have the, the micro peel, the light resurfacing, and

Dr. Minni Saluja 13:35

the micro peel, the light resurfacing and then- Fotona Resurfacing Light and Fotona Resurfacing Max. So those- And Fotona is,

Kane Rogers 13:39

and Fotona is, uh, you say that specifically I think, right? Because they have the, the hand pieces and the technology to

Dr. Minni Saluja 13:46

the technology to- Fotona's the, the manufacturing company. Okay. And we have the Dynamis Max, which is kind of the, highest grade of their

Kane Rogers 13:53

like the Bentley, uh, devices of, of

Dr. Minni Saluja 13:57

It is, but we use that constantly. Okay. We use it constantly in the practice. Yeah, I've been really pleased with that. So that's kind of the... So this differs from the 4D, which 4D is a multimodal, treatment with four different steps in it that's kind of treating the tissue from the inside out.

Kane Rogers 14:15

And that one- And there's a whole separate episode on that from, in this podcast. So if you're interested in learning more about the 4D, then you can listen to that one.

Dr. Minni Saluja 14:23

Yep, that's episode 27. You got it. So that's it. That's what I wanna talk about

Kane Rogers 14:28

was simple and easy. I actually could wrap my brain around that and understand it.

Dr. Minni Saluja 14:32

Okay, good. I'm glad. Super easy. All right, everyone, we'll see you later, and thanks so much for always listening to the

Kane Rogers 14:38

Thanks everybody. Bye now.

Dr. Minni Saluja 14:39

Bye now. Bye-bye.