✨ Peter Attia Skincare: Lasers, Peels & Resurfacing Explained

After Peter Attia’s skincare episode 355 with Tanuj Nakra, M.D., and Suzan Obagi, M.D. some listeners were left with more questions than answers. Toward the end of the facial again podcast, they demystify the often confusing world of “resurfacing” — but it's still confusing! Plus, the industry sometimes uses jargon as a medspa money grab.

Walk into a dermatologist’s office and you’ll hear all kinds of terms: fractional, microneedling, peels, IPL… but at the end of the day, very few people understand these tools...

🧽 What does “resurfacing” mean?

Resurfacing means creating controlled injury to your skin so it heals back firmer, smoother, and more even. The deeper the injury, the bigger the result — but also the longer the downtime.

🔊 What about ultrasound and radiofrequency?

You may also hear about ultrasound and radiofrequency devices — these are usually non-ablative too. They work by delivering energy below the skin to stimulate collagen without removing any surface layers. Results are subtle and gradual, and they’re marketed under many brand names, adding to the confusion.

💸 Why does it feel so complicated? (And how to cut through it)

Because the industry makes it intentionally confusing as a money grab: medspas and device makers use flashy brand names, new-sounding technologies, and proprietary terms to upsell you into expensive packages you may not need. Even within ablative and non-ablative, they emphasize subtle differences and give them fancy names to make them sound like unique treatments — when in reality, they’re just variations on the same two principles.

✅ Takeaway: these are just techniques to deliver controlled injury at different depths. The science is real — but the branding is often just marketing. Be aware that some deep peels and ablative treatments can leave your face looking so raw and peeling that you might literally scare children at the grocery store even weeks after treatment — so downtime and appearance during healing are important to consider.

⚠️ Caution: As Dr. Obagi cautioned, doing aggressive resurfacing too early in life (under the age of 40 or 45) or too frequently can also deplete facial fat pads, which can prematurely age your face instead of rejuvenating it.

📖 Quick Glossary of Medspa terms:

• Ablative: Removes surface layers of skin for stronger results but more downtime.

• Non-ablative: Heats or stimulates skin below the surface without removing it; less dramatic but easier recovery.

• Fractional: Treats skin in a pixelated pattern, leaving some skin intact to heal faster.

• CO₂ laser: A strong ablative laser using carbon dioxide to vaporize skin layers.

• Er:YAG laser: Another ablative laser, gentler than CO₂, with less heat damage.

• Chemical peel: Uses acids to remove outer skin layers; can be light, medium, or deep.

• IPL (Intense Pulsed Light): Uses broad-spectrum light to treat pigment/redness, not technically a laser.

• Microneedling: Creates micro-injuries to stimulate collagen, subtle and minimal downtime.

• Ultrasound & Radiofrequency: Non-ablative energy-based treatments to tighten skin and boost collagen.

🪞 Ablative or Non-Ablative

No matter what fancy name or brand a treatment has, it ultimately fits into one of these two buckets: ablative (removes surface) or non-ablative (heats or stimulates below the surface). Knowing this makes it easier to cut through the marketing hype.

🧭 How to Choose Facial Rejuvenation Wisely

• See a board-certified dermatologist or plastic surgeon who performs these treatments frequently — experience matters.

• Be clear on your goals (texture? pigment? scars?).

• Understand your downtime tolerance.

• Don’t let the brand names fool you — focus on the category.

• Maintain results with sunscreen, retinoids, and good skincare habits.

👉 Bottom line: Everything on the menu boils down to ablative vs. non-ablative. Both work when done properly — just pick the right level for your skin and lifestyle.

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