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Skin rejuvenation with the Alma Hybrid (CO₂ laser) at Dr. Nüchel Aesthetik in Mönchengladbach

Laser treatments

Skin rejuvenation with the Alma Hybrid (CO₂ laser)

Skin rejuvenation with the Alma Hybrid – one of the most advanced hybrid laser systems of its generation: ablative and non-ablative wavelengths work together, so that result and downtime can be dosed precisely – from gentle collagen stimulation to intensive skin resurfacing.

Treatable areas

  • Eye wrinkles & crow's feet
  • Mouth & lip lines
  • Acne scars
  • Forehead & frown lines
  • Cheek wrinkles
  • Neck & décolleté
  • Scars

For skin rejuvenation we use the Alma Hybrid – one of the most advanced hybrid laser systems of its generation. It unites two wavelengths in a single device: the ablative fractional CO₂ laser (10,600 nm), which removes aged or scarred tissue in a controlled way within a fine grid of microscopically small zones, and the non-ablative 1570 nm laser, which delivers its heat specifically into the depth of the skin, where it can stimulate new collagen formation – without injuring the skin's surface.

The real advantage lies in the interplay: both wavelengths can be used individually or combined within the same session, and we tailor their ratio individually to you. If you want as little downtime as possible, we increase the non-ablative share and rely on collagen stimulation built up over several sessions; if maximum renewal is the priority, the ablative share leads. In this way, the right treatment path emerges for every skin condition – and every calendar.

All information is provided for general guidance and does not replace personal medical advice. Treatment results can vary from one individual to another.

Indications

Who it is suitable for

Whether a treatment makes medical sense in your case is something we determine together in a personal consultation. Typical concerns include:

  • Lines and crepey wrinkles, for example around the eyes and mouth or on the cheeks
  • Acne scars, in particular sunken (atrophic) scar forms
  • Scars following injuries or operations
  • Sun-damaged, prematurely aged skin (photoageing)
  • Slackened skin, e.g. on the face, neck or décolleté
  • Pores that appear enlarged and an uneven skin texture
  • A wish for skin rejuvenation without surgery

Step by step

How the treatment works

This is how the treatment usually proceeds with us – from the first consultation through to aftercare.

  1. Consultation and information

    We examine your skin, discuss your concern and expectations, and clarify the mode of action, realistic results, risks, alternatives and possible contraindications; from this, your individual treatment plan is drawn up.

  2. Preparation and anaesthesia

    On the day of treatment the skin is cleansed and an anaesthetic cream is applied, which takes effect over about 30 to 45 minutes; if needed, we add a local anaesthetic.

  3. Laser treatment

    The laser is guided systematically over the area and sets a fine grid of microscopic treatment zones; we adjust the energy and pulse density to your findings. Depending on the size of the area, this step takes about 15 to 30 minutes.

  4. Immediate aftercare in the practice

    Directly afterwards, the skin is cooled and treated with wound-healing-supporting care; you receive precise behavioural recommendations for the first few days.

  5. Healing phase and check-up

    After a few days of redness and swelling, the skin flakes off finely while the new surface forms. At the check-up we plan further sessions if needed, at intervals of four to eight weeks – for mild photoageing a single session can often already bring a visible improvement, for pronounced acne scars or deeper lines two to four are often sensible.

Two wavelengths

One system – three treatment paths

What makes the Alma Hybrid special: the treatment path is not dictated by the device, but by you. Which combination suits your findings, skin type and the recovery time your everyday life allows is something we determine together in the consultation.

Treatment pathHow it worksTypical downtimeSuitable when …
Gentle – 1570 nm, non-ablativeCollagen stimulation in the depth of the skin, the surface remains intactapprox. 0–2 daysas little time out as possible is desired – gentle tightening and skin refinement built up over several sessions
Hybrid – both wavelengths combinedAblation and deep stimulation in one session; the ratio is dosed individuallyapprox. 2–5 daysa clearly visible result with a plannable, moderate recovery time is desired – the most common path
Intensive – fractional CO₂ laser, ablativeControlled ablation and tightening, the classic skin resurfacingapprox. 4–7 dayspronounced lines, acne scars or photoageing are to be addressed as far as possible in a single session

Transparency

Prices

Halbes Gesicht
300 €
Ganzes Gesicht
550 €

All prices are guide values for initial orientation. Medical services are billed according to the German scale of fees for physicians (GOÄ); the final amount depends on the individual effort involved and is discussed transparently with you before treatment. For treatments without a listed price, we are happy to give you a guide value during your consultation.

Enquire about this treatmentView the full price list →

Patient information

Safety & patient information

Responsible treatment includes open information about possible risks and side effects – even when they occur only rarely.

  • Redness and swelling

    In the first few days, marked redness and slight swelling are the rule; the skin often feels like sunburn. This expectable reaction usually subsides within about a week.

  • Flaking and dryness

    While the new skin surface forms, the skin flakes off finely and may feel dry or tight. The fine crusts should not be detached – this disturbs the healing and increases the risk of scars and pigment changes.

  • Prolonged redness (erythema)

    In a proportion of those treated, the redness lasts longer than the usual few days – sometimes over several weeks. It usually recedes by itself and can be covered with make-up during this time.

  • Temporary itching and sensitivity

    As part of wound healing, itching, a sensation of warmth or increased sensitivity may occur – usually mild and temporary; the recommended care usually relieves these complaints.

  • Post-inflammatory hyperpigmentation (PIH)

    After the inflammatory healing response, treated areas may temporarily become darker – above all with darker skin types and promoted by UV radiation. The shift usually recedes over weeks to months; consistent UV protection is the most important preventive measure.

  • Hypopigmentation (lightening)

    Less commonly, treated areas appear lighter than the surroundings. Such lightening may persist for longer and is not in every case fully capable of resolving.

  • Reactivation of cold sores

    With treatments on the face – in particular in the mouth area – a predisposition to cold sores (herpes simplex reactivation) can be activated. With a known tendency, we discuss a preventive antiviral prophylaxis with you in advance.

  • Infections

    As long as the skin barrier is not yet closed, there is an overall low risk of bacterial infections; careful hygiene, the recommended care and clean hands lower it.

  • Scar formation

    Very rarely, excessive scar formation may occur despite correct performance – in particular with a corresponding predisposition (a tendency to raised scars, so-called keloids) or disturbed healing, for example through the early detachment of crusts or an infection.

  • Absent or insufficient result

    The skin reacts individually: the intended result may turn out smaller than hoped for or require further sessions. We cannot guarantee a particular treatment success.

When we do not treat

In certain situations we do not carry out a treatment, or only at a later time – for your safety.

  • Pregnancy and breastfeeding (as a precaution, since insufficient safety data are available)
  • acute infections, inflammation, open wounds or an active herpes outbreak in the treatment area
  • active inflammatory skin conditions in the area, such as florid acne or an acute flare-up of a chronic skin disease
  • fresh tanning from the sun or tanning bed as well as imminently planned intensive sun exposure
  • known tendency to excessive or raised scar formation (keloids, hypertrophic scars)
  • intake of certain strongly photosensitising medications or those affecting wound healing, including a past or ongoing therapy with high-dose vitamin A acid derivatives (oral acne medication)
  • diseases or medications that markedly impair wound healing, as well as pronounced immune deficiency
  • unrealistic expectations or a lack of willingness to comply with the necessary aftercare including consistent UV protection

This information does not replace a personal medical consultation. Before every treatment we inform you individually about the procedure, risks and alternatives.

In depth

Medical details & background

How it works & the evidence

The CO₂ laser works with a wavelength of 10,600 nanometres in the infrared range, which is absorbed particularly strongly by water – the chromophore, that is, the target structure that converts light energy into heat. Since skin consists to a large extent of water, the heated tissue in the affected zones evaporates in a controlled manner within fractions of a second (ablation), while the surroundings remain largely spared.

The decisive principle of action is fractional photothermolysis: the beam is divided into many fine individual beams that create a grid of microthermal treatment zones; between them, islands of healthy skin remain, from which regeneration starts. Through energy, point density and depth of penetration, it is possible to control how intensively and how deeply the treatment acts.

The second building block of the Alma Hybrid is the 1570 nm laser. Its energy is likewise absorbed by water, but dosed in such a way that fine columns of tissue in the depth are coagulated – that is, specifically altered thermally – while the skin's surface remains closed (non-ablative). This stimulus can activate the collagen-forming cells without creating an open wound surface. In hybrid mode, both wavelengths are combined within the same treatment grid: the ablation of the CO₂ laser and the deep effect of the 1570 nm laser complement each other, and the mixing ratio allows the balance of effect and recovery time to be controlled individually – this is what distinguishes this still young class of devices from classic single-wavelength systems.

The controlled thermal stimulus promotes the renewal of the outer skin (epidermis) and activates the collagen-forming fibroblasts in the dermis, which form new collagen and elastin over weeks and months. This remodelling unfolds over months – the result therefore shows gradually. The laser does not introduce any artificial substance but sets in motion the body's own renewal response, whose strength varies individually with skin type, age and the treated area.

Fractional ablative laser therapy is among the best-studied procedures in aesthetic dermatology. Controlled studies and systematic reviews describe positive effects for atrophic (sunken) acne scars, light-induced skin ageing and fine lines; its use for acne scars is particularly well supported, where the procedure is often classified as one of the more effective non-surgical options.

At the same time, restraint is appropriate: many studies work with small case numbers, different devices and inconsistent assessment standards, often based on subjective scales; reliable statements about long-term durability are only possible to a limited extent. Moreover, results cannot be transferred one to one to the individual case – skin type, initial findings and healing response considerably influence the result. For this reason we do not formulate success rates and do not give guarantees: how clearly an improvement turns out can only be seriously estimated after an individual examination – as an expectation, not as a promise.

Preparing for your treatment

A few simple measures before your appointment help you contribute to the best possible result with as few complications as possible.

  • From about four weeks before the treatment, avoid intense sun and tanning beds; only untanned skin is treated.
  • Inform us about all medications and dietary supplements; never stop anticoagulant preparations (including over-the-counter blood-thinning painkillers) on your own initiative, but only after medical consultation.
  • Tell us about skin conditions, a tendency to cold sores or excessive scars, as well as previous skin treatments – this may require a preventive or adjusted approach.
  • In the days before the treatment, refrain from irritating skin care (e.g. fruit acid or retinol products) and other irritating measures in the treatment area.
  • Come to the day of treatment with clean, make-up-free skin without creams in the treatment area.
  • Plan for sufficient recovery time; do not schedule appointments of a representative nature immediately after the session.
Aftercare

The right care after treatment supports healing and the result. You will receive individual recommendations from us – as a rule:

  • Cool the skin in the first few hours as recommended in order to relieve the sensation of warmth and swelling.
  • Use exclusively the recommended wound-healing-supporting care, keep the skin moist and avoid irritating or strongly perfumed products.
  • Consistent UV protection is the most important measure against pigment shifts: avoid direct sun for several weeks and, after healing, apply SPF 50+ daily.
  • Do not detach the fine crusts and flakes, but let them fall off by themselves – this helps prevent scars and pigment changes.
  • Refrain for about a week – or as individually recommended – from intensive exercise, sauna, steam bath and swimming pool; sweating, heat and chlorine irritate the healing skin.
  • Do not apply make-up to the treatment area in the first few days and touch the skin only with clean hands.
  • Attend agreed check-up appointments, so that we can assess the course of healing.
  • Contact us immediately if unusual complaints occur, such as increasing pain, the formation of pus, severe swelling or fever.

FAQ

Frequently asked questions

Answers to questions we are asked particularly often about “Skin rejuvenation with the Alma Hybrid (CO₂ laser)”.

Thanks to the anaesthetic cream – supplemented if needed by a local anaesthetic – it is well tolerable for most patients; what is usually described is a sensation of warmth or slight burning. Afterwards the skin may feel like sunburn for a few hours; cooling usually relieves this reliably.

First improvements usually become apparent after the healing is complete, that is, after about one to two weeks. Because the formation of new collagen continues over months, the appearance of the skin can refine further for up to half a year; refresh treatments are possible after a few years.

Exclusively a licensed physician with a dermatological background: ablative laser treatments, in which skin is removed, are reserved for physicians in Germany under the NiSV (Ordinance on Protection against the Harmful Effects of Non-Ionising Radiation). Examination, information, treatment and follow-up check are all in a single medical hand with us.

A classic CO₂ laser knows only the ablative path. The Alma Hybrid unites the CO₂ wavelength with a non-ablative 1570 nm laser in a single system – both can be used individually or combined, and their ratio can be dosed individually. This allows the treatment to be controlled far more finely: from gentle collagen build-up without significant time out to intensive resurfacing – effect and recovery time become plannable.

Largely, yes: in the purely non-ablative mode (1570 nm), the skin's surface remains intact; usually there is only redness and slight swelling for one to two days. In return, the result builds up more gently over several sessions, as the deep collagen stimulation takes time. Whether this path is sufficient for your concern is something we determine during the examination.

We preferably treat from autumn to spring, as the freshly treated skin is particularly sensitive to UV radiation for weeks. In summer, a treatment requires that you consistently avoid direct sun and use SPF 50+ daily – a beach holiday shortly after the session does not fit with this.

With darker skin types, the risk of pigment shifts, in particular a temporary darkening (post-inflammatory hyperpigmentation), is increased. A treatment is not ruled out, but requires particularly careful consideration, more cautious parameters and very consistent UV protection; in some cases we recommend gentler alternatives.

Sources & guidelines

  • AWMF guideline register – guidelines on laser therapy of the skin and on dermatological care (www.awmf.org)
  • German Dermatological Society (DDG) – professional statements and patient information on aesthetic and surgical dermatology
  • Ordinance on Protection against the Harmful Effects of Non-Ionising Radiation in Application to Humans (NiSV) – requirements for application and qualification in ablative laser treatments
  • Prescribing information and safety notices from the manufacturers of the laser systems used regarding indications, parameters and contraindications

Personal consultation

Arrange a personal consultation

In a confidential conversation on our practice floor at the Albertus Zentrum in Mönchengladbach, we take time for your questions and assess whether the treatment may be suitable for you.

Book a consultation

More treatments

You might also be interested in

Depending on the findings, another procedure may be a better fit: the Erbium:YAG laser, which ablates closer to the surface, for a gentler skin rejuvenation, the pico or Nd:YAG laser for pigment changes and tattoo removal, the dye laser for vascular changes, as well as botulinum toxin for expression lines and hyaluronic acid fillers for volume loss. These procedures can also sensibly complement the CO₂ laser.

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