At 33, which laser would be best to maintain my skin?
At 33 with minimal sun damage, my vote would be for IPL because you can build a little collagen, take care of small red veins, small brown spots and minimize pores a little with 1-3 treatments for your initial series and then one treatment a year. There is no real downtime and the expense is lower. None of the other modalities you mention can do all that as cost effectively.
Just make sure the office you choose has a powerful IPL. The ones sold to salons are usually too weak to do much. And, some of the ones in doctors offices are not very customizable. In my opinion, the Lume One IPL system by Lumenis is still the best for power and customizability.
The IPLs are a light based treatment but not a true laser. I call them laser cousins. They use cut off filters to concentrate light to a range of wavelengths. For example, in our office a single treatment will use 3 different cut off filters – a 590nm, 560nm and a 515 nm. In addition, we will often use the YAG laser (also with that Lumenis system) on the larger veins around the nose.
Thank you for writing and I hope this helps, Dr. I