Who is that in the mirror?

Sharon Mebus can't help but laugh every time she asks herself that question.

She expects a young woman with fresh, unlined skin.

Instead, she sees a 57-year-old with a few wrinkles here and there and tiny blood vessels visible around her nose.

With plenty of options, Mebus last month chose a FotoFacial procedure to freshen her skin at American Laser Center. A package of 10 treatments, which alternates laser with another skin procedure called microdermabrasion, costs $3,000.

"I wouldn't want a facelift," says Mebus, a retired licensed nurse practitioner. She reports: "I look at least 10 years younger, at least in my mind."

For millions of Americans, extreme makeovers are, well, just too extreme. Scalpels, anesthesia, bruises and weeks of recovery are scary. Lasers, as well as heat and light devices, offer what many consider the right compromise to rejuvenate the skin, eliminate rashes, birthmarks and imperfections, remove hair, get rid of fatty tissue and more.

"The industry as a whole is growing dramatically," says Rich Morgan, president of the Farmington Hills, Mich.-based American Laser Centers. The company expects to double its revenues from last year to $100 million this year, at 100 clinics in 27 states. It offers skin rejuvenation, hair removal and cellulite reduction.

Laser treatment is performed by a doctor or a technician working under a doctor's guidance. Michigan law, for example, requires only that doctors be accessible for supervision, such as by telephone.

Cindy Pusz, 39, went on a job interview after a recent laser hair removal procedure at American Laser. "I love it," she says. "I hope it lasts a long time."

It may.

Hair removal usually is permanent or lasting. Many skin rejuvenation procedures need touchups every year or two. A conventional facelift might last as much as 10 years.

In 50 years, the use of lasers in medicine has spread widely, so consumers need to know what they're getting into.

"There is a big difference between a $30,000 unit and a $90,000 unit and the energies used and what you are capable of doing with it," says Dr. Richard J. Ferrara, Jr., medical director of the Skin & Laser Center of Grosse Pointe, in Grosse Pointe Woods, Mich.

He or another doctor always is present at the facility to oversee the care and monitor machine settings to be sure they are used safely, he says.

His office offers more than a half-dozen different laser, heat and light machines. "There isn't one machine that fits all needs," he says. The devices can dramatically help people with acne and a wide range of skin problems, from itchy patches of skin caused by psoriasis to blotchy rosacea, with results in as little as a month, and without the complications of drugs, he says.

The technology is changing so fast that newer equipment can accomplish more than machines that may only be a few years old. Some older-model lasers, for example, are not appropriate for darker skin.

Dr. Tristan Guevara, who works at Ferrara's center, called Marel Anne Thomas last year to tell her he wanted her to come in for treatments with a new I2PL intense pulse light laser. She had undergone five treatments with a different laser for treatment of facial veins.

"They were real tacky," recalls Thomas, 61. "My face resembled a road map." But after five treatments, she told him she had hoped for better results.

"Bless his heart, he called me back," she says. "He told me they got this new laser." After two treatments with the new laser, she was thrilled. "I couldn't believe the difference. He did me a real service. I'm a positive person, but I have to say this enhances my confidence in social situations.

"I like what I see in the mirror."

Thomas' treatment raises a key issue: What are your expectations?

Laser and other therapies "are good for fine wrinkles, dark spots and age spots," says Dr. Michelle Hardaway, a Michigan plastic surgeon.

"The problem is some people think the results are the same as surgical results.

"What you don't want is a patient expecting one thing and who says the result isn't good enough," she says.