CO2 Laser Resurfacing: All You Need to Know
CO2 lasers are the most common type of laser beam used in skin resurfacing treatments. Here’s all you need to know about the specifics of CO2 laser resurfacing.
Image source: Instagram @accessdentalsmile
CO2 laser resurfacing is a subtype of laser skincare. Specifically, it refers to any method of laser treatment that uses carbon dioxide gas as a medium for the light energy of the laser. CO2 is used as a medium in a few different types of lasers.
Here’s a comprehensive guide on the methods of CO2 laser resurfacing, the conditions it can help treat, how to handle the recovery and aftercare, and who is a good candidate for it.
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How Does CO2 Laser Resurfacing Work?
Laser skin resurfacing in general can be done by one of four methods: ablative, non-ablative, fractional, or IPL (Intense Pulsed Light). Each method utilizes different types of laser and treats different skin conditions.
CO2 lasers are used in ablative and fractional laser resurfacing treatments.
Ablative CO2 Laser
The CO2 laser is the earliest type of laser in skin care, and ablative treatments are the earliest method of applying it. In these treatments, the carbon dioxide laser emits energy in one of two ways:
- In very short individual pulses (called ultrapulses)
- In a continuous beam that moves in a scanning pattern
Ablative lasers target the epidermis and vaporize the outermost layer of skin cells using concentrated heat. If the treated condition is severe, or afflicting a large area, the laser might go deeper and target one or more cell layers in the upper dermis too.
In either case, the vaporization inflicts a micro-injury on the skin. This prompts the body to start producing new collagen and elastin in the area. That boost to the natural recovery cycle results in new skin that is more flexible, smoother, tighter, and healthier.
When used in ablative treatments, CO2 lasers remove the targeted layers of skin with great precision, while keeping the heat damage to the surrounding tissues at a minimum.
Fractional CO2 Laser
Fractional resurfacing technically includes both ablative and non-ablative treatments, so CO2 lasers fall under that umbrella too. Fractional treatments get their name from the particular way that the laser is applied.
In a fractional CO2 laser treatment the beam of energy is split into hundreds, even thousands, separate mini-beams. This leaves untouched spots of skin between the treated areas.
Fractional CO2 laser resurfacing reduces the required downtime, as well as the client’s total recovery time.
Image source: Instagram @labellavitamedispa
CO2 Cool Peel
A cool peel is a new laser resurfacing treatment with CO2 lasers. It gets its name from the main difference between it and traditional CO2 resurfacing: a cool peel does not deliver any thermal damage to the skin.
This type of laser facial is a recent treatment that can only be done with the latest generation of carbon dioxide lasers, called Tetra CO2 Lasers.
The laser energy is delivered in extremely short pulses, in a spray pattern. That way the total treatment time is drastically reduced, and the individual laser beams don’t have time to heat the tissue as much as a traditional CO2 facial.
This means virtually zero downtime and minimal thermal trauma to the treated skin. The downside of this new technology is that it only targets the most superficial layer of the epidermis, so the span of conditions it can treat is limited.
Cool peels are used on fine lines, minor sun damage, minor to moderate pores, and mild texture issues.
Who Is a Candidate for CO2 Facial Resurfacing?
Remember that C02 laser treatments are exclusively ablative or fractional. If you’re interested in non-ablative laser skin resurfacing or Intense Pulsed Light therapy, you’ll need to consider other types of laser, such as Er:YAG, pulsed-dye, or alexandrite.
You might be suitable for a CO2 facial if you struggle with any of the conditions we cover below. You also need to have a healthy immune system and no underlying health issues.
In addition, consider your skin type. Not all skin types are suited to all types of treatments. Consult your laser tech.
Is CO2 Laser on Dark Skin Safe?
Not every type of laser is suitable for every skin tone. It’s important to remember that CO2 lasers are primarily ablative, even when they’re applied in the fractional format.
As such, people with darker skin are more at risk of certain side effects that might occur when skin cells that are rich in melanin are exposed to the concentrated energy of the laser beams.
In particular, there is the risk of hyperpigmentation, hypopigmentation, and keloid scarring.
When a CO2 laser targets the skin cells, that includes melanocytes, the cells that produce our natural pigment. The body wants to fix the situation, so it boosts melanin production, but it overcompensates.
The excess melanin gathers in clumps of pigment molecules, which results in patches of dark discoloration in the treated area. If the damage to the melanocytes is severe enough, the hyperpigmentation can even be permanent.
Conversely, the melanocytes can be affected by the laser to the extent that they stop functioning altogether. In that case, the production of melanin in the area is stunted, resulting in patches of noticeably lighter skin (hypopigmentation).
Finally, if you have naturally dark skin, it means you have naturally more collagen, which puts you at risk of keloid scars. This side effect is more likely to occur in people of African Caribbean, Black African, Chinese, Mediterranean, or South Asian descent.
If you fall into these categories, you should have detailed consultations with your doctor, dermatologist, and laser technician about applying CO2 laser.
Who Shouldn’t Get CO2 Resurfacing?
Sometimes carbon dioxide laser resurfacing might not be the best idea. In addition to your skin type, overall health, and age, the following factors might be an obstacle to getting a CO2 facial:
- Very deep wrinkles
- Sagging skin
- Excess skin
- Herpes infection
- Active acne
- History of frequent laser treatments (facials and otherwise)
If any of these apply to you, that doesn’t automatically mean that you can’t get a laser resurfacing treatment. However, you will likely need to adjust your expectations.
For example, your technician might recommend a different type of laser or a different method that would be more effective on your skin.
If you have loose skin or very deep wrinkles, you might benefit more from microneedling or nanoneedling.
NOTE
The herpes simplex virus is not a contraindication for CO2 facial resurfacing (unless you have an active flare up). Your technician will probably put you on a course of antiviral meds before and after your laser facial.
@kalosplasticsurgery • Fractional Laser Resurfacing • Ablative Therapy • 🤩 🤩 #co2 #co2laser #skinresurfacing #skincaretreatment #satisfying ♬ Tubarão Te Amo - DJ LK da Escócia & Tchakabum & Mc Ryan SP
What Treatments Is CO2 Laser Used For?
CO2 laser is used in treating basically any condition that calls for ablative laser skincare. Of course, you should consult with your provider as to whether CO2 is the best choice for your skin, or if you would benefit more from another type of laser.
As with any laser treatment, you can opt to target one specific area, or to get a full face CO2 laser resurfacing session.
CO2 Laser for Wrinkles
Co2 lasers are highly effective in treating wrinkles. By vaporizing the skin cells in the wrinkled area and triggering collagen and elastin production, the treatment provokes increased elasticity and flexibility of the skin.
The new skin that emerges after treatment is tighter than the originally treated skin, and this tightening reduces the intensity of the wrinkle folds. Depending on the original wrinkle depth and the number of lasering sessions, they might even completely disappear.
CO2 Laser for Under Eye Wrinkles
Carbon dioxide laser has been proven effective in treating the sensitive area around the eyes, albeit with certain precautions. Numbing cream is applied before the treatment, and the method used is almost exclusively fractional.
Image source: Instagram @np_katie
CO2 Laser for Pores
Clogged pores can appear larger than they actually are.
You can’t really change your pore size, because that’s determined by your genetics. In particular, people of Asian descent often have this aesthetic concern, as well as anyone with the III and IV Fitzpatrick skin type.1
However, you can treat them with a CO2 laser to make them appear smaller.
Since the laser promotes collagen production and boosts your elastin fibers, the skin around the pores becomes tighter. Tightening the surrounding skin makes the pore opening look smaller, and might even help reduce the rate of them clogging up.
CO2 Laser for Scar Removal
Ablative and fractional lasers (including CO2) are a highly popular and effective method of diminishing various types of scars. This application of lasers heavily relies on the skin’s natural collagen production.
NOTE
If you are prone to keloid scarring, laser treatments might make it worse. CO2 may not be the best choice for your particular case. Discuss your case with your doctor and laser tech before you commit to an appointment.
Image source: Instagram @dr.saidanewalid
CO2 Laser for Surgical Scars
Ablative laser treatments are effective in treating surgical and traumatic scars. The best results are usually achieved when the laser resurfacing is administered quickly.
If it’s meant to treat surgical scars, it should be done immediately after surgery if possible. In either case, CO2 laser resurfacing should be done within 6-10 weeks after the surgery or the trauma. 2
CO2 Laser for Acne Scars
Carbon dioxide laser is highly effective in resurfacing acne scars, particularly when it’s applied via the fractional method. Different types of acne scars respond to the treatment to a different degree.
Rolling and boxcar acne scars are easier to remove than icepick acne scars, and high-energy lasers yield better results than low-energy ones. 3
Image source: Instagram @ornaskin_clinic
NOTE
The longer an acne scar has been in place, the more difficult it will be to remove, and the higher risk of side effects there is. Such side effects include pigmentation, skin sensitivity, persistent erythema, and acneiform eruption.
CO2 Laser For Hypertrophic Scars
Hypertrophic scars are abnormal responses to wound healing, where the skin produces excess connective tissues. This results in a final scar with an obvious raised surface, though not so much as a keloid scar.
CO2 laser treatments are very effective in improving the clinical appearance of such scars. In the cases where the scars are large enough to inhibit movement, carbon dioxide resurfacing can reduce them.
The best results in treating hypertrophic scars are achieved when combining fractional CO2 laser with other modes of laser skin resurfacing.4
CO2 Laser for Keloid Scars
Carbon dioxide laser is one of the options available for treating keloid scarring, but only on suitable candidates and only with careful consideration.
Since keloids are basically an overproduction of collagen, any skin care method that boosts collagen production (including CO2 laser) can make it worse instead of better, especially in people who are already prone to keloid scarring.
There isn’t one ideal form of treatment for this skin condition. If you decide to try CO2 laser resurfacing for keloid management, your healthcare provider will probably combine it with other treatments, such as intralesional steroids.5
CO2 Laser Stretch Marks Treatment
CO2 lasers are quite effective at reducing stretch marks, mostly when used fractionally.
The boosted collagen production in targeted spots tightens the area as new skin forms. This tightening process pulls on the stretch marks, makes them contract, and ultimately makes them smaller.
Applying CO2 Laser Under Eyes
We already mentioned applying CO2 laser under eyes when treating wrinkles, but it can also be used on other under eye imperfections.
CO2 Laser for Under Eye Bags
In treating under eye bags, CO2 lasers are commonly recommended as an alternative to more aggressive methods like eyelid cosmetic surgery.
A laser resurfacing treatment is much safer because it works to remove the bags via natural processes, by boosting elastin and collagen production to rejuvenate the skin.
Image source: Instagram @katie_plastics_np
CO2 Laser for Dark Circles
Dark circles under the eyes aren’t a matter of skin pigmentation, but its thickness. As we age, the skin becomes thinner. This makes the blood vessels underneath more visible, so the skin appears darker.
Fractional CO2 laser treatment can help address this problem. By stimulating collagen and elastin production, the skin of the under eye area is noticeably rejuvenated. The new skin is smoother and more elastic, and thus less transparent.
This in turn makes the blood vessels in the eye area less visible, and the perceived darkness is diminished.
CO2 Laser for Fordyce Spots
Fordyce spots or granules are visible oil glands, without hair follicles, that appear as small white or yellowish bumps in the oral, genital, or breast area.
They’re generally harmless and don’t require any kind of treatment, but they can be a cosmetic insecurity.
Vaporizing treatment with CO2 laser is highly successful in removing Fordyce spots. In this case, the laser is applied as a superpulsed beam.6
CO2 Laser for Rosacea
CO2 lasers can be helpful in repairing or restructuring skin that has suffered rosacea damage. This mostly refers to excess skin buildup, or even scarring, that can happen as a result of chronic rosacea flare-ups.
In particular, CO2 laser resurfacing is often used to treat rhinophyma, the bulbous, thickened skin around the nose that develops due to phymatous rosacea.7
CO2 Laser for Pigmentation
Adjusting skin pigmentation is arguably the most common application of CO2 lasers, whether ablative or fractional. CO2 laser therapy can help with freckle removal, lip lightening, and other forms of pigmentation management.
Image source: Instagram @3daestheticsleamingtonspa
CO2 Laser Mole Removal
Removing moles via carbon dioxide laser is completely safe if performed in a clinical medical setting. However, not all types of moles are suited to laser removal.
CO2 laser mole removal is best suited for moles which are clearly raised from the skin surface. Flat moles, dark, or highly pigmented ones benefit more from a surgical procedure.
How Much Does a CO2 Laser Treatment Cost?
The cost of your CO2 laser treatment will depend on several factors:
- The condition you’re treating,
- Whether the treatment is fractional or purely ablative,
- The size of the treated area,
- How many sessions you need,
- The expertise level of your provider,
- The clinic’s location and reputation,
- Whether anesthetic is needed, etc.
Ablative laser treatments are generally pricier than non-ablative ones.
Recent statistics from the American Society of Plastic Surgeons place the average cost of ablative laser skin resurfacing at around $2,500, but keep in mind that this isn’t the total price.
You need to factor in the cost of additional sessions, anesthesia, aftercare products, medication, and other costs that might be involved.
Most insurance plans don’t cover the CO2 laser treatment cost, because it’s categorized as a cosmetic procedure. You might get an exception if your insurance provider determines that the condition you’re treating is a medical problem.
However, most clinics offer payment plans and other financing strategies.
How Long Does CO2 Laser Healing Take?
You can expect your skin to heal from your CO2 facial within 5-21 days, but there are 2 timelines to consider: your skin healing from the treatment itself, and the residual aftereffects disappearing completely.
The natural healing rate varies widely between individuals, influenced by the following factors:
- The specific condition you’re treating
- The size of the treated area
- The treatment method
- Your skin type
- Your age and overall health
- Your lifestyle
After the skin has healed, it will stay noticeably pink or red for an extended period. It might also be more sensitive to sunlight than. This post-healing period can last anywhere from 2-3 months to a whole year.
CO2 Laser After Care
Skin care after CO2 laser mostly comes down to nourishment and protection. Keep your skin hydrated with quality moisturizer. Your provider might also prescribe you a broad-spectrum SPF to protect it from UV exposure in your daily routines.
If the redness/pinkness makes you uncomfortable, feel free to cover it up with makeup after your skin has completely healed. Use products with green undertones to neutralize the red, and stick to oil-free cosmetics to prevent clogging up your pores.
Image source: Instagram @moxymedicalspa
Why Am I Peeling After CO2 Laser?
It can be uncomfortable and scary, but skin peeling is actually a completely natural and expected effect of a CO2 facial. In particular, it happens after a fractional CO2 laser resurfacing treatment.
The old, superficial layer of skin that was targeted by the laser is being discarded. Your body is making way for the new skin it created during the healing period.
The peeling stage of your healing process usually starts around 3-5 days after the treatment, and should be completely over by day 10 or so.
What to Do After CO2 Laser Treatment
First of all, obey your after care instructions to a T. Use the products that your provider prescribed, and if they advise you to stay away from certain cosmetics or activities for a while, listen to them.
You can also be proactive and consult your dermatologist. Tell them about the procedure you had, what your laser tech recommended, and how your healing is going.
They might have some additional tips, or could help you create a custom skincare routine tailored to your post-treatment face.
They’ll also be informed and ready to help you if your sensitive fresh skin ends up irritated by sunlight, pollutants, etc.
You should also periodically go in to your dermatologist for a check-up. Keep an eye on how your skin is healing, and whether there is any risk of the condition you treated coming back.
CO2 Laser Resurfacing – Main Takeaways
CO2 resurfacing can treat a variety of concerns, both medical and cosmetic. You can choose between ablative and fractional treatments, as well as the newest cool peel approach.
The best choice for you will depend on your skin type, age, health, the specific issue you want to address, and the size of the area that needs to be treated.
Make sure you choose a licensed, certified, reputable service provider: either a laser technician, surgical dermatologist, or cosmetic surgeon. They will advise you on healing, aftercare, long-term care, and answer any concerns you might have along the way.
References:
- Kwon, Hyuck Hoon, et al. “Clinical and histological evaluations of enlarged facial skin pores after low energy level treatments with fractional carbon dioxide laser in Korean patients.” Dermatologic Surgery 44.3 (2018): 405-412.
- Xiao, Anny, and Leila Ettefagh. “Laser revision of scars.” (2019).
- Li, Bingyan, et al. “Efficacy and adverse reactions of fractional CO2 laser for atrophic acne scars and related clinical factors: a retrospective study on 121 patients.” Journal of cosmetic dermatology 21.5 (2022): 1989-1997.
- Simbolon Sitohang, Irma Bernadette, Sondang Aemilia P. Sirait, and Fadhila Dea Safira. “Fractional carbon dioxide laser for treating hypertrophic scars: A systematic review of randomised trials.” Australasian Journal of Dermatology 63.1 (2022): 27-35.
- Garg, Gaurav A., Prajct P. Sao, and Uday S. Khopkar. “Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids.” Journal of cutaneous and aesthetic surgery 4.1 (2011): 2.
- Ocampo‐Candiani, Jorge, et al. “Treatment of Fordyce spots with CO2 laser.” Dermatologic surgery 29.8 (2003): 869-871.
- Rivero, Alexis Lara, and Margot Whitfeld. “An update on the treatment of rosacea.” Australian prescriber 41.1 (2018): 20.
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