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Laser Resurfacing Facts You Should Know

What is a CO2 Laser? 

The CO2 laser,(carbon dioxide laser) one of the most commonly used in the field of dermatology.    In the early 1990s, the CO2  laser was considered a major advancement in ablate the epidermis to stimulate collagen production and remodel the underlying dermis.

Today ablative full-face laser resurfacing is still regarded as the gold standard for facial rejuvenation of severely photoaged skin.  (1,5)

The CO2 laser has proven to be effective in the improvement of acne scars in addition to photo rejuvenation. 

“Although laser resurfacing can deliver dramatic results and significant improvement in wrinkles, as well as help smoothen out acne scars, it will not completely eliminate deep wrinkling or severely sagging skin.”  The Naderi Center   

What is the difference between the CO2 Laser and Fractional C02 laser?

The fully ablative CO2 laser was a forerunner of the newer fractional CO2 laser. Both laser procedures are effective.  

CO2 Lasers are generally ablative (some outer layers of skin are removed)  lasers used to treat scars, warts, wrinkles and other deeper skin flaws. Treatment may require local anesthetic injections or intravenous sedation to keep a patient comfortable. (2)  

Unlike full face ablation, CO2 Fractional Lasers break up the laser energy into thousands of tiny beams to treat the skin in a pixilated or segmented fashion.   The fractional laser leaves segments of untreated skin between where it has caused thermal injury.

Given to the fact, the fractional laser leaves some of the skin is intact, the recovery process is quicker and the patients have less anticipated reactions such as swelling and redness.  Generally, the results from one fractional  CO2 lasers are not as dramatic as in the case of one full face ablation.   For example, acne scars or deep wrinkles may need more than one treatment.

CO2 Laser

The ablative approach of CO2 is exceptional for the most severe examples of conditions, including acne scars, rhytides  (a rhytid is a wrinkle in the skin) and other conditions of aging skin. 

There are more risks linked with the CO2 laser and typically, it is much riskier to attempt to treat other areas of the body besides the face.    The limitation of off-face usage may be due to the relative lack of pilosebaceous units in other areas of the body. 

The results from full laser ablative are very effective and patients are usually happy with the end results.  Nevertheless the process is not comfortable, warranting the need for topical anesthesia and sedation.

With the CO2 laser there is a significant amount of downtime.  Ablative lasers can require a 2 to 3 week healing process, depending on depth, before the new skin has completely healed.

During the recovery period, you may experience  severe and unsightly oozing and crusting in the first few days after the procedure followed by the potential unwanted sequelae of prolonged erythema, infection, scarring and herpes simplex lesions.

So for the first 10 days or so, you may want to postpone any social events until your face has recovered. 

“Although laser resurfacing can deliver dramatic results and significant improvement in wrinkles, as well as help smoothen out acne scars, it will not completely eliminate deep wrinkling or severely sagging skin.  (3)

Fractional CO2 Laser

A non-ablative approach with less downtime.  Only a fraction of the top layer of skin is removed.   

I found the reasons why cosmetic surgeons like the fractional CO2 laser so much, are the safety record and profile versus the fully ablative procedure.

Even though additional treatments may be needed to achieve the desired results, many patients opt for the less aggressive fractional CO2 non-ablative procedure, with the much shorter downtime. 

There are additional benefits of the fractional CO2 laser, there are no off-face limitations. 

The fractional CO2 laser can also be used on darker skin types which may not possible with the fully ablative CO2 laser.

 Expect some redness right after the treatment and the redness could last for about 24 hours.  Expect about 3-5 days of downtime before resuming normal activities. The skin will begin to peel and then after 7 days, it will look pink.  After about two weeks, the skin should be completely healed.

While in some cases, a single laser treatment will take care of a patient’s concern; most non-ablative lasers call for a series of treatments to produce the most satisfying results.  (4)

According to studies, the results are typically pretty close to that of the fully ablative CO2 laser resurfacing, but maybe not quite as much improvement when comparing individual treatments with the CO2.  Although the before and after photos I found showed pretty good results. 

The reasons, cosmetic surgeons like the fractional CO2 laser so much is because it has a better safety record and profile versus that of the fully ablative laser. 

The fractional CO2 laser can effectively treat:

  • Fine lines
  • Loose skin on the face
  • Wrinkles
  • Sun damage
  • Acne scars
  • Age spots
  • Pigmentation issues
  • Surgical scars
  • Brow lift
  • Laser eyelid lift
  • Diseases of the toenail, such as onychodystrophy,  and the often extremely painful ingrown toenail (5)

Before and After photo of a   a single fractional CO 2 treatment for acne scarring

 

 

Before and After photo of a patient who received a single fractional CO 2 treatment for acne scarring

  Dr Davin Lim

 

 

 

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999431/
(2)  https://www.americanboardcosmeticsurgery.org/skin-resurfacing/the-top-8-things-you-need-to-know-about-laser-skin-resurfacing/
(3) https://www.virginiafacialplasticsurgery.com/procedures/co2-laser 
4)   https://www.americanboardcosmeticsurgery.org/skin-resurfacing/the-top-8-things-you-need-to-know-about-laser-skin-resurfacing/
(5)   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527843/


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