C02 Lasers

C02 Laser Ablative Skin Resurfacing

Carbon Dioxide (C02) Laser systems are ablative laser systems that are commonly used for laser resurfacing procedures. CO2 Lasers are popular treatments for moderate to severe acne scars. C02 Lasers are capable of penetrating deep into the skin and underlying tissue. C02 Lasers are available at higher fluences (power) than many other laser systems used in dermatology and cosmetic surgery.

How Do CO2 Lasers Work?

Fractional C02 Laser Treatment in Progress
Fractional C02 Laser Treatment in Progress

Carbon Dioxide (CO2) Lasers use a gas mixture that contains about 20% carbon dioxide as the lasing medium. C02 lasers generate an intense laser beam in the far infra-red spectrum (~10,000 nm). Energy from a CO2 Laser beam is strongly absorbed by water. Because cells are composed mainly of water, they are quickly heated or ablated (vaporized) by CO2 laser treatment.

Fractional CO2 Laser Resurfacing Closeup and Histology (Gotkin)
Fractional CO2 Laser Resurfacing Closeup and Histology (Gotkin)

The ability to penetrate into the supportive tissue underneath the skin surface makes CO2 Lasers a preferred choice for ablative laser resurfacing treatments, such as the repair of skin damage associated with moderate to severe acne scars. The C02 laser penetrates more deeply than the Er:YAG laser (which is another popular laser system for acne scar treatment), and CO2 Lasers are the preferred modality for deep-seated acne scars. CO2 Lasers directly destroy (ablate) scar tissue, which allows new healthy tissue to regrow in the treated area. The process of laser ablation of tissue is called photothermolysis.

CO2 Lasers and Acne Scars

Fractional CO2 Acne Scar Treatment Before and After 2 (Cho)
Fractional CO2 Acne Scar Treatment Before and After 2 (Cho)

Carbon Dioxide (CO2) lasers can be an effective treatment for many types of facial acne scars. In general, both physician and patient satisfaction with the results of CO2 Laser resurfacing are good. For patients with moderate to severe acne scarring, multiple treatments are often necessary to achieve maximum improvement in the appearance of the skin. This is especially true for acne scars around the temple and the middle of the cheeks because these regions tend to respond less favorably to laser resurfacing than other areas of the face.

Improvement in Acne Scars in Different Regions of the Face After C02 Laser Treatment - Ratings by Patients and Physicians (Trimas)
Improvement in Acne Scars in Different Regions of the Face After C02 Laser Treatment – Ratings by Patients and Physicians (Trimas)

Ablative CO2 Laser resurfacing treatments are among the most popular and effective methods for repairing acne scars. Treatment is applied to the entire scarred area. In addition to ablating scar tissue and encouraging the regrowth of healthy skin tissue, CO2 Lasers can be used to shape large acne scars in order to reduce their appearance.  CO2 Lasers can be used to ablate the edges and ridges of large scars, which creates a gentler slope and minimizes the apparent depth of the scar. CO2 Laser systems allow for more precise control of the treated area than many other skin resurfacing technologies (eg. Microdermabrasion and Chemical Peels).  CO2 Laser resurfacing can also tighten the skin by inducing the contraction of the dermal collagen, which causes scars to appear flatter and less noticeable.

Complete vs Fractional CO2 Laser Resurfacing

Ablative vs Nonablative Laser Resurfacing Diagram
Ablative vs Nonablative Laser Resurfacing Diagram

CO2 Lasers can be used for either complete resurfacing or fractional resurfacing. Complete resurfacing treats all of the tissue in a given area, while fractional resurfacing pixelates the laser beam and leaves small regions of untreated skin between the regions of treated skin.

Frequency of Side Effects After Fractional CO2 Laser Resurfacing (Gotkin)
Frequency of Side Effects After Fractional CO2 Laser Resurfacing (Gotkin)

Fractional CO2 laser treatments (eg. Fraxel) are very popular because they tend to have fewer side effects and require shorter healing times than complete resurfacing. Possible side effects of CO2 Laser resurfacing include complications such as edema, prolonged erythema, scarring and hyperpigmentation. Both complete and fractional CO2 treatments have risks of these side effects, although they are substantially higher with complete resurfacing. Patients with darker skin tones appear to be at higher risk of certain types of of side effects (eg. hyper- and hypo- pigmentation) after CO2 resurfacing.

Another advantage of fractional CO2 treatment is that it is safer for higher-power (more aggressive) treatment protocols that ablate tissue to greater depths. This can be helpful for the treatment of deep-seated acne scars.

Fractional CO2 Treatment of Facial Acne Scars Before and After (Walgrave)
Fractional CO2 Treatment of Facial Acne Scars Before and After (Walgrave)

According to many clinical research studies, the effectiveness of fractional CO2 laser resurfacing for acne scar treatment is comparable to traditional complete resurfacing. Many fractional CO2 Laser systems are now commercially available, and complete CO2 resurfacing is no longer a common procedure in most places. Although they are safer, fractional CO2 systems generally require significantly more treatment sessions than complete CO2 resurfacing to achieve the same level of improvement.

How and Where is CO2 Laser Treatment Administered?

Potential Side Effects of Fractional CO2 Resurfacing - Erythema and Scarring (Fife)
Potential Side Effects of Fractional CO2 Resurfacing – Erythema and Scarring (Fife)

CO2 Lasers are agressive laser resurfacing technologies that can cause significant and permament skin damage if used improperly. They may also require the use of anesthetics. Because of this, CO2 resurfacing procedures are generally only available in a specialized clinical settings.

CO2 Laser treatment of acne scars is a complicated procedure that tends to be substantially more expensive than many other types of Light and Laser Treatments used for acne or acne scars. In general, CO2 Laser resurfacing of the face tends to cost between $750 and $2500 per session. Effective fractional CO2 treatment of acne scars generally requires 2-6 sessions depending on the specific treatment area, types of acne scars and their severity.

Popular CO2 Laser Systems

Active FX, Affirm CO2, Deep FX, Fraxel Re:pair, Juvia CO2 Fractional, Mixto SX, Mosaic, Pixel CO2 OMNIFIT, Sharplan, SmartXide, Ultra-30 Plus, Ultrapulse.

CO2 Laser Resurfacing Images


CO2 Laser Resurfacing Patient Reviews @ RealSelf
CO2 Lasers @ Wikipedia
A clinical and histologic comparison of electrosurgical and carbon dioxide laser peels. Acland, et al. 2001.
A Prospective Survey of Patient Experiences After Laser Skin Resurfacing. Batra, et al. 2003.
Ablative Skin Resurfacing With a Novel Microablative CO2 Laser. Gotkin, et al. 2009.
Carbon Dioxide Laser Abrasion. Trimas, et al. 2000.
Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars. Kim. 2008.
CO2 Laser Physics and Tissue Interactions in Skin. Fulton, et al. 1999.
Complications of Fractional CO2 Laser Resurfacing: Four Cases. Fife, et al. 2009.
Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. Manuskiatti, et al. 2009.
Evaluation of a Novel Fractional Resurfacing Device for Treatment of Acne Scarring. Walgrave, et al. 2009.
Fractional photothermolysis—an update. Allemann, et al. 2010.
Laser Punch-Out for Acne Scars. Koo, et al. 2001.
Laser Resurfacing: Usual and Unusual Complications. Rendon-Pellerano, et al. 1999.
Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Jordan, et al. 2000.
Long-Term Efficacy of a Fractional Resurfacing Device. Ortiz, et al. 2010.
Successful Treatment of Acneiform Scarring With CO2 Ablative Fractional Resurfacing. Chapas, et al. 2008.
The Efficacy and Safety of 10,600-nm Carbon Dioxide Fractional Laser for Acne Scars in Asian Patients. Cho, et al. 2009.
The principle of a three-staged operation in the surgery of acne scars. Whang, et al. 1999.
The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars. Alster, et al. 2007.