The Benefits of CO2 Laser Resurfacing: Reasons Why It’s the Best for Skin Rejuvenation

Many people start their skincare journey with cosmetic products. They’re easy to use, have tolerable or no side effects, and make us feel good overall. However, they take time to work and address only mild skin issues. Additionally, some become ineffective when the skin changes faster than you can treat it.

People serious about their skin health often come to a point when they start considering an in-office procedure. One of the most sought-after is CO2 laser skin resurfacing and for a number of good reasons. This article discusses the benefits of CO2 laser treatment. It also explains how CO2 laser resurfacing works and what to expect from the process.

CO2 Laser Skin Resurfacing—What Is It, and How Does It Work?

Understanding how the treatment works requires knowledge about lasers and their effects on the skin. Simply put, lasers are powerful, narrow-spectrum light beams. In dermatology, carbon dioxide laser, aka “CO2 laser,” is invisible, far-infrared light with a length of 10,600 nanometers generated from carbon dioxide. Water molecules selectively and highly absorb light of such a wavelength.

The epidermis—the topmost layer of the skin—is sensitive to CO2 laser beams. When CO2 lasers hit the skin, the energy heats up and vaporizes epidermal water molecules and, with them, the epidermal cells. In the hands of a skilled laser dermatologist, CO2 lasers can strip off the epidermis with minimal damage to underlying tissues. The CO2 laser is an ablative laser because it removes the skin’s superficial layers.

The following events occur after CO2 laser treatment: 

• Removing the epidermis takes away its imperfections. They include wrinkles, rough areas, pigmentation problems, and superficial scars. 
• The intense laser heat burns away damaged collagen strands and contracts loose collagenous tissue. 
• Stripping off the skin’s top surface alerts the immune system and stimulates inflammatory processes. These events lead to the release of substances that induce the body’s natural repair mechanisms. During the healing process, the epidermal cells grow back and the skin produces more collagen. The deeper skin layers also undergo repair and renewal.

So at the end of your recovery, you’ll notice the following changes:

• The superficial blemishes are gone, while the deep ones are significantly reduced.
• The treated area becomes smoother as the new epidermis replaces the old one. 
• The skin is tighter and firmer due to the contraction and enhanced formation of collagen.

Overall, you get younger-looking, more even-toned skin that you can’t have from years of applying cosmetic products alone.

What Is the Difference Between Fractional and Non-Fractional CO2 Laser Treatment?

Fractional CO2 laser treatment exposes your skin to small, thin columns of laser light instead of wide beams. One pass of the equipment creates multiple micro-sized injuries rather than one continuous area of damaged skin tissue. Fractional lasers reduce heat injury to the skin and its side effects. They also produce multiple mini-repair sites, so recovery is usually faster.

What Skin Problems Can CO2 Laser Resurfacing Treat?

CO2 laser therapy is highly recommended for severely sun-damaged skin, the symptoms of which include the following:

• Fine and coarse wrinkles
• Dyspigmentation and other forms of skin discoloration
• Spider veins
• Loss of elasticity

It is also highly effective in improving the following skin conditions:

• Post-surgical, chicken pox and acne scars
• Stretch marks
• Pigmentation issues like melasma and brown spots
• Rhinophyma or severe pore enlargement of the nose from conditions like rosacea

CO2 laser resurfacing is an alternative treatment option for benign skin growths like actinic keratosis, warts, and moles, as well as superficial non-melanoma skin cancers. Consider this procedure if you have a skin problem unresponsive to other therapies or when facial plastic surgery is contraindicated.

What Are the Biggest Benefits of CO2 Laser Resurfacing?

Knowing how CO2 laser treatment works makes it easier to appreciate its upsides, the most important of which are the following:

1. Superior Cosmetic Results

CO2 laser resurfacing treatment is considered the gold standard for rejuvenating photoaged skin. Its cosmetic outcomes are superior to non-ablative procedures like Vbeam and intense pulsed light. Experts attribute this to its greater ability to induce the skin’s healing response and tighten loose collagen strands.

Fractional CO2 laser resurfacing yields comparable results to the non-fractional technique, but it has the advantage of having an easier recovery period.

2. Great for Multiple Skin Lesions

Clustered skin lesions like wrinkles and acne scars are tough to treat by incisions because they have a greater risk of complications. By comparison, lasers are precise surgical tools. A highly experienced laser dermatologist can easily avoid normal skin tissue and remove multiple lesions safely.

3. Highly Effective Against Severe Skin Issues

A gentler skin treatment like a night cream or microdermabrasion won’t have any effect on deeper wrinkles and scars. They do not penetrate the skin deeply enough or stimulate a response in the inner skin layers. Meanwhile, CO2 laser treatment not only peels away visible lesions but also kickstarts repair mechanisms, effectively improving skin texture and tone.

4. Longer-Lasting Cosmetic Effects

One of the best things about CO2 laser treatments is that they get rid of skin lesions for good, but you must address the underlying cause. Religious skin care and sun protection keep the skin lesions from coming back after this procedure. 

5. Fewer Sessions 

CO2 laser treatments produce dramatic changes. Most patients need only one session to see results unless the lesions are widespread or they respond poorly. Consider this procedure, especially fractional laser treatment, if you have a busy schedule.

Additionally, if you have a complex skin condition, you can safely combine CO2 laser resurfacing with other procedures. For best results, entrust your skin treatments only to a highly experienced, board-certified dermatologist.

What Can You Expect During Your CO2 Laser Treatment Journey?

During your initial consultation, your skin care specialist will give you a complete medical evaluation to see if this procedure is right for you. If they think you’re a suitable CO2 laser treatment candidate, they’ll schedule you for an appointment. Your specialist will also give recommendations to prepare for your session.

Before Your Session

Good preparation is crucial in preventing complications after the procedure. Your laser dermatologist may advise the following:

• Stop skin-sensitizing treatments that increase your risk of laser burns. They include hydroxy acids, oral isotretinoin (Accutane), and some acne antibiotics like minocycline.
• Avoid drugs and supplements that can interfere with the wound-healing process. They include blood thinners, ibuprofen and similar painkillers, steroids, vitamin E, and many others.
• Abstain from smoking and drinking, which can also disrupt the skin’s repair mechanisms.
• Start using sun protection regularly. Avoid tanning beds and sun exposure, which increase the risk of post-inflammatory hyperpigmentation (PIH).
• Take a cold sore medication, as the procedure can trigger a relapse.
• A few weeks of topical tretinoin or hydroquinone pre-treatment to help speed up recovery and prevent PIH.

Cleanse your face and leave it makeup-free before coming in for your appointment.

During Your Session

At the start of your procedure, your specialist will ask you to change into a comfortable patient gown and wear eye protectors. Once you get settled down, they will use numbing medication in the treatment area. After about 30 minutes, they will apply the laser in pulses. 

Your session may last about 1-2 hours, depending on the extent of the treatment area. Most patients are awake or mildly sedated throughout the procedure and feel little to no pain. 

After Your Session

Once done, your specialist will clean up the treated skin and apply a thick layer of ointment to it. In some cases, they may use an airtight dressing to protect the area. The doctor will send you home with aftercare instructions. You may have a companion assist you when you leave the clinic.

The downtime depends on the procedure and the extent of the treatment area. Non-fractional CO2 laser treatments result in significant inflammation. The skin heals in one or two weeks, but some patients may experience redness lasting several weeks to months. By comparison, the recovery after fractional laser resurfacing ranges only from four to ten days due to less inflammation.

Aftercare

Post-treatment care regimens after CO2 laser treatments widely vary among practitioners. Yours may recommend the following:

• Remove any dressings after 24 hours. Replace as instructed.
• Cleanse the treated skin twice daily or as instructed. If you’re not advised to dress it, you must keep it moist with a thick layer of ointment throughout the day to prevent scabbing. Do this until the skin closes up.
• Some practitioners advise vinegar soaks several times a day while the skin has not healed over. Doing so protects the area from microbes. Others choose to prescribe an oral antimicrobial as an alternative.
• Protect the skin from trauma, pressure, and irritants while it’s actively healing. Skin under repair is highly irritable and may scar or develop pigmentation problems if without protection. 
• For pain relief, you may apply ice packs throughout the day or take acetaminophen.
• Sleep with your head upright in the first few nights after your session. This prevents swelling, oozing and heavy pressure on the treated area.
• Use hats and other physical forms of sun protection in the first three or four weeks after the procedure. Once the skin heals fully, you may start applying a gentle sunscreen formulation. 
• Avoid alcohol and cigarettes while the skin hasn’t completely closed up.
• You may start using mineral makeup a week after the skin heals or as advised by your specialist.

Follow your dermatologist’s aftercare instructions meticulously to avoid complications and speed up your recovery.

Timeline of Skin Changes After CO2 Laser Skin Resurfacing

In the first few days after your procedure, you will notice inflammation of the area. This is a normal part of the healing process, though it can be uncomfortable. Remember that the treated skin has no protective barrier at this time. The typical symptoms are burning pain, redness, and swelling, which will go away spontaneously. Skin repair begins at the end of this phase.

After a week or two, the skin will close up in a process called “re-epithelialization.” You will see the epidermis growing back, completely covering the treatment site.

Collagen production begins to pick up as soon as the repair process starts. It will peak in the third month, by which time you will see a significant improvement in skin texture. Sagging areas and other skin imperfections will continue to improve for several months up to a year due to sustained collagen remodeling.

Risks of CO2 Laser Resurfacing

No treatment is completely risk-free, no matter how good the outcomes are. In the case of CO2 laser surgery, the most common side effects are swelling, pain, and redness, which are all normal reactions to the procedure. As previously mentioned, these symptoms will resolve on their own after a few days.

The following are some of its possible complications:

• Laser burns—may occur if the equipment is not set up properly or the patient has overly sensitive skin.
• Acne and small, white lumps called “milia”—develop as a reaction to dressings and ointments.
• Contact dermatitis—manifests as an itchy rash that forms in reaction to cleansers, moisturizers, and topical medications used during recovery.
• Persistent redness—prolonged inflammation that can occur when the wrong laser settings are used.
• Pigmentation problems—patients with darker skin tones are more prone to PIH. Hypopigmentation has also been observed in some individuals.
• Infection—either bacterial, fungal, or viral. Treated skin doesn’t have an intact barrier during the active healing phase and is vulnerable to microbes.
• Scarring—may occur in susceptible individuals or when the provider doesn’t perform the procedure properly.
• Aggravation of lower eyelid surgery—the eyes’ supporting structures weaken after blepharoplasty (eyelid surgery). CO2 laser treatment near the area can worsen it.
• Visual problems—may occur if the eyes are not protected during the procedure.

The contraindications of CO2 laser treatment include the following:

• Active infection or inflammation in the treatment site
• Ongoing oral isotretinoin therapy
• A history of bad scarring
• Skin of color with a positive CO2 laser spot test and is, thus, PIH-prone
• Conditions associated with poor healing, such as collagen disease, diabetes mellitus, immune problems, malnutrition, and others
• Recent UV exposure or chemical peel

You can minimize these risks by following the pre- and post-treatment recommendations carefully and choosing a bona fide laser expert to perform your procedure.

Zap Away Sun Damage and Other Lesions Effectively

If you have photoaging symptoms or any skin concern unresponsive to at-home therapies, it may be time to consider CO2 laser resurfacing. The treatment effectively and safely corrects various skin issues and evens skin tone and texture. Most patients need only one session, and its cosmetic effects last long. Fractional laser treatment reduces inflammation and downtime while producing results comparable to its non-fractional counterpart.

Book Your Appointment Today! 

Lastly, to get the most from your CO2 laser procedure, trust only a highly-trained, board-certified dermatologist to do it. Only a real laser expert can ensure the safety and effectiveness of your treatment. At BHSkin Dermatology, you can expect to get that guarantee as well as a satisfying therapeutic experience. 

Book your appointment today! 

References:

1. Alexiades-Armenakas, MR, et al. The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing. Journal of the American Academy of Dermatology. May 2008.
2. Gaitan, S and Markus, R. Anesthesia Methods in Laser Resurfacing. Seminars in Plastic Surgery. August 2012.
3. Gushiken, LFS, et al. Cutaneous Wound Healing: An Update from Physiopathology to Current Therapies. Life. July 7, 2021.
4. Hunzeker, CM, et al. Fractionated CO2 Laser Resurfacing: Our Experience with More Than 2000 Treatments. Aesthetic Surgery Journal. July 1, 2009.
5. Kaur, RR, et al. Achieving hemostasis in dermatology—Part 1: Preoperative, intraoperative, and postoperative management. Indian Dermatology Online Journal. April-June 2013.
6. McIlwee, BE and Alster, TS. Chapter 209: Laser Skin Resurfacing: Cosmetic and Medical Applications. Fitzpatrick’s Dermatology, 9th edition. 2019.
7. Preissig, J, et al. Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Seminars in Plastic Surgery. August 2012.
8. Ramsdell, WM. Fractional Carbon Dioxide Laser Resurfacing. Seminars in Plastic Surgery. August 2012.
9. Verma, N and Yumeen, S. Ablative Laser Resurfacing. StatPearls. April 23, 2023.
10. Ziai, K and Wright, HV. Carbon Dioxide Laser Rejuvenation of the Facial Skin. Clinics in Plastic Surgery. August 2022. 

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online