CO2 Laser Recovery: A Unique Experience, but Is It Worth It?

The carbon dioxide laser, or CO2 laser, is an ablative surgical instrument. It cuts the surface of the skin, allowing it to remove mass lesions or correct minor blemishes efficiently. The post-treatment period can disrupt your routine for a significant amount of time. But experts prefer to use it for skin resurfacing over other laser types because of its distinct advantages. Is CO2 laser treatment worth it? Find out as we explain the basics of the procedure and what you can expect during the recovery process.

What Happens During CO2 Laser Surgery? 

You will be asked to put on protective eyewear at the start of your session. Your doctor will then clean up the surgical site. CO2 laser creates shallow, open wounds in the problem area, so you will need numbing medication during the procedure. Local anesthesia usually suffices, but patients with large blemishes may need to add an oral sedative or be given some other form of pain management. The equipment emits powerful light beams in the far-infrared spectrum, which selectively target the water molecules in the skin’s outermost layers. Vaporizing the water in this region does the same to the surrounding tissue, effectively stripping off the skin’s surface. The injury induces significant inflammation, resulting in vigorous tissue repair and renewal. Dermatologists can use the instrument to cut out skin lumps or treat aging or damaged skin. The procedure is indicated for a wide variety of skin issues, including the following:

• Sun damage
• Acne scarring
• Fine and coarse wrinkles
• Brown spots
• Benign growths like seborrheic keratoses
• Stretch marks
• Warts
• Lesions with prominent blood vessels, etc.

CO2 laser resurfacing sessions generally take less than an hour, but the treatment of widespread lesions may take longer. The local anesthetic usually sets in 30 minutes after injection. Most patients need only one session, but those with severe skin problems may require more. 

How Does the CO2 Laser Compare to the Er:YAG Laser?

The erbium-doped yttrium aluminum garnet (Er:YAG) laser, also called “erbium laser,” is also an ablative type. But its light beams are even more selective for water in the superficial skin layers, allowing more precision in its use. Erbium ablative laser treatment produces less damage to skin cells and, consequently, less inflammation. While studies show that it is as effective as CO2 laser resurfacing, experts believe that the latter still produces better cosmesis. Combining the two techniques reduces inflammation and downtime and yields similar results.

What Is the Difference between Ablative and Nonablative Lasers?

Nonablative laser types include Vbeam and IPL. Their light rays bypass the skin surface and target the structures right underneath. They do not create outer skin defects but injure only the inner layers. They produce much less inflammation than ablative laser resurfacing. Consequently, the cosmetic changes are also gradual and modest by comparison. Generally, it would take more sessions to correct the same skin problem if one used a nonablative than an ablative laser.

What Is Fractional CO2 Laser Surgery?    

Traditional CO2 lasers destroy continuous skin areas. But in a fractional approach, the instrument creates microscopic columns of damaged tissue, leaving intact regions in between. The uninjured zones serve as centers for tissue regeneration and healing. Fractional CO2 laser resurfacing limits skin damage. It hurts less than the conventional kind, so skin cooling or topical anesthesia is enough to manage pain during the procedure. Additionally, the downtime is shorter, and the risk of postop scarring and pigmentation changes is lower. But it is also less effective in treating deeper lesions.  Fractionation may also be done to laser types other than the CO2 laser.   Regardless of the kind, you must choose an experienced dermatologist to perform your laser skin surgery. Only a highly skilled laser dermatologist can give you excellent cosmetic outcomes. But in the hands of a less qualified provider, these complex instruments can do more harm than good. For safe and effective laser treatments, check out our article on finding the right laser specialist.

What Is the Timeline of the Changes after CO2 Laser Skin Resurfacing Treatment?

In the first 1-3 days after the procedure, you will observe significant inflammation of the treated area. Old, damaged collagen strands break down, and immune cells actively clear up tissue debris. Healing of the outer skin surface (re-epithelialization) and deeper, collagenous tissues starts afterward. Closure of the defect is complete by the 14th day postop. Collagen production peaks in the 3rd month, but its strengthening and remodeling can go on for months to years. Skin texture and appearance visibly improve after three months, though it may take up to a year to see the treatment’s full effects. Sagging skin likewise tightens up. With proper care, the enhancements from CO2 laser skin resurfacing can last for years.

What Should You Do to Get the Best Outcomes after CO2 Laser Treatment?

Good aftercare hastens your recovery and helps you get the best cosmetic results. Here’s a list of what you can do to optimize the benefits of CO2 laser skin resurfacing:

• Proper wound care  Unlike their nonablative counterparts, ablative lasers produce skin defects that need special care. Before your session ends, your physician will give you care instructions for the surgical wound. You may be advised to wash the site with water and mild soap after 24 hours. Petroleum jelly is applied afterward, followed by a change of dressing. You may be instructed to replace the bandage with a fresh one at least once daily.

• Minimizing your risk for trauma Trauma to the surgical site is not only painful but also delays your recovery. You may have to restrict your activities for 10-14 days to avoid it. You must also refrain from scratching or picking at the treated area.

• Taking the prescribed postop medications Some patients may be prescribed anti-inflammatory or antimicrobial drugs postop to prevent or treat complications. However, you can remedy some side effects conservatively by minimizing sun exposure, applying an ice pack on the treated site, proper wound care, etc. If your doctor prescribes any postop medications, you must take them as instructed. 

• Abstinence from smoking and drinking Cigarettes and alcohol can delay the skin repair process. You may be advised to avoid them before your surgery and while the postop wound is still in the early stages of healing.

• Eating healthfully and staying hydrated A balanced diet promotes healing. It provides all the nutrients you need to repair the skin.

• Avoidance of harsh chemical treatments, toxins and exposure to dirty surfaces Healing skin is highly irritable and prone to infection. We recommend resuming your skincare regimen only after getting clearance from your dermatologist. Stay away from polluted places and dirty pools and avoid touching your skin with unclean hands.

                                    Laser Wart Removal Aftercare Additionally, call your physician for problems that you think could be related to your surgery. Severe pain, swelling, redness and bleeding are uncommon after CO2 laser skin resurfacing. Postop fever and wound pus indicate the presence of an infection. Widespread rashes and difficulty of breathing could be signs of a serious allergic reaction. You must seek immediate help if you notice any of these symptoms.

Is CO2 Laser Resurfacing Painful?

Nonfractional CO2 laser surgery requires local anesthesia. Sedation and other forms of pain management may be given when treating extensive areas, e. g. full-face skin resurfacing for wrinkles, or if they occur in pain-sensitive regions. By comparison, applying a skin coolant or topical anesthesia is usually enough for fractional laser procedures. Pain during the CO2 laser recovery period is due to inflammation and peaks in the first three days. You may take acetaminophen for moderate pain. But for more pronounced inflammation, you may need anti-inflammatory medications like ibuprofen and steroids. Pain goes away when inflammation subsides.

What Is the Downtime after a CO2 Laser Skin Resurfacing Procedure?

The downtime usually takes two weeks or about as long as the period of re-epithelialization. Advanced age and adverse health conditions can prolong the process. Good aftercare can speed it up. Skin redness may persist for 1-4 months, forcing some individuals to limit their outdoor activities longer. While part of it may be due to an underlying health condition, it may also relate to the laser provider’s technique. Applying topical ascorbic acid, avoiding harsh skin treatments and minimizing sun exposure can reduce its severity. You may use hypoallergenic makeup to conceal the discoloration. Patience is key while recovering from CO2 laser treatment, which takes longer than recovery from other laser procedures. But the robust inflammatory reaction, skin renewal and collagen production it induces lead to superior cosmetic outcomes. For many patients, the stunning transformation is worth the wait.

What Are the Side Effects of CO2 Laser Resurfacing?

Pain, redness and swelling are expected after surgery because of postop inflammation. But they are usually tolerable and resolve spontaneously after a few days. Over-the-counter anti-inflammatory drugs can further reduce these symptoms. Slight bruising may occur in vulnerable patients. It may be remedied by applying an ice pack on the treated area in the first 24 hours postop. Some individuals may also experience itching of the surgical site due to the increased sensitivity of healing skin. Oral antihistamines or mild topical steroids may alleviate it. Complications after CO2 laser skin resurfacing are rare if it is done properly. But they include the following:

• Hypersensitivity Allergic reactions to anesthetics, surgical gloves and wound dressings may occur. Antihistamines and steroids remedy the symptoms. But a laser expert avoids them by taking a good history and making adjustments during the procedure.

• Acne Emollients and wound dressings used postop can trigger a pimple breakout. It can go away on its own once the patient stops these treatments, but severe cases require antibiotics. 

• Milia This condition is marked by small skin bumps, and it may also occur with the use of emollients and wound dressings. It resolves spontaneously by stopping these treatments. 

• Infection Poor surgical technique and non-adherence to the aftercare instructions can predispose patients to bacterial or fungal infection. Microbial contamination can delay wound healing. Antimicrobials are necessary for treatment. Additionally, CO2 laser skin resurfacing can trigger cold sores. Your doctor may prescribe antiviral drugs before and after your session for prevention or treatment.

                 CO2 Laser Resurfacing of Loose Skin

• Hyperpigmentation People with darker skin tones are more likely to observe this. It is temporary, although sunscreen and topical retinoic or glycolic acid may help speed up its resolution. 

• Hypopigmentation This may occur in vulnerable patients months after surgery. Phototherapy can help improve the condition. 

• Scar formation or aggravation A careless surgical approach can worsen a skin blemish. Keloid-prone individuals are highly susceptible. When it happens, Vbeam laser treatment may improve the scar’s appearance. 

• Sagging of the lower eyelid Eyelid surgery can loosen up the structures in the treated eye. CO2 laser skin resurfacing done right after can cause the lower eyelid to turn outward, a condition known as “ectropion.” Surgery can correct the problem, but meticulous history-taking helps a good dermatologist avoid it.

As you can see, the occurrence of complications largely depends on patient attributes and the laser provider’s expertise. While genetic factors like skin type are beyond your control, finding the right laser specialist is not. So make sure that only the best performs your laser surgery.

Is CO2 Laser Treatment Safe for Everyone?

CO2 laser resurfacing treatment is generally safe, but the following conditions can make it unsuitable for some people:

• Susceptibility to keloid formation
• Dark complexion classified as Fitzpatrick V or VI
• Diseases of the connective tissues, immune system, blood or metabolism
• Recent radiation therapy
• Recent isotretinoin treatment
• Recent facelift or eyelid surgery

If you have any of these in your medical history, your doctor may recommend an alternative treatment or delay laser surgery for a set period to avoid complications. Medical clearance may be required if you are receiving treatment for a chronic health condition.  

Considering Getting a CO2 Laser Peel? 

If you have deep or large skin blemishes, CO2 laser skin resurfacing may be suitable for you. It is an ablative procedure, causing significant inflammation by creating open wounds on the target area. The recovery period is longer than that required by other laser treatments, and the aftercare regimen is also a little more time-consuming. But the post-surgical cosmetic transformation is considered superior by experts. When you decide to get this procedure, find a bona fide laser dermatologist to do it. An inexperienced provider cannot handle its intricacies and may put you in harm’s way. But choosing the right specialist helps you ensure the effectiveness and safety of the treatment.

Let LA’s Best Laser Dermatologists Vaporize Those Skin Imperfections

Skin laxity, coarse wrinkles and deep acne scars are just a few problems that do not go away with pills and creams. CO2 laser skin resurfacing is one alternative that can effectively solve these issues, but you need a highly trained medical professional to do it. At BHSkin Dermatology, our laser specialists are some of the best in California. They can get rid of your skin imperfections expertly. Consult with them face to face at our Glendale or Encino office or remotely through our virtual portal. Book your appointment today!

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