What is a CO2 laser and what does it do?
Fractionated carbon dioxide (CO2) lasers are one of the greatest advances in non-surgical skin rejuvenation treatments. The CO2 laser has the longest wavelength of all lasers on the market and can also be used without hesitation on darker skin types with appropriate adjustments to the settings. Certain fractional erbium lasers can also produce similar results.
Fractional CO2 lasers are excellent for treating deeper wrinkles, more serious structural changes from sun damage, wrinkles, blemishes, acne scars, and surgical or traumatic scars. It can be used on the delicate skin of the eyelids and around the mouth. It is also a very effective treatment for sun damage and pre-cancerous growths (actinic keratoses – note that this is not covered by insurance).
It can be used to improve texture, wrinkles and blemishes on the neck and chest, but this should only be done by experts as there is a higher risk of complications, including scarring, in these areas.
What is it doing NOT do? It doesn’t address redness including dilated blood vessels (telangiectasia) or the reddish patchy discoloration on the neck (poikiloderma). Temporarily, these problems may even be made worse because the laser treatment itself causes some redness while healing. For redness and vein issues, a medical (not salon) BBl/IPL or a pulsed dye laser like a Candela is more effective.
Therefore, the question of which fractional laser system to choose is important. As a consumer, how do you find out? First, find a reputable cosmetic dermatologist or plastic surgeon (see Finding a Good Doctor section). Good equipment in inept hands won’t help you!
How does the fractional CO2 laser work?
The fractional CO2 laser takes the CO2 laser beam and fractionates it. This means that one ray becomes thousands of tiny rays of light. These tiny rays of light penetrate into the deeper layers of the skin. The skin then repairs these tiny ripples by pushing out the old sun-damaged skin and replacing it with new skin. The “collateral” heat damage also helps shrink existing collagen.
Can I combine the fractional CO2 laser with other cosmetic treatments?
It can be performed by experts on the same day with specific BBL/IPL treatments or radio frequency (RF) treatment. The CO2 laser is compatible with Botox, Juvederm, Restylane, Sculptra and other laser based technologies such as hair removal, Fraxel Restore, IPL, pulsed dye, etc. with the right timing.
How long does the effect of fractional CO2 resurfacing laser treatment last?
That depends on how well you protect your skin from the sun and other aging factors like your general health, smoking, weight changes, etc. By putting on sunscreen and wearing a brimmed hat, you can keep the good effects of your CO2 laser treatment for years.
When do I see results?
Remember that fractional CO2 laser can be customized. Treatments can be deeper, with more healing and downtime, or shallower, with less healing time. The deeper the treatment, the better the results in general. However, some patients prefer two treatments that are not as deep so they can avoid a lot of downtime.
You will see some immediate results but you will not see the full results for 3-6 months. After your skin has healed, which can take up to 3-14 days, there is a period of 4-6 weeks after that when your skin may be slightly pink. During this time, your skin will feel smoother and look less blotchy. As the color returns to normal, you’ll see fewer lines, fewer spots, and more shine.
How much do fractional CO2 laser treatments cost?
Costs vary depending on where you live (New York is more expensive than Seattle), the office you go to, and the size of the area being treated. Count on full face treatments between 4,000 and 8,000,000. During your consultation, you will receive a specific cost estimate from your dermatologist. In general, up to 2 areas can be treated at the same time. For example, face and neck or neck and chest would have different prices. In some situations it is safe to work three areas, but this will be determined at your consultation.
How are fractional CO2 laser treatments performed?
This is a prototype treatment for our practice. Other offices will be different so ask around and don’t just assume it’s the same! You must arrive 1½ hours before your treatment. You or a technician will clean the treatment area and then apply a numbing cream to the area to be treated. We also have our patients take the anti-inflammatory Toradal, which helps relieve discomfort. Then just relax, read and listen to music while the numbing cream takes effect.
After about an hour of anesthesia, the anesthetic gel is removed. The treatment takes about an hour for a full face and feels a little like tingling. During the treatment, a strong stream of cold air (a room cooler) is blown onto the area to make it comfortable. Complaints range from mild to moderate (2-4/10). Plan a total of 2 ½ to 3 hours in the office.
Most people drive to and from their own fractional CO2 laser appointments. Offices differ in this. Some practices use mild narcotics or anti-anxiety medication that others may have to drive to after treatment.
How does this laser work on acne scars and other scars?
CO2 lasers have always been very effective for acne and other scars, and fractional CO2 is no exception. See an expert if scars are your problem.
Are Eyelid Treatments Safe?
Yes, because special laser “contact lenses” are used to protect the eyes. Do not let anyone perform directly on the eyelids without these treatments. Numbing eye drops are put in the eye before a contact lens-like eye shield is put in. A protective ointment on the side of the eye pads the special shield. The shield fits comfortably in the eye and is easily removed at the end of treatment. Even our patients who do not wear contact lenses feel comfortable.
The eye treatment is then performed on the upper and lower eyelids. It is normal (as with all fractional CO2 laser treated areas) to experience swelling and redness for 2-4 days after treatment. You must also avoid any sun exposure during the healing period. Allow 2-3 weeks to be “camera ready”.
What will I look like right after the treatment and how long will it take to heal?
Follow your dermatologist’s instructions. For the first 24 hours after treatment, your skin may feel like it has been sunburned. Ice packs/frozen peas can be used 5-10 minutes per hour for the first 5-6 hours after treatment.
Your skin will peel for 2-7 days and will be pink for 1-6 weeks. This healing depends entirely on how deep your treatment is. After a week or so, you can apply makeup to cover the pink. Rarely, bruising can occur, which can take up to two weeks to clear up. To be safe, allow 2-4 weeks for weddings, reunions, family photos, etc. Allow longer for body areas such as arms or legs. Infections cause the redness to last longer.
Can I get back to work and activities immediately?
No, you must take the rest of the day off to ice and groom the treated area. For the lighter fractional CO2 treatments you will need 3-5 days of downtime. Allow 7-10 healing days for the more in-depth treatments before going public. Please follow the advice of your dermatologist.
Are there reasons not to be treated with these lasers?
Reasons for not doing fractional laser treatment may include use of medications that increase photosensitivity, use of anticoagulants (some are fine), use of Accutane during 6 months of chemotherapy, history of difficulty healing or scarring, history bleeding disorders and pregnancy. Your doctor will discuss these with you.
Are there any medical or cosmetic side effects?
A good dermatology practice with experience in lasers is the best way to avoid complications. And complications are generally rare. But here is a list of the most common side effects. Your doctor/nurse should go through these, explain them and answer questions.
- Pains. Most people experience very little pain during treatment due to the above measures. Rarely is there slight discomfort on the first day after surgery, but Tylenol is effective for this.
- redness. A pink color may persist from two weeks to six months after laser surgery. In rare cases, it can take three to six months. This is more common in patients who have a history of flushing easily or who already have dilated vessels on the skin’s surface.
- wound healing. The CO2 laser creates a superficial wound on the skin that takes about 2 to 10 days to heal. Superficial injury to the outer layers of skin can cause mild to moderate swelling. Crusting is rare, but peeling is common. After treatment, the surface may be sensitive to the sun for about 4-6 weeks.
- pigment changes. The treated area may heal with increased or decreased pigmentation. This is rare and is most common on darker skin and occurs 2-6 weeks after treatment. Hyperpigmentation usually fades in three to six months, although pigment changes can rarely be permanent
- infection. Occasionally infections can occur. If not treated promptly, these can lead to scarring.
Hope that helps!
dr Brandith Irwin, MD
Founder of SkinTour & MadisonMD Skincare
Follow my skin tips and trips on Instagram!