Fractional CO2 Laser: What It Treats, Downtime and Who Should Avoid It

What is fractional CO2 laser?

A CO2 (carbon dioxide) laser is an ablative laser: it removes the outer layer of skin and heats the layer beneath, which prompts the skin to grow new collagen as it heals. “Fractional” means the laser treats many narrow columns of skin and leaves the skin between them untouched.

Because much of the skin is left intact, less skin is injured than with older resurfacing that treats the whole surface. Cleveland Clinic explains that the skin tightens as the collagen between the treated columns contracts.

CO2 isn’t the only kind of resurfacing. Non-ablative lasers heat the skin without removing its surface and need little or no downtime, and erbium lasers are another resurfacing option. Your doctor will say which suits your skin and your concern.

What can a CO2 laser treat?

Laser resurfacing is used to soften the look of scars and wrinkles, even out skin colouring and tighten skin. According to Cleveland Clinic, people who may suit it include those with:

• scars from acne or chickenpox
• fine lines or wrinkles around or under the eyes, on the forehead or around the mouth
• sun-damaged skin
• uneven pigmentation and age spots
• enlarged oil glands on the nose

For acne scars, the American Academy of Dermatology (AAD) explains that as skin heals after laser resurfacing, it makes collagen and elastin, which can make scars less noticeable. For a different laser approach, read about pico laser for acne scars. If dark spots are your main concern, read our separate guide on which laser suits pigmentation.

CO2 lasers have also been used for some benign growths, such as warts and birthmarks. Have any growth or spot checked by a doctor first: the AAD points out that what looks like a harmless age spot could be a skin cancer.

Who should avoid CO2 laser, or wait?

Some people are not good candidates for laser resurfacing, and others need to wait or prepare first. Cleveland Clinic lists active acne, very dark skin, deep wrinkles and excess or sagging skin as reasons resurfacing may not be the right choice.

Tell your doctor, and expect to wait or prepare, if you have:

• Active acne. The AAD says scar treatment usually starts once acne is under control.
• Very dark skin. The risk of pigment changes is higher (see the next section).
• Deep wrinkles or loose, sagging skin. Resurfacing may not be the right tool for these.
• A history of cold sores or shingles in the area. You may be asked to start antiviral medicine before treatment.
• A recent tan. Cleveland Clinic advises avoiding tanning and heavy sun for four weeks before.
• Acne medicines, now or recently. Starting some scar treatments while using, or soon after stopping, certain acne medicines can cause unwanted side effects.
• Any medicines, supplements or skin products. Some medicines make the skin more sensitive to laser light, so tell the doctor about everything you use.

Is CO2 laser safe for darker or Asian skin?

CO2 laser can be used on darker skin, but the risk is higher. People with medium to darker skin tones have a greater chance of healing with darker patches, called post-inflammatory hyperpigmentation (PIH), and more rarely with lighter patches (hypopigmentation).

The AAD says lasers can be used on all skin types, but darker skin is more prone to burns and dark marks after laser treatment. It advises working with a doctor who has experience treating darker skin with lasers, so ask how often your doctor treats skin like yours.

Sun protection lowers the risk. Cleveland Clinic recommends broad-spectrum sunscreen for weeks before and after treatment to help prevent pigment changes. If dark patches do appear, a lightening cream may be used. The AAD notes that a dark spot a few shades darker than your natural colour usually fades within 6 to 12 months once the cause stops, while discolouration deep in the skin can take years.

There are other routes too. Cleveland Clinic says erbium resurfacing causes fewer side effects than CO2 and may be a good choice for darker skin, and your doctor may suggest a non-ablative option instead.

What is the downtime after fractional CO2 laser?

Plan for about a week before you feel ready to go out with camouflage makeup, and expect some pinkness for weeks or months after that. Cleveland Clinic gives one full week of recovery for fractional laser resurfacing, and many people stay home for the first few days.

Healing time depends on the depth of treatment. Cleveland Clinic says treated areas generally heal in 5 to 21 days, depending on the condition treated and the laser used, and redness can take up to a year to disappear fully in some people. The deeper the treatment, the longer the recovery.

What are the side effects and risks of CO2 laser?

Redness, swelling, itching and stinging are expected for a few days after treatment. Other possible effects include:

• milia, small white bumps that can appear while the skin heals
• darker patches (PIH) and, more rarely, lighter patches
• cold sore flare-ups, especially when the area around the mouth is treated
• infection
• scarring, which is rare, but more of a risk with fractional CO2 because it reaches deeper into the skin than other lasers

The AAD says the results of a laser procedure depend largely on the skill of the person performing it. However tempting, never scratch or pick at crusts, as this can cause scarring or infection.

How do you prepare for CO2 laser, and how do you care for your skin after?

Your doctor’s instructions come first. Cleveland Clinic’s general guidance looks like this.

Before treatment:

• avoid tanning and heavy sun, and use broad-spectrum sunscreen every day for four weeks before
• avoid deep peels, other laser resurfacing or dermabrasion for four weeks before
• tell your doctor about cold sores, shingles, medicines and supplements
• you may be asked to apply a retinoid for about four weeks beforehand, so follow your doctor’s plan rather than starting one yourself

After treatment:

• clean the skin as instructed and keep it moist with the ointment you’re given
• don’t scratch, pull peeling skin or pick crusts
• avoid strong actives such as tretinoin or glycolic acid for four weeks, and other irritating products for six weeks
• avoid activities that make you flush for two weeks
• once healed, use a broad-spectrum sunscreen with SPF 30 or higher every day

In Malaysia, the sun is strong all year, and healing skin darkens easily, especially if you have medium to darker skin. Plan for shade, a hat and sunscreen on every outing, including short trips, until your doctor says the skin has fully settled.

CO2 laser or pico laser: which is right for you?

They are different tools. CO2 is a resurfacing laser with about a week of downtime, used mainly for texture, scars and lines. Pico laser works in a different way, so people with acne scars or dark spots often weigh the two up. Read how pico laser and CO2 laser compare for the full picture, and let your doctor advise which fits your skin and how much time off you can take.

When will you see results, and how long do they last?

Your skin looks smoother as it heals, and Cleveland Clinic says it may keep improving for up to a year. The improvement may last several years, but normal ageing carries on and new lines will form over time.

Results vary from person to person. For acne scars, Cleveland Clinic says scars may not disappear completely, but most treatments make them smaller and less visible. Your doctor will consider the type and number of your scars, your age and your skin tone when planning treatment.

What affects the cost of CO2 laser in Malaysia?

The cost depends on what is being treated and how. The main factors are:

• the concern and the size of the area treated
• how deep the treatment is
• how many sessions your doctor recommends
• numbing or pain control
• aftercare products and follow-up reviews

Ask what the fee includes and whether anything is charged separately, so you can compare plans fairly.

Is fractional CO2 laser right for you?

Fractional CO2 laser can soften acne scars, fine lines and rough texture, but it asks for about a week of downtime and careful sun protection afterwards, and it carries a higher risk of dark marks in darker skin. At Westwood Clinic, a doctor assesses every patient before any treatment is suggested, so you’ll know whether CO2 or another option suits your skin. Read about CO2 laser treatment at Westwood Clinic, then find your nearest Westwood Clinic outlet to book an assessment.