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CO2 LASER

WHAT IS THE CO2 LASER?

The first laser designed to resurface skin, the CO2 treats wrinkles, discoloration, sun damageage spots, and scars, including acne scars and stretch marks. It works by directing short, concentrated beams of laser that vaporize skin by targeting water molecules. This removes damaged skin in a very precise (read: safe) manner and causes the regrowth of younger-looking superficial skin of the epidermis. Simultaneously, it stimulates collagen production in the deeper dermal layer, minimizing deeper wrinkles, acne scars, and tightening saggy skin.

There are two kinds of CO2 laser: fully ablative and fractional or fractionated CO2. 

  • The fully ablative CO2 laser strips away all of the superficial skin (i.e., epidermis) while heating the deeper dermal layer to ramp up collagen production. The results can be dramatic, but the procedure may require anesthesia and sedation and can involve significant downtime (think weeks to months).
  • A fractional CO2 laser is a newer technology that targets only a part of the skin’s surface, focusing the beam in a series of patterned, pixelated dots reminiscent of a dot matrix printer. Impacting some parts of the skin and leaving others intact speeds healing time and reduces the risk of complications. Fractional CO2 laser resurfacing produces wonderful and dramatic results .The fractional CO2 laser can also be performed in a more aggressive ablative mode for acne scars, lines, wrinkles, and for more aggressive skin tightening, or it can be used in a micro ablative mode for complexion quality, pores, and sun damage.”

The ideal CO2 laser candidate has clear, acne-free skin and a light to medium skin tone (Fitzpatrick scale: 1 to 3 for light skin). Any type of CO2 laser can cause hyperpigmentation on olive or brown skin (Fitzpatrick scale: 4 to 6 for dark skin tone).

WHAT ARE THE PROS AND CONS OF THE CO2 LASER?

Pros (fully ablative)

·       Is an effective option for treating fine lines, wrinkles, hyperpigmentation, scars, and mild laxity. 

·       It delivers more consistent, precise, controlled results than a chemical peel or dermabrasion.

·       For fully ablative lasers, only one treatment suffices per year. For fractional, you may want to have a procedure every quarter and see the results. 

Cons 

·       Patients who have dark skin or active acne may not be good candidates.

·       Risk include hypopigmentation, scarring, cold sore flare-ups, or (very rarely) ectropion, a turning of the eyelid.

·       You will need considerable healing time (ie weeks to months). Your skin may be ‘weepy’ (raw and oozing) for up to two weeks, and the entire area can take many weeks to heal. 

·       You’ll have increased sun sensitivity for up to a year.

·       Redness may persist for weeks to months (but can be treated with vascular lasers or oxygen facials; ask your doctor about Pulsed Dye LaserLaser GenesisIPL, or Excel V).

·       You may see a line of demarcation where the treatment area ends.

Pros (fractional)

·       Less invasive and painful compared to the fully ablative version.

·       Ablative resurfacing actually removes skin and causes significant downtime for healing says 

·       Non-ablative does not remove skin and creates only redness for a day, so you do not need to miss work.

·       Works well to erase scars, sun damage, and pigmented skin spots.

·       Can be used on the chest and neck. 

Cons 

·       You may need multiple treatments to see results (sometimes as many as five sessions).

·       Even though it’s a milder procedure, you will still have sun sensitivity for one to two weeks after a fractional treatment. 

WHAT HAPPENS DURING A CO2 LASER TREATMENT?

For best results, your provider may give you a skincare routine for up to six weeks before your CO2 laser treatment. If you have a history of cold sores around the mouth, your doctor will prescribe an antiviral medication to begin before the procedure. 

Stop all acne medications containing isotretinoin (for up to 6 months)—they can lead to poor healing or scarring. 

Conventional over-the-counter (OTC) products, like aspirin, can increase the risk of post-procedure bleeding. Be upfront and honest with your doctor about any medications or supplements you’re taking. 

CO2 laser resurfacing is an outpatient procedure. With the fully ablative CO2 laser, sometimes general anesthesia is recommended required, so you would be asleep and have no pain during treatment.  If you’re having a fractional CO2 laser treatment, your doctor will numb your skin with a local anesthetic or provide a sedative to help you relax or do injectable nerve blocks. It will feel like rubber bands snapping against the skin, but the extent of the snap will depend on the laser used, the intensity, and the size of the area being treated. The procedure will take anywhere from 30 minutes to two hours.

After the procedure, your skin may be covered with petroleum jelly, topical medical grade skin care, dressings, or a bandage. You will need to arrange for a ride home if you were sedated for the procedure. Your doctor will also prescribe antibiotics to prevent infection due to compromised skin after laser.

What should you expect during CO2 laser recovery?

Because of the CO2 laser’s ablative nature, skin will be raw, swollen, and itchy post-treatment, which can be painful. It will feel like an exaggerated sunburn, but ice packs will help take down the sting within one to two hours. Over-the-counter pain relievers can offer some relief. You will need to clean the treated area several times a day and apply topical medical grade skin care ointment and serums, to keep scabs from forming. There is typically minimal bleeding with fractional CO2, but there can be some pinpoint bleeding. 

Downtime is usually five to seven days, with social downtime of up to two weeks, but some doctors say redness can last longer. Fractional lasers have a downtime of three to ten days with weeks of sensitivity and healing. 

Once new skin covers the treated area, you can use cosmetics to conceal any redness. Swelling can be managed with prescription steroids, ice packs, and keeping your head elevated while sleeping. 

It’s important to keep skin moisturized during recovery—initially, with an ointment and thicker creams and later, with thinner creams and serums. Talk to your doctor to learn which formulas they recommend. Retinol and glycolic acid products can be resumed around the six-week mark, with your doctor’s permission. And because of increased sun sensitivity, daily use of a broad-spectrum sunscreen is essential.

WHEN WILL YOU SEE CO2 LASER RESULTS?

For the fractional laser, skin can remain pink for several weeks after treatment; with each passing day, you’ll see a difference in skin quality and appearance. With vigilant sun protection, the effects can last for years, but it’s not guaranteed. 

With the fully ablative laser, you will see full results after a month or more, when the face has completely healed. 

HOW LONG WILL YOUR CO2 LASER RESULTS LAST?

Fractional lasers should be done every quarter to maintain results whereas the fully ablative CO2 laser can be done every one to two years, unless you have very deep lines or scars.

These will vary on an individual basis, depending on skin quality and thickness and the settings used during the procedure.