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CO2 — carbon dioxide — laser resurfacing uses targeted beams of light to remove the superficial layer of your skin.

This type of laser treatment can:

Depending on the issue being addressed, a dermatologist or cosmetic surgeon might also use fractional lasers, another type of CO2 lasers. Fractional lasers, however, are more superficial than traditional CO2 lasers, so they’re mainly used to address fine lines or blotchy skin.

Read on to learn everything you need to know about CO2 laser resurfacing.

C02 laser resurfacing uses pulses of laser light. These beams penetrate the skin’s surface, where water in the skin cells absorbs them.

When this happens, the epidermis, or superficial layer of your skin, is vaporized. The dermis, or middle layer, heats up, stimulating the growth of new collagen fibers. As the area heals, new firmer, smoother skin replaces the old layers.

During CO2 laser resurfacing, a cosmetic surgeon or dermatologist can target specific areas of your skin with precision, so the treatment won’t affect the rest of the skin nearby.

How to prepare

Your dermatologist will give you instructions to prepare for treatment. Depending on your medical history, pre-care typically involves:

  • avoiding tanning or heavy sun exposure for 4 weeks before treatment
  • not using medications that cause sun sensitivity, such as doxycycline, for 3 days before treatment
  • taking an antiviral medication for a few days before and after treatment if you have a history of herpes or shingles
  • quitting smoking for 2 weeks before and after treatment, since smoking can interfere with healing

The procedure

Here’s an idea of what to expect on the day of your CO2 laser treatment:

  1. This outpatient procedure generally takes between 30 minutes and 2 hours, depending on the issue being addressed and the area of skin receiving treatment.
  2. CO2 laser resurfacing does involve some pain. The level of pain you experience will depend on the depth and extent of resurfacing, the skill of the dermatologist or surgeon, and your own pain tolerance.
  3. You’ll receive a combination of local anesthetic and a sedative to prevent pain and help you relax. For extensive resurfacing, you may receive general anesthesia so you sleep through the treatment.
  4. Before the treatment begins, your skin will be thoroughly cleaned and you’ll receive special eyewear to protect your eyes from the laser.
  5. During the treatment, the dermatologist or surgeon will move the laser wand slowly over the area of skin being treated.
  6. You may receive an ice pack to apply to the treated area for 15 minutes to prevent swelling.
  7. Finally, an antibacterial ointment and nonstick dressing will be applied to the treated skin. Leave this on as instructed, usually for 24 hours.

You may need more than one treatment session, depending on the treatment required and intensity of the laser used.

CO2 laser resurfacing can treat numerous cosmetic and medical skin issues, from visible signs of aging and sun damage to scars and skin cancer.

Fine lines and wrinkles

CO2 laser resurfacing can lessen the appearance of fine lines and wrinkles. It may prove especially effective on:

Not only can it reduce the appearance of wrinkles right away, it also encourages collagen production, which can improve the health of your skin over time.

Sun-damaged skin

Exposure to UV light may contribute to visible signs of skin aging, such as:

CO2 laser resurfacing can significantly reduce the appearance of all of the above.

Baggy eyes

Loose skin above the upper and lower eyelids can cause what’s commonly known as “baggy” or “hooded eyes.”

CO2 lasers can help tighten skin, and they may also help improve eyelid skin laxity and minimize the appearance of baggy eyes.

Acne scars

C02 laser treatment helps reduce the appearance of acne scarring by stimulating collagen production that helps tighten and smooth out the scars.

That said, it may not work on all types of acne scars.

A 2018 review suggests combination therapy — including microneedling, subcision, and a trichloroacetic acid (TCA) peel — may prove more effective for ice-pick type acne scars.

Warts

Dermatologists usually recommend other treatment methods, like over-the-counter remedies or freezing, for warts. But they may use lasers on warts that don’t respond to other treatments.

Sebaceous hyperplasia

Sebaceous hyperplasia occurs when sebum gets trapped in an oil gland. When this happens, the gland becomes enlarged and causes a small, waxy bump on the skin, usually on the face. While harmless, some people have them removed for cosmetic reasons.

CO2 lasers can effectively remove these bumps and prevent them from growing back, though some research suggests that an erbium laser may be a better option. A 2020 review found that treatment with an erbium laser often only requires one session and involves fewer side effects than CO2 and other lasers.

Skin cancer

CO2 lasers can help prevent or treat skin cancers by shrinking and destroying tissue with little bleeding or damage to the surrounding tissue.

A dermatologist might use CO2 lasers on pre-cancerous actinic keratoses or, in some cases, to treat certain types of early stage skin cancer.

CO2 lasers, in use since the early 1960s, are considered safe and effective.

Still, like most procedures, CO2 laser resurfacing does involve some risk. Having the treatment performed by a reputable, board certified dermatologist or plastic surgeon can significantly minimize your risk of complications.

Common side effects of CO2 laser resurfacing include:

  • some skin discoloration and swelling
  • skin that feels raw, similar to a mild sunburn
  • itching
  • dryness and peeling
  • sun sensitivity

Deeper, more extensive resurfacing can leave your skin looking and feeling like it might after severe sunburn. Your skin might also ooze and blister.

Potential complications

CO2 laser resurfacing can occasionally lead to:

  • infection
  • acne flares
  • cold sore reactivation, if you have a history of cold sores
  • scarring
  • milia, or very small skin bumps
  • hyperpigmentation
  • skin burns and injuries, if the laser is not used correctly

Again, choosing a board certified cosmetic surgeon or dermatologist and following their pre-care and post-care instructions can significantly reduce your risk of any side effects or complications.

It typically takes 1-2 weeks to recover from CO2 laser resurfacing. Following your dermatologist or surgeon’s aftercare instructions will help with healing and lower your risk of complications.

Here’s what to expect during the recovery process:

  • Your skin will feel raw for the first few days and may feel like a sunburn with itching, stinging, and peeling.
  • Your skin may blister, ooze a yellow liquid, and crust over.
  • After about 5-7 days, your skin will become dry and start to peel. The skin beneath may have a pink or pale appearance that will gradually take on your skin color. This process can take up to a year.

These tips can help you during the healing process:

  • Avoid rubbing, scratching, or picking at your skin.
  • Cleanse the treated skin as instructed by your doctor, usually 2-5 times a day with saline or a vinegar solution.
  • Apply a thin layer of moisturizer or antibacterial ointment twice a day, as recommended by your doctor.
  • Apply an ice pack wrapped in a clean, soft towel to the area as needed during the first 24-48 hours.
  • Sleep with your head elevated to help with swelling.
  • Once your skin heals, wear clothing that covers the area or apply sunscreen formulated for sensitive skin every time you go outdoors.

To lower your risk of complications and get the best results from the procedure, opt for a reputable, board certified dermatologist or plastic surgeon. You can ask your doctor for a referral or find one in your area through one of these online resources:

According to RealSelf, CO2 laser resurfacing costs, on average, about $2,750. Some of their reviewers do report paying as much as $6,100, however.

The cost varies between ablative and fractional treatment — ablative laser treatment is more expensive. Other factors that affect how much you’ll pay for CO2 laser resurfacing include:

  • location
  • your dermatologist or surgeon’s credentials and experience
  • the number of sessions needed to achieve the desired results
  • the area of skin receiving treatment

Insurance typically doesn’t cover cosmetic treatments. That said, your insurance provider may cover laser treatment used for medically necessary purposes, such as removing skin cancer.

You can learn more about your coverage options by checking with your insurance provider.

When performed by an experienced cosmetic surgeon or dermatologist, CO2 laser resurfacing can rejuvenate your skin and treat certain skin conditions.

Considering CO2 laser treatment? Start by booking a consultation with a reputable professional for more guidance on whether this treatment might help your skin concerns.


Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.