CO2 laser resurfacing

The carbon dioxide (CO2) laser is an ablative resurfacing laser. Its wavelength is absorbed by water in the skin, which means it vaporises the outer layers of tissue while heating the layer beneath - stimulating collagen and elastin as the skin regenerates.

It produces the most change of any of Me Clinic's laser skin treatments. It also involves the most downtime and the most risk. Those two facts are inseparable, and no honest account of this treatment separates them.

Ablative and non-ablative

• Non-ablative lasers - such as Laser Genesis - heat the dermis without breaking the skin surface. Little downtime, gradual results, a course of sessions.
• Ablative lasers remove the surface layer of skin. Substantially more change, substantially more recovery.

CO2 can be delivered fully ablative (the whole surface) or fractional, treating microscopic columns and leaving untreated skin between them to speed healing. Fractional CO2 sits between full ablative resurfacing and non-ablative treatment in both effect and downtime, which is why it is the more commonly used approach today.

What it addresses

• Deep lines and wrinkles, particularly around the mouth and eyes
• Sun damage and solar keratosis
• Acne scars and other scars
• Uneven skin texture and enlarged pores
• Pigmentation and uneven skin tone
• Mild skin laxity, through collagen contraction and remodelling
• Certain skin lesions

What it does not do

CO2 resurfacing acts on the skin. It does not lift descended tissue or remove significant excess skin - that is a facelift, neck lift or blepharoplasty. It is often performed alongside those procedures, because surgery repositions tissue and resurfacing improves the quality of the skin covering it - two different problems.

The procedure

Topical anaesthetic is applied, and depending on the depth of treatment, local anaesthetic or sedation may be used. The laser is then passed over the treatment area.

Treatment depth is chosen deliberately: deeper settings produce more change and a longer recovery; lighter settings the reverse. This is discussed and decided at consultation with your circumstances in mind - including how much downtime you can actually take.

Recovery - plan for it properly

This is the part people underestimate.

• Days 1 to 3 - significant redness and swelling, a hot sunburn-like sensation, and weeping or oozing from the treated skin. Frequent application of ointment and cool compresses.
• Days 3 to 7 - crusting and peeling as the treated skin sheds. Do not pick.
• Week 2 onwards - new skin, initially bright pink or red.
• Weeks to months - redness fades gradually. After deeper treatment it can persist for several weeks, occasionally months.
• 3 to 6 months - the collagen response continues and the final result develops.

Allow real time away from work and social commitments after deeper resurfacing. Sun avoidance and rigorous sun protection during healing are not optional - sun exposure on newly resurfaced skin is the most common cause of post-treatment pigmentation.

Who should not have it, or should think harder

• Darker skin types. Ablative resurfacing carries a materially higher risk of post-inflammatory hyperpigmentation in darker skin. It can be done, but with lower settings, more preparation and a frank discussion of the risk.
• Recent sun exposure or tanning, including fake tan - treatment is deferred.
• Active infection in the area, or active acne in some cases.
• Cold sore history - antiviral medication is generally prescribed before treatment around the mouth, because resurfacing can trigger a widespread outbreak in raw skin.
• Recent oral isotretinoin use - an interval is required.
• A history of keloid or hypertrophic scarring.
• Smokers - healing is impaired.
• Anyone who cannot take the downtime. Rushing back into sun exposure and normal activity is how good treatments produce bad outcomes.

Any suspicious lesion in the treatment area must be assessed before treatment, not resurfaced over.

Risks

• Prolonged redness - expected after deeper treatment, and occasionally lasting months
• Swelling, oozing, crusting and peeling during healing
• Pain and burning during and after treatment
• Infection - bacterial, fungal, or viral including a widespread cold sore outbreak
• Post-inflammatory hyperpigmentation - common, particularly in darker skin, and can take months to resolve
• Hypopigmentation - permanent loss of pigment in treated skin, which can appear months to years later and is difficult to correct
• A visible demarcation line at the edge of a treated area
• Scarring, including hypertrophic scarring
• Ectropion - pulling down of the lower eyelid, where treating close to the eye
• Acne flare or milia during healing
• Eye injury without proper protective eyewear
• An unsatisfactory or uneven result

Contact the clinic promptly for increasing pain, spreading redness, pus, fever or blistering during recovery.

Please read our information on the risks and complications of cosmetic surgery before proceeding.

Cost and booking

Cost depends on the area, the depth of treatment and whether it is combined with another procedure. A quote is provided at consultation after assessment.

As at September 2024 and including GST, a consultation with a Cosmetic Doctor is $150, and with a Specialist Plastic Surgeon $350 where the treatment is being planned alongside surgery.

Me Clinic has over 35 years of experience in cosmetic medicine and 20 years with laser treatments. Me Clinic is at 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050.

Related pages

See laser cosmetic surgery, Fraxel laser, laser skin rejuvenation, skin conditions, or all face procedures.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.