It is a botulinum toxin.
Botox is the brand name for onabotulinumtoxinA, given by a trained clinician.
Botox vs Fractional CO2 Laser
Botox: An injection that temporarily weakens specific facial muscles, so the lines those muscles make soften. It wears off in about three to four months. It does not fill, lift, or improve the quality of the skin.
Fractional CO2 Laser: An ablative laser that vaporizes thousands of microscopic columns of skin, leaving untouched skin between them to heal from. It is the most effective in-office treatment for indented acne scars, and the one with the most downtime and the highest pigment risk.
Choose Botox if…
Choose for lines that appear when you move — frowning, squinting or raising your brows.
- Frown lines, crow's feet, forehead lines
- You want no downtime
- You're fine with a visit every 3–4 months
Choose Fractional CO2 Laser if…
Choose for the biggest single improvement in indented acne scars or deep sun damage, accepting the most downtime and pigment risk.
- Boxcar or rolling acne scars
- Deep sun damage or wrinkles
- You can take a week or more off
Often combined
Can you have both?
Often used together: CO2 resurfaces wrinkled skin and Botox stops the lines from re-forming as it heals. Botox is usually done 1 to 2 weeks before the laser.
Key differences
● Botox
● Fractional CO2 Laser
DowntimeNone → 2+ weeks
None
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Minimal
Needs anesthesia or sedation
Results showImmediately → 3+ months
Within days
1–3 months
How long it lastsWeeks → Years or permanent
3–6 months
Years or permanent
Visits neededOne → Every few months
Every few months
A short series (2–3)
Cost per visit$ → $$$$$
$$
$$$$
ReversibleYes, can be undone → No, permanent
No, wears off
No, permanent
What is it?
Botox
Fractional CO2 Laser
What is it?
It relaxes selected muscles.
Its effect on muscle activity is temporary.
It is not a filler.
It does not add volume.
Health history matters.
Neuromuscular disease, swallowing problems, pregnancy and previous toxin treatment should be discussed.
It is an ablative laser.
It creates microscopic columns of injury in the skin.
Untreated skin speeds healing.
Skin between the columns supports recovery.
It is intensive.
It is stronger than a facial but less than fully ablative resurfacing.
History matters.
Pigment, keloid, herpes and isotretinoin history need assessment.
What it treats
Evidence level
Botox
Fractional CO2 Laser
Strong evidenceMost established uses
Wrinkles and Fine Lines
Smooths frown lines and crow's feet.
Hyperhidrosis
Stops underarm sweating for months.
Acne Scarring
Major improvement in many scar types.
Boxcar Scars
Smooths wide scars.
Wrinkles and Fine Lines
Tightens and smooths.
Moderate evidenceSome supportive research
—
Sun Spots
Clears sun damage.
Limited evidenceEarly or small studies
Rosacea
Small studies show less flushing.
—
Little evidence
Deep Wrinkles
Lines at rest may need filler.
—
Not effective
Sagging Skin
Doesn't lift loose skin.
Volume Loss
Doesn't add volume.
—
Can make it worse
—
Melasma
High risk of darkening.
Rosacea
Can worsen redness.
Treatment areas
Treatment areas
Forehead, between the brows, crow’s feet and underarms.
Face; the selected area depends on the concern and treatment plan.
Skin tones
Skin tone
● Botox
● Fractional CO2 Laser
Lighter skin
Low risk
No pigment change expected.
Some risk
Prolonged redness possible.
Medium skin
Low risk
No pigment change expected.
Higher risk
Dark marks are common; pre-treatment helps.
Deeper skin
Low risk
No pigment change expected.
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
How it works
Botox
Fractional CO2 Laser
How it works
Diagram explanation
Placed near nerve endings: A clinician injects botulinum toxin into selected muscles. Reduces signal release: The treated nerve ending releases less acetylcholine. Muscle activity relaxes: Movement-related lines can soften as contraction decreases.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Creates tiny treatment channels: Laser energy absorbed by water removes narrow columns of tissue. Untreated skin supports healing: Skin between the channels helps the surface repair. Collagen remodels over time: Repair can improve selected scars, lines, and texture.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Before your treatment
Botox
Fractional CO2 Laser
2–4 weeks before
Planning: Timing: Allow at least 2 weeks before an important event; results settle in 10–14 days and bruises may last a week.
Sun and pigment cream: No sun, and do not arrive tanned.
Sun and pigment cream: On deeper skin tones a pigment-blocking cream usually starts two to four weeks ahead.
Plan ahead: Time off and supplies: Book the time off, arrange a driver if sedation is planned, buy plain petrolatum and a gentle cleanser, and plan a week at home.
The week before
Preparation: Medicines and alcohol: Ask about fish oil, vitamin E and ibuprofen; avoid alcohol for 24 hours.
A few days before: Bruising and alcohol: Never stop a prescribed blood thinner on your own.
Actives and smoking: Stop retinoids, benzoyl peroxide and acids.
1 to 2 days before: Antiviral tablets: Antiviral tablets start a day or two before and continue for several days after, since an outbreak in healing skin can scar.
Day of treatment
Botox
Fractional CO2 Laser
Before you arrive
What to bring: Arrive with a clean face, reference photos and clear treatment goals.
Not specified
Arrival & prep
You say what bothers you while the injector watches your face move.
Skin is examined and photographed.
Treatment
The skin is cleaned, then small injections go into the chosen muscles, a few in each area.
The visit runs 10 to 20 minutes. Each point is a sharp sting, then it is over — most people rate it below a blood test. The forehead and between the brows are the most sensitive.
The handpiece is passed or stamped over each zone.
Expect rapid clicking, a burning smell, and a smoke evacuator running. Heat builds fast and feels hot rather than sharp. A full face takes 30 to 60 minutes, genuinely painful without proper anesthesia. The burning carries on for an hour or two.
Before you leave
Small raised bumps like insect bites settle within about 20 to 30 minutes.
Skin is deep red, hot, swollen and weeping clear fluid, with a fine grid pattern visible.
After your treatment
Botox
Fractional CO2 Laser
First 24 hours
Days 1 to 3: A few people bruise, usually near the eyes.
Days 1 to 3: Swelling peaks on the first or second morning and can partly close the eyes.
Days 2–7
Days 3 to 5: Movement feels different — heavy, or a muscle that will not quite fire.
Days 10 to 14: The true result.
Days 3 to 14: The skin turns bronze or grid-patterned brown, then flakes and sheets off, showing bright pink skin.
Weeks 2–4
Not specified
Week 3 to Month 12: Redness fades slowly, a month on light settings and three months or longer on aggressive ones.
Time to results
Starts in 3–5 days, full at 2 weeks
1–3 months, improving to 6
How long results last
3–4 months
Years
Risks
Risks
- A droopy upper eyelid
- A heavy or dropped brow
- Unevenness
- A headache or a flu-like day or two
- A lump or bruise that is not settling
- Dry, gritty eyes or double vision
- Dark patches
- Redness that will not settle
- Pale or white patches
- An acne or milia flare
- Itching that is severe
Cost
Per session
In the US it is priced per unit or per area.
A full-face session in the US usually runs $1,000 to $3,000, varying by city, device, depth, and whether sedation or an operating room is involved.
Insurance
Insurance does not cover cosmetic use.
Insurance does not cover resurfacing for acne scars, which is classed as cosmetic.
Questions
Botox
Fractional CO2 Laser
Individual Questions
How long does it last?
Three to four months for most people and areas. The jaw muscle and underarm sweating last longer. Fading is gradual, so movement returns over a few weeks.
Does it hurt?
A sharp sting for a second or two per injection, several times. Most people find it easier than expected and skip numbing.
Will I look frozen?
Only if the dose says so. Amount and placement decide how much movement you keep, and a lighter dose at a first appointment is reasonable. You can add more at two weeks; you cannot take any away.
What if I do not like the result?
There is no antidote, so it has to wear off over weeks to a few months. Some problems can be balanced with a few extra units elsewhere, which is why starting conservatively is safer.
Is it safe long-term?
Decades of medical use at doses far larger than cosmetic ones, with no pattern of lasting harm. The main reported change is treated muscles getting somewhat weaker over years, which is the intended effect.
How many units do I need?
That depends on the muscle and the face, not a standard number. As a rough reference, frown lines between the brows are commonly treated with about 20 units of one common brand. Units are not comparable between brands, so ask which product is used.
How much downtime does fractional CO2 really need?
Five to ten days at home. Swelling and oozing days one to three, bronzing and sloughing days three to seven, and by day seven to ten the surface has closed and mineral makeup is usually allowed. Redness then fades over weeks to a few months.
Will it get rid of my acne scars?
It improves them substantially, more than any other single treatment, but it does not remove them. Rolling and boxcar scars respond best, icepick scars least, and mixed scarring usually needs subcision or TCA CROSS too.
Is it safe on deeper skin tones?
Experienced providers do it using lower density, longer intervals, and pigment creams before and after. Dark marks are common and fade over months. The rare risk of permanent pigment loss is why many people with deeper skin tones choose microneedling instead.
How many sessions will I need?
One to three, 6 to 12 weeks apart, judged six months after the last one.
Does it hurt?
Yes, without proper anesthesia. Numbing cream alone is not enough for a full face, so nerve blocks, injected anesthetic or oral sedation are standard, and burning continues for an hour or two afterward.
Can I have it before a wedding or a big event?
Only with months of margin. Skin looks worse before it looks better, and redness can last one to three months. Six months ahead is a reasonable minimum.
Related
Procedure
Fractional CO2 Laser
Procedure
Botox
Compare
Chemical Peel vs Fractional CO2 Laser
Compare
Fractional CO2 Laser vs Microneedling
Compare
Fractional CO2 Laser vs RF Microneedling
Compare
Botox vs Chemical Peel
Compare
Clear + Brilliant vs Fractional CO2 Laser
Compare
Fractional CO2 Laser vs Fraxel
Compare
Fractional CO2 Laser vs Glycolic Acid Peel
Compare
Fractional CO2 Laser vs IPL
Compare
Fractional CO2 Laser vs LED Light Therapy
Compare