It is an ablative laser.
It creates microscopic columns of injury in the skin.
Fractional CO2 Laser vs Fraxel
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.
Fraxel: A laser that heats thousands of microscopic columns in the skin and leaves the skin between them untouched. Used for sun damage, acne scars, and rough texture. It takes a course of treatments and a few days of looking sunburned each time.
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
Choose Fraxel if…
Choose for acne scars or sun damage with a few days of downtime per session instead of the week-plus of ablative lasers.
- Rolling or boxcar scars
- Sun spots and rough texture
- You can plan 3–5 sessions
Alternatives, not combined
Can you have both?
Both are fractional resurfacing lasers. CO2 is deeper with longer healing; Fraxel needs more sessions. One is chosen per treatment plan.
Key differences
● Fractional CO2 Laser
● Fraxel
DowntimeNone → 2+ weeks
1–2 weeks
3–7 days
PainMinimal → Needs anesthesia or sedation
Needs anesthesia or sedation
Moderate
Results showImmediately → 3+ months
1–3 months
1–3 months
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
A short series (2–3)
A longer series (4–6+)
Cost per visit$ → $$$$$
$$$$
$$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent
What is it?
Fractional CO2 Laser
Fraxel
What is it?
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.
It is a nonablative fractional laser.
Fraxel heats microscopic zones while sparing skin in between.
Platforms differ.
Wavelength and device determine the treatment.
It is not CO2 resurfacing.
It is less intensive than ablative lasers.
It is not risk-free.
Burns, redness and pigment changes can occur.
What it treats
Evidence level
Fractional CO2 Laser
Fraxel
Strong evidenceMost established uses
Acne Scarring
Major improvement in many scar types.
Boxcar Scars
Smooths wide scars.
Wrinkles and Fine Lines
Tightens and smooths.
Acne Scarring
Improves rolling and boxcar scars.
Sun Spots
Clears sun damage.
Moderate evidenceSome supportive research
Sun Spots
Clears sun damage.
Wrinkles and Fine Lines
Smooths texture.
Limited evidenceEarly or small studies
—
Melasma
Low settings may help some.
Little evidence
—
Ice Pick Scars
Too deep for most sessions.
Can make it worse
Melasma
High risk of darkening.
Rosacea
Can worsen redness.
Rosacea
Can worsen redness.
Treatment areas
Treatment areas
Face; the selected area depends on the concern and treatment plan.
Face and hands.
Skin tones
Skin tone
● Fractional CO2 Laser
● Fraxel
Lighter skin
Some risk
Prolonged redness possible.
Low risk
Redness and swelling for days.
Medium skin
Higher risk
Dark marks are common; pre-treatment helps.
Some risk
Dark marks possible; lower settings help.
Deeper skin
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
Some risk
Safer than ablative lasers at lower density with an experienced provider.
How it works
Fractional CO2 Laser
Fraxel
How it works
Diagram explanation
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.
Fractional heat zones leave surrounding tissue untreated. Superficial 1927 nm treatment helps fade uneven pigmentation; deeper 1550 nm treatment triggers repair and collagen remodeling.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Before your treatment
Fractional CO2 Laser
Fraxel
2–4 weeks before
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.
4 weeks before: Sun: Avoid tanning, self-tanner and sunburn.
Pigment preparation: For deeper skin tones, providers may prescribe a pigment-lowering cream for 2–4 weeks and test near the ear.
The week before
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.
Cold sores: Tell your provider; preventive antiviral medicine often starts the day before.
Hair removal: Stop waxing, threading and hair-removal creams.
Actives: Stop retinoids, retinol and acids 3–7 days before.
Day of treatment
Fractional CO2 Laser
Fraxel
Before you arrive
Not specified
Arrive with clean skin and no makeup.
Arrange a ride if you will have strong settings or oral pain medicine.
Arrival & prep
Skin is examined and photographed.
Skin is cleaned and photographed. Numbing cream stays on for 45–60 minutes.
Treatment
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.
The laser passes over the skin while cold air cools it.
Expect prickly heat that builds with each pass, often strongly uncomfortable—especially on the forehead and around the mouth.
Before you leave
Skin is deep red, hot, swollen and weeping clear fluid, with a fine grid pattern visible.
Skin feels hot, red and swollen. Ice packs and a bland ointment are usually applied.
After your treatment
Fractional CO2 Laser
Fraxel
First 24 hours
Days 1 to 3: Swelling peaks on the first or second morning and can partly close the eyes.
Days 1–2: Redness and swelling, especially around the eyes.
Days 2–7
Days 3 to 14: The skin turns bronze or grid-patterned brown, then flakes and sheets off, showing bright pink skin.
Days 3–7: Rough, bronzed skin flakes away. Do not scrub or pick.
Weeks 2–4
Week 3 to Month 12: Redness fades slowly, a month on light settings and three months or longer on aggressive ones.
Not specified
Beyond 1 month
Not specified
1–3 months: Time to results.
Scar improvement can last years; sun damage can return with sun exposure.
Time to results
1–3 months, improving to 6
Not specified
How long results last
Years
Not specified
Risks
Risks
- Dark patches
- Redness that will not settle
- Pale or white patches
- An acne or milia flare
- Itching that is severe
- Dark patches
- Worsening redness
- Cold sores
- Acne or white bumps
- Lighter patches
Cost
Per session
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.
About $900–1,500 for a full face in the US. Smaller areas cost less.
Insurance
Insurance does not cover resurfacing for acne scars, which is classed as cosmetic.
Cosmetic treatment is not covered. Coverage for surgical or injury scars is uncommon.
Full course
Not specified
Several thousand dollars. Packages may reduce the per-session price.
Questions
Fractional CO2 Laser
Fraxel
Individual Questions
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.
How many Fraxel sessions will I need?
Three to five, two to four weeks apart. Sun damage sometimes needs fewer, acne scars usually need the full course, and deeper skin tones are treated at lower settings, which means more sessions.
Does Fraxel get rid of acne scars?
It improves them rather than removing them. Studies of nonablative fractional lasers show partial improvement in scar depth and appearance over a course. Deep icepick scars respond least and are often better treated by combining the laser with subcision or filler.
How much downtime is there really?
Plan for a week. Two days of redness and swelling, then a few days of rough, bronzed skin that flakes off. Most people cover it with makeup from day three and look normal by day seven.
Does it hurt?
With an hour of numbing cream and cold air, most people call it hot and strongly uncomfortable rather than unbearable, and it stops as soon as the laser does. The forehead and around the mouth are the worst.
Is it safe for deeper skin tones?
It can be done, but differently. The main risk is temporary dark patches. Lower settings, more sessions, pre-treatment creams and strict sun protection all lower that risk, and the provider experience with your skin tone matters more than the device.
Is Fraxel the same as CO2 laser?
No, though one device sold under the Fraxel brand is a carbon dioxide laser. The Fraxel most people mean is nonablative, heating the skin without removing the surface. A carbon dioxide laser removes tissue, does more per session, and brings one to two weeks of downtime and more pigment risk.
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