It is an ablative laser.
It creates microscopic columns of injury in the skin.
Fractional CO2 Laser vs IPL
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.
IPL: A broad-spectrum flashlamp, not a laser, used mainly for brown sun spots and facial redness. It is effective for those two problems on lighter skin, and it is not safe on deeper skin tones.
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 IPL if…
Choose for sun spots and facial redness on lighter skin — it is not safe on deeper skin tones.
- Lighter skin with brown sun spots
- Rosacea redness or small vessels
- You'll avoid tanning before and after
Fine together
Can you have both?
They treat different things: IPL for redness and spots, CO2 for wrinkles and texture. Space them out; IPL is often done first.
Key differences
● Fractional CO2 Laser
● IPL
DowntimeNone → 2+ weeks
1–2 weeks
1–2 days
PainMinimal → Needs anesthesia or sedation
Needs anesthesia or sedation
Mild
Results showImmediately → 3+ months
1–3 months
1–4 weeks
How long it lastsWeeks → Years or permanent
Years or permanent
6–12 months
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, fades slowly
What is it?
Fractional CO2 Laser
IPL
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 broad-spectrum light.
IPL uses filtered pulses across a range of wavelengths, not a laser.
It has several uses.
It treats redness, benign pigmentation and unwanted hair.
Spots need a diagnosis first.
A brown spot should be assessed before fading.
Skin type affects risk.
Tanning, darker skin and medicines raise the risk of burns or pigment change.
What it treats
Evidence level
Fractional CO2 Laser
IPL
Strong evidenceMost established uses
Acne Scarring
Major improvement in many scar types.
Boxcar Scars
Smooths wide scars.
Wrinkles and Fine Lines
Tightens and smooths.
Rosacea
Reduces redness and vessels.
Sun Spots
Darkens spots that then flake off.
Moderate evidenceSome supportive research
Sun Spots
Clears sun damage.
Spider Veins
Clears small facial vessels.
Post-Inflammatory Redness
Fades red marks.
Not effective
—
Acne Scarring
Doesn't change texture.
Can make it worse
Melasma
High risk of darkening.
Rosacea
Can worsen redness.
Melasma
Patches often rebound darker.
Treatment areas
Treatment areas
Face; the selected area depends on the concern and treatment plan.
Face, neck, chest and hands.
Skin tones
Skin tone
● Fractional CO2 Laser
● IPL
Lighter skin
Some risk
Prolonged redness possible.
Low risk
Spots darken then flake.
Medium skin
Higher risk
Dark marks are common; pre-treatment helps.
Some risk
Burns and dark marks possible; conservative settings.
Deeper skin
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
Higher risk
Not safe — high risk of burns and pigment change.
How it works
Fractional CO2 Laser
IPL
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.
Filtered light enters skin: A range of wavelengths is selected for the treatment target. Pigment or blood absorbs energy: Melanin or hemoglobin converts absorbed light into heat. Selected targets fade: Healing can reduce the treated brown spots or visible vessels.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Before your treatment
Fractional CO2 Laser
IPL
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 and tanning: No sun, sunbeds or self-tanner.
2 weeks before: Hair removal: No waxing, threading or hair removal cream.
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.
3 to 5 days before: Actives and clean skin: Stop retinoids and exfoliating acids.
Day of treatment
Fractional CO2 Laser
IPL
Arrival & prep
Skin is examined and photographed.
Skin tone: A good provider will ask, and will decline if IPL is wrong for your skin.
Skin tone: Be direct about your skin tone and how easily you tan.
Skin is cleaned and examined, and the provider checks your skin tone and recent sun.
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.
Opaque goggles go over your eyes and stay on; that is not optional.
The handpiece is pressed on the skin and fired in overlapping shots. You see a bright flash through closed eyelids. Each pulse feels like a hot rubber band snap, hottest over brown spots and hair, and stops as it ends. A full face takes about 20 minutes.
Before you leave
Skin is deep red, hot, swollen and weeping clear fluid, with a fine grid pattern visible.
Skin looks pink and feels warm, like mild sunburn.
After your treatment
Fractional CO2 Laser
IPL
First 24 hours
Days 1 to 3: Swelling peaks on the first or second morning and can partly close the eyes.
Days 1 to 2: Redness fades.
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 to 14: Treated spots darken into fine brown flecks like coffee grounds, then flake away, leaving more even skin.
Weeks 2–4
Week 3 to Month 12: Redness fades slowly, a month on light settings and three months or longer on aggressive ones.
Weeks 2 to 6: Vessels and background redness clear gradually, and keep improving over later sessions.
Time to results
1–3 months, improving to 6
1–2 weeks per session
How long results last
Years
Months to years; new spots with sun
Risks
Risks
- Dark patches
- Redness that will not settle
- Pale or white patches
- An acne or milia flare
- Itching that is severe
- Dark patches
- Blistering or a burn
- Loss of skin color
- Melasma getting worse
- A cold sore outbreak
- Hair loss where you did not want it
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.
In the US a full-face session usually runs about $300 to $600.
Insurance
Insurance does not cover resurfacing for acne scars, which is classed as cosmetic.
Insurance does not cover cosmetic pigment or redness treatment.
Questions
Fractional CO2 Laser
IPL
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.
Is IPL safe for deeper skin tones?
No. Broadband light is absorbed by all the pigment in its path, including the pigment that gives skin its color. On deeper skin tones that means burns and light or dark patches, and pale patches can be permanent. For pigment, ask about prescription creams and superficial peels. For hair, a 1064 nm Nd:YAG laser.
Can I use a home IPL hair removal device on deeper skin tones?
No. The skin tone chart supplied with home devices exists because the technology injures skin with more pigment, and most are labeled unsuitable for deeper skin tones and tanned skin. Many refuse to fire. The risk is the same as a clinic device, with nobody present to spot a problem early.
Does IPL help melasma?
Usually not, and it commonly makes melasma worse: better for a few weeks, then darker and wider. If you have brown patches on the cheeks, forehead or upper lip, get a diagnosis before any light-based treatment.
Why do my spots look darker afterward?
That is what is meant to happen. Treated sun spots darken into fine brown flecks over the first few days, then flake off over one to two weeks. Do not scrub or pick.
How many sessions will I need?
Usually three to five for the face, three to four weeks apart, then maintenance once or twice a year. Brown spots improve faster than redness. Hair reduction takes six to ten or more.
Does IPL work on wrinkles or acne scars?
No. IPL works on color: brown pigment and red vessels. Wrinkles, texture, pores and indented scars need a fractional laser or microneedling.
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