Fractional CO2 Laser vs Microneedling

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.

Microneedling: A pen or roller of fine needles makes thousands of tiny controlled punctures in the skin, which sets off healing and new collagen. It is used mainly for indented acne scars and rough texture. It makes them shallower over a course of sessions, not gone.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026

Editorial illustration for Fractional CO2 Laser, based on the entry’s treatment or equipment reference.

Editorial illustration for Microneedling, based on the entry’s treatment or equipment reference.

Choose if Key differences What is it?What it treats Treatment areas Skin tones How it works Before your treatment Day of treatment After your treatment Risks Cost Questions Related

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 Microneedling if…

Choose for indented acne scars and rough texture with little downtime and low pigment risk — shallower, not gone.

Rolling or boxcar acne scars
Deeper skin tone, where lasers are riskier
You can plan 3–6 sessions

Alternatives, not combined

Can you have both?

Both build collagen for scars and texture. CO2 is deeper with more downtime; microneedling is milder. One is chosen per plan.

Key differences

● Fractional CO2 Laser

● Microneedling

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

How long it lastsWeeks → 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

What is it?

Fractional CO2 Laser

Microneedling

What is it?

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.

It creates controlled punctures.

Fine needles puncture the skin in a controlled way.

It treats scars and texture.

Results depend on device, depth and technique.

It differs from RF microneedling.

No radiofrequency energy is involved.

Added substances change the risk.

Devices are not cleared for use with every serum or blood product.

What it treats

Evidence level

Fractional CO2 Laser

Microneedling

Strong evidenceMost established uses

Acne Scarring

Major improvement in many scar types.

Educational illustration of healed broad indented scars with defined edges on the left cheek, with the face turned to the person’s right on light skin.

Boxcar Scars

Smooths wide scars.

A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Tightens and smooths.

Acne Scarring

Improves rolling and boxcar scars.

Rolling Scars

Good results with a series.

Moderate evidenceSome supportive research

Sun Spots

Clears sun damage.

Two areas of fair skin side by side on a hip. New pink-red bands sit above, and older flat silvery-white bands below, with only a small difference in color between the pale marks and the skin around them.

Stretch Marks

Softens older marks.

Wrinkles and Fine Lines

Improves texture.

Little evidence

—

Ice Pick Scars

Too deep for needling alone.

Can make it worse

Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

High risk of darkening.

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Can worsen redness.

Acne

Can spread active breakouts.

Treatment areas

Face; the selected area depends on the concern and treatment plan.

Skin tones

Skin tone

● Fractional CO2 Laser

● Microneedling

Lighter skin

Some risk

Prolonged redness possible.

Low risk

Redness like a mild sunburn.

Medium skin

Higher risk

Dark marks are common; pre-treatment helps.

Low risk

One of the safer scar treatments.

Deeper skin

Higher risk

Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.

Low risk

Lower pigment risk than lasers; dark marks are still possible.

How it works

Fractional CO2 Laser

Microneedling

How it works

Fractional CO₂ Laser mechanism diagram. 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.

Microneedling mechanism diagram. Fine needles create tiny punctures: A device makes controlled channels in selected skin. Healing signals are released: The tissue response activates repair processes. Collagen remodels gradually: Healing may improve selected scars and skin texture.

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.

Fine needles create tiny punctures: A device makes controlled channels in selected skin. Healing signals are released: The tissue response activates repair processes. Collagen remodels gradually: Healing may improve selected scars and skin texture.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Fractional CO2 Laser

Microneedling

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.

Pigment cream: On deeper skin tones, some providers start a pigment-blocking cream a few weeks ahead.

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.

Actives and hair removal: Do not arrive tanned or sunburned.

Actives and hair removal: Stop retinoids (tretinoin, adapalene, retinol), benzoyl peroxide and acids 3 to 5 days before.

Actives and hair removal: No waxing, threading or hair removal creams.

Day of treatment

Fractional CO2 Laser

Microneedling

Before you arrive

Not specified

Clean skin: Come with a clean face and no makeup, and plan not to wear any that day.

Clean skin: If you have active pustules or an infection in the area, move the session.

Arrival & prep

Skin is examined and photographed.

Skin is checked and photographed, and you confirm what you have stopped using.

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 pen is passed over the skin in overlapping passes, one area at a time, with sterile gel or saline as a glide.

It sounds like a small vibrating motor and takes 20 to 30 minutes for a full face. Pinpoint bleeding is normal at deeper settings over scars. With good numbing it is uncomfortable rather than painful, a scratchy dragging with pressure.

Before you leave

Skin is deep red, hot, swollen and weeping clear fluid, with a fine grid pattern visible.

Skin is bright red, warm and tight, like a strong sunburn, sometimes with faint tracking lines and dots of dried blood.

After your treatment

Fractional CO2 Laser

Microneedling

First 24 hours

Days 1 to 3: Swelling peaks on the first or second morning and can partly close the eyes.

Days 1 to 5: Redness turns pink and swelling settles, most noticeably around the eyes the first morning.

Days 2–7

Days 3 to 14: The skin turns bronze or grid-patterned brown, then flakes and sheets off, showing bright pink skin.

Not specified

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 1 to 4: Skin looks normal and nothing appears to be happening.

Beyond 1 month

Not specified

Months 2 to 6: Texture keeps improving after the visible healing finishes, which is why the photograph that matters is taken months later, not the week after.

Time to results

1–3 months, improving to 6

1–3 months after each session

How long results last

Years

Years for scars

Risks

Dark patches
Redness that will not settle
Pale or white patches
An acne or milia flare
Itching that is severe

Dark patches
Tracking lines
Prolonged redness
Bumps that will not go
A cold sore outbreak

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 $200 to $700, with medical offices at the higher end and packages of three to six cheaper per session.

Insurance

Insurance does not cover resurfacing for acne scars, which is classed as cosmetic.

Insurance does not cover microneedling for acne scars, since it is classed as cosmetic.

Questions

Fractional CO2 Laser

Microneedling

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.

Does microneedling get rid of acne scars?

No. It makes indented scars shallower and less noticeable over three to six sessions. Rolling and shallow boxcar scars respond best, icepick scars respond poorly, and improvement is partial in every study. That is worth having; complete clearance is not what this treatment does.

How many sessions will I need?

Three to six for scarring, four to six weeks apart, then a wait. Texture keeps improving for three to six months after the last session, so do not judge the outcome before then.

Does it hurt?

With numbing cream on for 30 to 45 minutes it is uncomfortable rather than painful, a scratchy pressure rather than a sharp pain. The forehead, nose and jawline are the worst part, and deeper settings over scars are sharper.

Is microneedling safe on deeper skin tones?

One of the better options, because there is no heat or light for melanin to absorb. Dark marks are still possible if the settings are aggressive or the skin sees sun afterward, and they fade over months. Choose someone who treats deeper skin tones routinely.

Can I do this at home with a dermaroller?

Anything at 0.5 mm or deeper is a medical depth and should not be used at home. Needles blunt, home rollers cannot be properly sterilized, and serums through fresh channels have caused lasting lumps of inflammation. Rollers at 0.2 to 0.3 mm are mostly harmless and mostly useless.

Is PRP worth adding?

Platelet-rich plasma is your own blood, spun down and applied or injected during the session. The evidence that it improves scar results is mixed, and it often doubles the price. A course without it is a reasonable course.

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