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Fractional CO2 Laser vs Picosecond Laser

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.

Picosecond Laser: A tattoo and pigment laser that fires in pulses lasting trillionths of a second. It works, and the marketing around the word “pico” has run well ahead of the evidence comparing it to the older quality-switched lasers.

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 Picosecond Laser, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

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 Picosecond Laser if…

Choose for tattoo removal or sun spots — it works, but don't pay extra for the word "pico" alone.

  • A tattoo you want faded or removed
  • You can plan many sessions
  • Colored ink that older lasers struggled with
Fine together

Can you have both?

They can be used in the same plan: picosecond for pigment, CO2 for texture. Space them at least 4 to 6 weeks apart.

Key differences

● Fractional CO2 Laser
● Picosecond Laser
DowntimeNone → 2+ weeks
1–2 weeks
3–7 days
PainMinimal → Needs anesthesia or sedation
Needs anesthesia or sedation
Significant
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

Picosecond Laser

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 uses ultra-short pulses.

Picosecond lasers act on pigment or create fractional tissue effects.

It has several uses.

Tattoos, pigmentation and texture each need different settings.

Pigment needs a diagnosis.

Spots should be confirmed before fading.

Some pigments are tricky.

Cosmetic tattoos may darken; melasma needs careful selection.

What it treats

Evidence level
Fractional CO2 Laser
Picosecond Laser
Strong evidenceMost established uses
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

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.

Unwanted Tattoos on light skin.

Unwanted Tattoos

Fades most ink colors.

Moderate evidenceSome supportive research
AI-generated educational illustration of Sun Spots: 1. Sun Spots Header — Light Skin; Lighter skin. Not a clinical photograph.

Sun Spots

Clears sun damage.

AI-generated educational illustration of Sun Spots: 1. Sun Spots Header — Light Skin; Lighter skin. Not a clinical photograph.

Sun Spots

Clears spots.

Limited evidenceEarly or small studies
—
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Focus lenses improve texture.

Not effective
—
Fine branching superficial spider veins on the lower leg.

Spider Veins

Doesn't target vessels.

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.

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

Melasma

Pigment can rebound.

Treatment areas

Treatment areas

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

The tattoo or diagnosed pigment spot determines the treatment site; location varies.

Skin tones

Skin tone
● Fractional CO2 Laser
● Picosecond Laser
Lighter skin
Some risk
Prolonged redness possible.
Low risk
Temporary whitening and swelling.
Medium skin
Higher risk
Dark marks are common; pre-treatment helps.
Some risk
Temporary lightening or darkening.
Deeper skin
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
Some risk
Lightening of skin can occur; longer wavelengths and spacing help.

How it works

Fractional CO2 Laser

Picosecond Laser

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.
Picosecond Laser mechanism diagram. Ultrashort pulses reach pigment: The wavelength and treatment mode are chosen for the target. Rapid energy delivery fragments pigment: Mechanical effects can break selected particles into smaller pieces. Clearance follows over time: The body clears some fragments; results depend on the pigment and skin.
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.

Ultrashort pulses reach pigment: The wavelength and treatment mode are chosen for the target. Rapid energy delivery fragments pigment: Mechanical effects can break selected particles into smaller pieces. Clearance follows over time: The body clears some fragments; results depend on the pigment and skin.

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

Before your treatment

Fractional CO2 Laser
Picosecond Laser
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: Avoid sun, sunbeds and self-tanner on the area.

4 weeks before: Sun and tanning: Tanned skin postpones a session — surface pigment competes for the light and raises the risk of burns and pigment loss.

Before you book: Numbing and history: Ask for numbing to be arranged in advance.

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 shaving: Stop retinoids and exfoliating acids.

3 to 5 days before: Actives and shaving: Shave the area.

Day of treatment

Fractional CO2 Laser
Picosecond Laser
Before you arrive
Not specified

Clean skin: Clean, product-free skin.

Arrival & prep

Skin is examined and photographed.

The tattoo or pigment is examined, photographed, and its colors noted, since they decide the wavelengths.

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.

Everyone wears eye protection.

The provider fires overlapping pulses, with a snapping sound and a faint smell. Skin whitens at once — frosting — and fades within about 20 minutes. A small tattoo takes minutes; a large piece is split across appointments. It feels sharper than getting the tattoo but far quicker, and bony areas are worse.

Before you leave

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

The area is white and raised, then red and swollen as the frosting fades.

After your treatment

Fractional CO2 Laser
Picosecond Laser
First 24 hours

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

Days 1 to 3: Swelling peaks on day one or two and can be marked around the eyes, hands and ankles.

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: Scabs form and fall away on their own, taking some ink with them.

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 8: Skin looks normal while the immune system clears ink fragments underneath.

Time to results

1–3 months, improving to 6

Fading over weeks after each session

How long results last

Years

Removed ink is gone

Risks

Risks
  • Dark patches
  • Redness that will not settle
  • Pale or white patches
  • An acne or milia flare
  • Itching that is severe
  • Loss of pigment
  • Dark patches
  • A tattoo that got darker
  • Blisters that keep forming
  • A raised or thickened area
  • Itching, swelling or hives in the tattoo

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 picosecond session on a small to medium tattoo commonly runs $200 to $500, with larger pieces priced higher and often split into sections.

Insurance

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

Insurance does not cover tattoo removal or cosmetic pigment treatment.

Questions

Fractional CO2 Laser

Picosecond Laser

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 a picosecond laser better than an older Q-switched laser?

Not settled. Studies generally find picosecond devices perform at least as well, and some report clearance in fewer sessions, but the head-to-head trials are few, small and inconsistent. “Pico” is a marketing category, not a standard, so devices differ a lot. The provider's experience and the wavelengths available for your ink colors matter more than the category name.

How many sessions will my tattoo take?

Most professional tattoos need five to ten or more, six to eight weeks apart, so a year or longer. Amateur tattoos need fewer, cover-ups more. Nobody can give an accurate number at the first visit; how the first two sessions go is the best predictor available.

Will my tattoo disappear completely?

Sometimes, but heavily faded with a faint shadow is more common. Ink type, depth, color, age and location all matter, and none can be judged from the surface beforehand. Treat a guarantee of complete removal as a warning sign.

Which colors are hardest?

Black and dark blue clear most readily. Green and light blue are hardest and need specific wavelengths. Red, orange and yellow are unpredictable. White, flesh-toned and pastel cosmetic inks can turn dark instantly, which is why they get a test spot first.

Can it be used on deeper skin tones?

Yes, generally at 1064 nm, because surface pigment absorbs it least — the same reason the Nd:YAG laser is preferred there for hair and vessels. Multicolored tattoos are harder, because the wavelengths needed for some colors carry more risk of a light or dark patch. Conservative settings, test spots and longer gaps are standard.

Does it help melasma?

Sometimes, with mixed results. Melasma often improves during a course and then returns, and heat and light can provoke it. Most dermatologists lead with sun protection and pigment creams and add laser cautiously.

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