Fractional CO2 Laser vs Q-Switched Laser Tattoo Removal

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.

Q-Switched Laser Tattoo Removal: A laser that breaks tattoo ink into fragments small enough for the body to carry away. It takes far more sessions than most people expect, black ink clears most reliably, and complete clearance is not guaranteed.

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 Q-Switched Laser Tattoo Removal, 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 Q-Switched Laser Tattoo Removal if…

Choose for tattoo removal, especially black ink — it takes more sessions than most expect and full clearance isn't guaranteed.

A black or dark-ink tattoo
You can plan a year or more of sessions
You'll protect the area from sun

Alternatives, not combined

Can you have both?

They treat different things. CO2 is not used for routine tattoo removal; Q-switched laser is the standard.

Key differences

● Fractional CO2 Laser

● Q-Switched Laser Tattoo Removal

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

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

Q-Switched Laser Tattoo Removal

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 breaks up ink.

Very short laser pulses fragment tattoo pigment.

Colors need different wavelengths.

Several treatments are usually needed.

Clearance is not guaranteed.

Some inks respond poorly.

Some pigments darken.

Cosmetic and white inks may need a test treatment.

What it treats

Evidence level

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

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.

Unwanted Tattoos

Fades ink over many sessions.

Moderate evidenceSome supportive research

Sun Spots

Clears sun damage.

Sun Spots

Clears spots.

Not effective

—

Acne Scarring

Doesn't change texture.

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.

Melasma

Pigment can rebound.

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

● Q-Switched Laser Tattoo Removal

Lighter skin

Some risk

Prolonged redness possible.

Low risk

Temporary whitening.

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 is more likely; 1064 nm settings and longer gaps help.

How it works

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

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.

Q-Switched Tattoo Removal mechanism diagram. Short pulses reach the ink: The wavelength is selected for the ink and skin. Pigment particles fragment: Rapid energy delivery breaks some ink into smaller pieces. Clearance happens gradually: The body clears some fragments between treatment sessions.

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.

Short pulses reach the ink: The wavelength is selected for the ink and skin. Pigment particles fragment: Rapid energy delivery breaks some ink into smaller pieces. Clearance happens gradually: The body clears some fragments between treatment sessions.

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

Before your treatment

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

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: Keep the area out of the sun and stop self-tanner.

Before you book: Your plans: Expect a week of healing.

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.

The day before: Shaving: Shave the area.

Day of treatment

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

Before you arrive

Not specified

30 to 60 min before: Numbing: Numbing cream goes on 30 to 60 minutes before, so arrive early or apply it at home if told to.

Arrival & prep

Skin is examined and photographed.

The tattoo is examined and photographed, and the colors and depth of the ink assessed.

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 moves across the tattoo pulse by pulse, with a loud snap each time.

The ink turns white at once — frosting, from gas released in the skin — and fades within about 20 minutes. A small tattoo takes a few minutes; a large one is split across sessions. It is sharper than getting the tattoo but much quicker, like hot fat spitting.

Before you leave

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

Red, raised and swollen, sometimes with pinpoint bleeding.

After your treatment

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

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: Blisters, sometimes large, are expected rather than a sign something went wrong.

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 4 to 14: Crusts form and lift on their own.

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: The fading happens now, as immune cells clear the broken ink.

Time to results

1–3 months, improving to 6

Visible fading after 2–3 sessions

How long results last

Years

Removed ink is gone

Risks

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

Paradoxical darkening
Pale patches
Dark patches
A lasting shadow
An itchy raised reaction
Texture change

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, tattoo removal is priced per session by the size of the area, commonly from about one hundred dollars for something very small to several hundred for a larger piece.

Insurance

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

Packages lower the price per session, but the number of sessions needed cannot be known in advance, so paying upfront for a fixed number carries risk.

Questions

Fractional CO2 Laser

Q-Switched Laser Tattoo Removal

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 sessions will I actually need?

A professional tattoo commonly needs eight to twelve or more, six to eight weeks apart — a year or two overall. Amateur tattoos often clear in four to six. Ink color, density, skin tone and location change the number, and no one can give an exact figure at the start.

Will the tattoo be gone completely?

Sometimes, but it cannot be promised. Heavy fading is the realistic goal; some tattoos leave a faint shadow, usually because of yellow, white or pastel ink.

Does it hurt more than getting the tattoo?

Each pulse is sharper, but the session is much shorter — most people describe hot fat spitting on the skin. Numbing cream or injected anesthetic makes it manageable.

Which colors are hardest to remove?

Yellow, white and pastel shades, because they absorb the available wavelengths poorly. Green and light blue need a specific laser not every clinic owns. Black and dark blue clear most reliably.

Is it safe on deeper skin tones?

Yes, with the right wavelength and settings. The 1064 nm beam is used most because melanin absorbs it least. Expect a test spot, lower energy, longer gaps, and more caution with colored ink.

Why did my cosmetic tattoo turn black?

Flesh-tone, white and cosmetic inks contain iron and titanium compounds the laser can change chemically, turning them gray or black instantly. That is why a test spot in a hidden area comes first for eyebrow, lip liner and areola tattoos. Further sessions sometimes clear the darkened ink and sometimes do not.

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