Fractional CO2 Laser vs RF 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.

RF Microneedling: Microneedling with heat added. Insulated needles carry radiofrequency energy to a set depth in the skin, so the healing response comes from both the puncture and the heat. It is used for indented acne scars, texture, and mild sagging.

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 RF 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 RF Microneedling if…

Choose for acne scars and texture with some tightening, with a lower pigment risk than resurfacing lasers.

Rolling or boxcar acne scars
Mild sagging too
Deeper skin tone where lasers are riskier

Alternatives, not combined

Can you have both?

Both build collagen for scars and wrinkles. CO2 is more powerful with more downtime; RF microneedling is safer for darker skin.

Key differences

● Fractional CO2 Laser

● RF Microneedling

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

How long it lastsWeeks → Years or permanent

Years or permanent

Visits neededOne → Every few months

A short series (2–3)

Cost per visit$ → $$$$$

$$$$

$$$

ReversibleYes, can be undone → No, permanent

No, permanent

What is it?

Fractional CO2 Laser

RF 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 combines needles and energy.

Radiofrequency energy is delivered into or beneath the skin.

It is a medical procedure.

It differs from conventional microneedling and home rollers.

Serious complications are reported.

The FDA has noted burns, scarring, fat loss and nerve damage.

Device and depth matter.

These should be discussed before consenting.

What it treats

Evidence level

Fractional CO2 Laser

RF 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

Heat remodels soft dips.

Moderate evidenceSome supportive research

Sun Spots

Clears sun damage.

Sagging Skin

Mild tightening.

Limited evidenceEarly or small studies

—

Enlarged Pores

May shrink pores.

Little evidence

—

Ice Pick Scars

Needs TCA CROSS or punch excision.

A relaxed forehead with pronounced deep horizontal furrows.

Deep Wrinkles

Modest change on deep folds.

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.

—

Treatment areas

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

Face and neck; depths and coverage depend on the treatment plan.

Skin tones

Skin tone

● Fractional CO2 Laser

● RF Microneedling

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.

Low risk

Insulated needles protect the surface.

Deeper skin

Higher risk

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

Some risk

Lower pigment risk than lasers; grid marks or dark spots possible.

How it works

Fractional CO2 Laser

RF 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.

RF Microneedling mechanism diagram. Needles enter the skin: A device places fine electrodes at a selected depth. RF energy heats nearby tissue: Controlled heating occurs around active needle segments. Repair remodels tissue: The healing response can change collagen 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.

Needles enter the skin: A device places fine electrodes at a selected depth. RF energy heats nearby tissue: Controlled heating occurs around active needle segments. Repair remodels tissue: The healing response can change collagen 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

RF 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 and sun: Do not arrive tanned or sunburned.

Pigment cream and sun: On deeper skin tones, many providers prescribe a pigment-blocking cream for two to four weeks first.

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: Stop retinoids, benzoyl peroxide and exfoliating acids about 5 days before.

Actives and hair removal: No waxing or hair removal creams on the area.

Day of treatment

Fractional CO2 Laser

RF Microneedling

Before you arrive

Not specified

Clean face: Clean face, no makeup.

Clean face: If injected anesthetic is planned, expect a long appointment and a ride home if anything sedating is used.

Arrival & prep

Skin is examined and photographed.

Skin is examined and photographed, and the provider maps depths for each area — shallower around the eyes and forehead, deeper over scarred cheeks and the jaw.

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 handpiece is pressed on the skin and fired one stamp at a time in a grid, not glided.

A full face takes 20 to 45 minutes, often with passes at several depths. With cream alone the sting is sharp, worst on the forehead and jaw; with injected anesthetic it is mostly pressure and heat.

Before you leave

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

Red, hot and swollen, with a visible grid of small dots.

After your treatment

Fractional CO2 Laser

RF 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 2: Swelling is worst the first morning, especially around the eyes and jaw, enough to change how your face looks.

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 10: Swelling drops, redness fades to pink, and the skin feels sandpapery with the grid faintly visible.

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

Months 1 to 6: Firmness and texture keep changing after the visible healing.

Time to results

1–3 months, improving to 6

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
A visible grid that will not fade
Prolonged swelling or redness
A hollow or a change in face shape
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 generally runs about $700 to $1,500, and a package of three commonly falls between $2,000 and $4,000.

Insurance

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

Insurance does not cover it, since it is classed as cosmetic.

Questions

Fractional CO2 Laser

RF 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.

Is Morpheus8 the same as RF microneedling?

Morpheus8 is one brand of radiofrequency microneedling device. Profound, Vivace, Genius, Secret RF, Scarlet and Sylfirm X do the same job. Needle insulation, depth, energy and the operator determine the outcome.

Does it work on acne scars?

Partly, and over a course. Rolling and boxcar scars become shallower across about three sessions. Icepick scars respond poorly. Expect improvement, not clearance.

Will it tighten my jawline?

Modestly, if the laxity is mild and early. It firms rather than lifts. Skin that visibly hangs will not respond, and a surgical consultation is the more honest next step.

How much does it hurt?

More than plain microneedling. Numbing cream alone leaves a sharp hot sting, so many providers add injected anesthetic or nerve blocks at deeper settings. With those it is mostly pressure and heat.

Is it safe on deeper skin tones?

Generally safer than ablative lasers, since melanin does not absorb the energy. Dark marks are still possible from the heat, sometimes in the grid pattern, and they fade over months. Ask about insulated needles and conservative starting settings.

Can it cause fat loss in the face?

Yes, and it is the risk worth understanding. Deep, high-energy settings in a thin face can shrink the fat under the skin, leaving a hollow that does not reliably return. Conservative settings built up over sessions, and a provider who takes the question seriously, are the protection.

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