Compare · Procedures

Fractional CO2 Laser vs Scar Revision

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.

Scar Revision: The whole set of procedures used to make an existing scar less noticeable — cutting it out and closing it more neatly, flattening it, releasing it, or resurfacing it. No procedure erases a scar. Revision trades the scar you have for one you would rather live with.

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 Scar Revision, 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 Scar Revision if…

Choose to trade a scar you dislike for a neater one — no procedure erases a scar.

  • A wide, raised or puckered scar
  • The scar is at least a year old
  • You accept a new, better-placed scar
Often combined

Can you have both?

CO2 laser is often used 6 to 8 weeks after scar revision surgery to blend the new scar.

Key differences

● Fractional CO2 Laser
● Scar Revision
DowntimeNone → 2+ weeks
1–2 weeks
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Needs anesthesia or sedation
Moderate
Results showImmediately → 3+ months
1–3 months
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 short series (2–3)
Cost per visit$ → $$$$$
$$$$
$$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

Fractional CO2 Laser

Scar Revision

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 improves scars.

It aims to improve appearance, comfort or movement.

It uses several methods.

Surgery, injections and resurfacing may be combined.

It does not erase scars.

It modifies scar tissue rather than restoring unscarred skin.

Keloids need special care.

Excision alone can cause a larger recurrence.

What it treats

Evidence level
Fractional CO2 Laser
Scar Revision
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.

Scars on light skin.

Scars

Improves width, texture and color.

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.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Combined with injections to prevent return.

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

Punch excision for deep scars.

Little evidence
—
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

Usually treated with lasers or needling.

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

Treatment areas

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

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone
● Fractional CO2 Laser
● Scar Revision
Lighter skin
Some risk
Prolonged redness possible.
Low risk
Scar fades over a year.
Medium skin
Higher risk
Dark marks are common; pre-treatment helps.
Some risk
Dark marks possible.
Deeper skin
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
Higher risk
Keloids can return larger; injections or radiation are often combined.

How it works

Fractional CO2 Laser

Scar Revision

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.
Scar Revision mechanism diagram. The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.
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.

The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.

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

Before your treatment

Fractional CO2 Laser
Scar Revision
Earlier planning
Not specified

6 to 12 months: Waiting: Surgeons want 6 to 12 months of natural settling first.

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.

Sun: Keep the scar out of the sun and use SPF 30 or higher.

2 weeks before: Smoking and vaping: Stop both at least two weeks before and after surgery.

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.

Not specified

Day of treatment

Fractional CO2 Laser
Scar Revision
Before you arrive
Not specified

What to bring: Old photos: Photographs from before the injury, if you have them.

Arrival & prep

Skin is examined and photographed.

The scar is photographed and examined relaxed and stretched.

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.

A steroid injection takes minutes and meets real resistance.

Surgical revision cuts the scar out as a narrow ellipse and closes it in layers, usually 30 to 90 minutes. A Z-plasty swaps small flaps to change direction. Punch excision removes a small round scar. Laser or microneedling takes 20 to 45 minutes. Expect pressure, not sharpness.

Before you leave

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

Tape over the line, wound care instructions, and a date for stitch removal — 5 to 7 days on the face, 10 to 14 days on the body.

After your treatment

Fractional CO2 Laser
Scar Revision
First 24 hours

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

First 2 weeks: Swollen, bruised and tender.

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 2 to 8: The new line turns pink, firm and slightly raised — normal healing, not failure.

Beyond 1 month
Not specified

Months 3 to 18: Redness fades and the ridge softens from month 3 to 6, with massage and silicone doing the work.

Time to results

1–3 months, improving to 6

Over 6–12 months

How long results last

Years

Permanent

Risks

Risks
  • Dark patches
  • Redness that will not settle
  • Pale or white patches
  • An acne or milia flare
  • Itching that is severe
  • A scar thickening or spreading again
  • Itching, burning or tenderness in the scar
  • A dent or pale patch after an injection
  • A new dark patch
  • Numbness or odd sensation

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 this varies more than almost any other dermatology procedure, because "scar revision" covers a five-minute injection and a ninety-minute operation.

Insurance

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

Insurance often pays when a scar limits movement or vision, interferes with function, or follows cancer surgery or an injury.

Questions

Fractional CO2 Laser

Scar Revision

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.

Can a scar be removed completely?

No. Every treatment replaces the scar with a different one — flatter, narrower, paler, or running in a less obvious direction. Often a large improvement, not removal.

How long should I wait before revising a scar?

Usually 6 to 12 months, because most scars keep improving on their own in that time. Scars that limit movement and raised scars still growing are treated sooner.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound borders and often flattens over a year or two. A keloid grows beyond them, keeps going, and does not settle by itself. Keloids come back after surgery much more often, so they are usually injected rather than cut.

Will scar revision help my acne scars?

Some of them. Rolling scars respond to subcision, needling and laser; deep icepick scars often need punch excision or a targeted acid technique; boxcar scars sit in between. Expect a course and partial improvement, not one operation.

Does insurance cover it?

Sometimes — when the scar restricts movement or vision, causes symptoms, or follows cancer surgery or trauma. Revision for appearance is cosmetic. Ask the office to check with your insurer before you book.

I have deeper skin tone, and I keloid. Is anything safe?

Yes, but the order changes. Injections, silicone and pressure come first, elective surgery on high-risk sites is approached carefully, and if a keloid is removed, something is always done alongside to control the healing. Tell the provider at the first visit.

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