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.
Key facts
Treats
Indented scars, wrinkles or sun damage
Recovery
Visible healing: about 5–10 days
Treatment plan
Often 1–3 sessions
Typical cost
About $1,000–3,000 per full face
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.
What it treats
Acne Scarring
Major improvement in many scar types.
Boxcar Scars
Smooths wide scars.
Wrinkles and Fine Lines
Tightens and smooths.
Sun Spots
Clears sun damage.
Melasma
High risk of darkening.
Rosacea
Can worsen redness.
Treatment areas
Fractional CO2 Laser
Face; the selected area depends on the concern and treatment plan.
Fractional CO2 Laser
Face; the selected area depends on the concern and treatment plan.
Skin tones
Lighter skin
Some risk
Prolonged redness possible.
Medium skin
Higher risk
Dark marks are common; pre-treatment helps.
Deeper skin
Higher risk
Highest pigment risk of these treatments; low-density settings and an experienced provider are essential.
How it works
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.
Types
CO2 lasers can treat the whole surface or only tiny columns of skin. Fractional treatment is far more common today because it heals faster.
Before your treatment
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.
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.
Day of treatment
Arrival & prep
Skin is examined and photographed.
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.
Before you leave
Skin is deep red, hot, swollen and weeping clear fluid, with a fine grid pattern visible.
After your treatment
First 24 hours
Days 1 to 3: Swelling peaks on the first or second morning and can partly close the eyes.
Days 2–7
Days 3 to 14: The skin turns bronze or grid-patterned brown, then flakes and sheets off, showing bright pink skin.
Weeks 2–4
Week 3 to Month 12: Redness fades slowly, a month on light settings and three months or longer on aggressive ones.
Time to results
1–3 months, improving to 6
How long results last
Years
Risks
Everyone gets swelling, oozing, crusting, sloughing and weeks of redness. That is the treatment, not a complication. What follows sits beyond it, and these risks are more serious than with other resurfacing.
Dark patches
Flat brown marks appearing 2 to 6 weeks afterward. The most common complication, and on deeper skin tones common enough to plan for. It fades over months, faster when treated early.
Redness that will not settle
Redness that is worsening, or still intense after three months, needs review.
Pale or white patches
Pigment loss appearing months to years later, usually after aggressive or repeated treatment. Uncommon, largely permanent, and one reason settings stay conservative.
An acne or milia flare
Common in the weeks after, from ointment and healing skin. Treatable; report it rather than picking.
Itching that is severe
Some itch is normal. Intense itch with a rash can be an allergy to something on the skin, often an antibiotic ointment.
Cost
Typical cost
About $1,000–3,000 per full face
Pricing
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.
Insurance
Insurance does not cover resurfacing for acne scars, which is classed as cosmetic.
Alternatives
Non-ablative fractional laser
The closest alternative. It heats columns without vaporizing them, so downtime is two to three days rather than a week. Less improvement per session, so it takes three to five sessions, and the pigment risk is lower but not absent.
Erbium YAG resurfacing
Ablative like CO2 but with less heat spreading sideways, so healing is a little faster and redness shorter. Slightly less collagen stimulation in exchange, and availability varies by practice.
RF microneedling
Reaches depth through needles rather than light, so melanin does not absorb the energy. Less improvement for scars, considerably less downtime, and a much smaller pigment risk. Often the better trade on deeper skin tones.
Microneedling
Far cheaper, minimal downtime, safest across skin tones, and clearly less effective. Needs a course of three to six rather than one to three sessions.
Subcision and TCA CROSS
Each for a specific scar shape. They do jobs resurfacing does not, and are commonly done alongside it rather than instead.
Chemical peel
For pigment and pores, none for indented scars at superficial depth. Not a substitute here.
At-home fractional laser devices
A small number of low-energy handheld devices exist and are sold for fine lines and tone. Their energy is a tiny fraction of an office device by design, since a home user cannot judge depth or manage a burn. Some people see modest smoothing after months of use. None of them treat indented scars.
What actually helps at home
A nightly retinoid builds collagen slowly and genuinely, daily sunscreen protects the result, and a pigment cream handles the brown marks people often mistake for scars. This is also exactly what makes an office treatment work better and heal cleaner.
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.
Related
Microneedling
Acne Scarring
Melasma
Wrinkles and Fine Lines
Rosacea
RF Microneedling
Chemical Peel
Sun Spots
Chemical Peel vs Fractional CO2 Laser
Fractional CO2 Laser vs Microneedling
Fractional CO2 Laser vs RF Microneedling
