Fractional CO2 Laser

One of the most frequent questions people have regarding their facial appearance is how to improve wrinkles and scars. These concerns can be addressed with a fractional CO2 (carbon dioxide) laser among others. The fractional CO2 laser is one of the more commonly used today due to the superior results and minimal discomfort and downtime.

The fractional CO2 laser works by drilling tiny pin-sized holes to a specific depth in the skin surface. This grid-like pattern resembles what looks like a cribbage board, but on a very tiny scale. These tiny “holes” heat the deeper portion of the skin called the dermis causing the collagen (the building block of your skin) to “remodel” thus smoothing wrinkles and other defects. This grid pattern allows the laser to spare islands of normal skin so that healing time is minimized. The laser beam is moved from spot to spot over the area you are treating. You may treat selected areas of the face or the whole face. This laser can also be used to treat scars on the body as well. You may require one or several treatments (typically spaced months apart) depending upon the response you have and the severity of the wrinkles or scars you have.

What to Expect During the Procedure

Prior to the procedure, a topical anesthetic is applied to the skin for 15-20 minutes. This cream is then removed prior to treatment. During treatment, discomfort is minimal and may be reduced further with cooling devices or ice. Immediately following the procedure you will be pink to red and may feel slightly swollen and tender for a few hours. This can be relieved with ice packs, topical or oral steroids, and anti-inflammatories like ibuprofen.

The ideal patient is light-skinned with acne scars or has scars from trauma or wrinkles from age and sun exposure. Former smokers are also good candidates for treatment. The use of fractional CO2 laser in darker skin is generally not recommended, since the laser will heat the skin causing it to darken. Lighter-skinned persons may also have some temporary darkening of the treated areas of skin, but this will fade over time. Persons who are active outdoors should treat with the CO2 laser in the late fall and winter to avoid excessive darkening. Current tanning bed users should not be treated with a laser of any kind. Tattooed skin should not be treated. Spray-on tan or self-tanning cream should be removed prior to treatment. Any hair over an area being treated should be shaved. This laser will not remove hair, but if left above the skin surface, will burn and mark the skin when the beam strikes it. If you have recently taken isotretinoin (Accutane), you should not treat acne scars until 6 months have passed since your last dose of medication. If you have any skin infections or recent wounds, these should heal completely before initiating any laser treatment. Pregnant women should not be treated.

After the Procedure

Most people take about two weeks for the redness to go away. If the laser darkens the skin, this pigmentation may take 8-12 weeks to fully fade. Wrinkle reduction and scar improvement may take 6-12 months to begin to see good results. Results improve with multiple treatments. The longevity of most cosmetic procedures depends upon your lifestyle and genetics. If you do not like to wear sunscreen and like to be in the sun, expect less durability from your cosmetic results. If your parents aged gracefully, you will likely do the same.

As mentioned before, it may take several treatments to reach the endpoint you desire. You will have some improvement in the turgor of the skin, but remember, a laser is not a facelift! You may have a facelift and fractional CO2 laser on the same day, however, this would be done with general anesthesia. If you need additional facial volume, you may be treated with a volumizing agent (like Sculptra) prior to your fractional CO2 laser treatment. Multiple procedures may be done, but it largely depends upon how you tolerate discomfort, downtime, and most importantly your budget.