Ablative Fractional CO2 Laser Resurfacing

Collagen is the main protein that keeps skin looking young and line free. Over time sun exposure, pollution and the natural process of aging destroys collagen therefore increasing wrinkles. The CO2 fractional treatment laser uses light energy to create tiny holes in the skin. These holes put the natural collagen created by the body into high speed, creating extra collagen and reducing wrinkles, fine lines, stretch marks, burns and scars.

Are there any side effects?

There will be redness and swelling that lasts about two days. According to the American Society for Dermatologic Surgery, patients with darker complexions may be at risk for pigmentation with any laser surgery.

What’s the Difference between the Fractional CO2 treatment and CO2 Laser Resurfacing? You might read online about the difficult recovery period of a CO2 treatment. This is referring to the old CO2 laser resurfacing that used older technology with good results, but with many limitations. The new “Gold Standard” for CO2 laser treatments is the fractional CO2. When doing your research, make sure you know the difference between the two. The fractional CO2 laser treatment has become more and more popular because of its small down time. Typically there are two days of swelling and redness and another two days of swelling before your face is back to looking normal. Make sure you remember that you will not see the results of the procedure until 2 months AFTER the treatment is performed. Your body is sending collagen, blood, water and oxygen to the face to tighten the skin. Because the CO2 treatment facilitates the natural body cycle, the procedure takes a while to see the results, but the treatment is more long term. The results are noticeable from 1-8 years based on most studies.

Why is it called Fractional? The name fractional comes from the fact that the laser beam is broken up or fractionated into many small micro beams. The micro beams only hit small areas of the skin and do not penetrate into the whole layer of skin as the old CO2 treatment did. Because of this, after the treatment you will see small holes in your skin on the treated area. The micro treatment zones cause sufficient injury to promote new collagen production. The picture above shows the 4 types of treatments that have been performed for skin resurfacing. Ablative means to surgically remove. The most effective and most popular treatment that does require approximately 4 days of down time is the ablative fractional resurfacing. This treatment will remove the heated column of skin and provide more substantial wrinkle removal, tightening of the skin and any other skin rejuvenation treatment. It is also long term with visible results lasting from 1-8 years. The ablative fractional resurfacing have better results and less downtime than any of the other available treatments.

There is the non-fractional CO2 and erbium laser resurfacing. Any treatment that is not fractional typically has a shorter healing time. The superficial fractional ablative resurfacing is not deep enough to create noticeable skin tightening and wrinkle removal. The 3rd picture is the non-ablative fractional treatment. This treatments heats the skin, but because it is non-ablative, it does not remove the skin. Multiple treatments of the non-ablative fractional treatment are required. The real plus of this treatment is there is virtually no down time. This is used for acne scars, shrinking pores and plumping wrinkles.

The Benefits of Non-Ablative Laser Treatments

For many procedures, lasers are already considered the minimally invasive alternative, yet there’s still a push to use lasers that require even less downtime. Enter non-ablative lasers – technology that can provide dramatic skin rejuvenation results with minimal downtime.

Non-Ablative Lasers Defined

Perhaps the best way to define non-ablative lasers is to first explain ablative lasers. The distinction between the two is essential for patients and doctors to understand as they select laser skin rejuvenation procedures.

Ablative lasers (such as CO2 lasers) use heat and light to vaporize damaged cells from the surface of the skin and to penetrate into the deeper layers. Often referred to as “resurfacing,” these ablative treatments can improve skin texture, smooth moderate wrinkles, and correct pigmentation problems.

Non-ablative lasers use light to penetrate beneath the skin without removing outer layers. The most common types of non-ablative lasers are IPL (Intense Pulsed Light), BBL (Broad Based Light) and fractional laser. When delivered to the dermis, the laser energy encourages the production of collagen and facilitates skin renewal from within. Non-ablative lasers can treat age spots, acne, veins, redness, sun damage, minor wrinkles, scars, and poor skin texture.


During ablative laser treatments, patients often need to be sedated with local anesthesia. After the procedure, a healing period of several days to several weeks should be expected, during which there will be significant discomfort, swelling and scabbing. Patients should plan to take time off work.

Non-ablative lasers, on the other hand, do not usually require downtime or recovery. Unlike ablative treatments, the non-ablative procedure is not performed with general anesthesia or sedation, although some patients report minimal discomfort (often compared to the snapping of a rubber band) which can be mitigated with a topical anesthetic. Post-procedure discomfort is minimal. Patients are generally able to return to their daily activities immediately, although they may appear “flushed.” Even though the impact on the skin is less dramatic, non-ablative lasers are still able to achieve substantial improvement.

However, as with any treatment, there are some minor drawbacks.

Multiple treatments may be necessary, usually spaced several weeks apart. In addition, continued treatments are often required to maintain results.
They cannot treat all skin conditions.
Though non-ablative technology continues to improve, the results that can be achieved may not be as dramatic as those of ablative lasers.

Choosing a Physician

The selection of a qualified physician is as important with non-ablative lasers as it is with any other cosmetic treatment, despite the fact that they are minimally invasive. A physician must have the education and experience to determine candidacy and select from among the many products on the market. In actually performing the procedure, the physician must be well-versed in the details and application of the laser technology to achieve improvement without damaging the skin. Patients should carefully review their physician’s credentials prior to selecting and embarking upon a photo rejuvenation treatment plan.