What is CO2 laser treatment and what can it do for skin?
⚠️ Contact your provider promptly if you notice these after treatment
After CO2 laser treatment, watch for signs of infection (increasing redness, warmth, pus, or fever), severe or worsening pain, blistering beyond what your provider described as normal, or significant changes in skin color. Contact your surgeon right away if any of these occur. Seek emergency care if you develop a high fever or spreading skin redness.
Short answer
CO2 laser is a well-established skin resurfacing technology used to treat acne scars, wrinkles, sun damage, and burn scars. Fractional CO2 laser is currently the most popular form, delivering results with less downtime than older full-surface techniques. Research supports its effectiveness and safety across multiple uses, though results and recovery vary by skin type and the specific concern being treated.
What the research shows
CO2 laser resurfacing has been used safely for facial skin since the early 1990s [6]. It works by removing the outer skin layer and generating heat in deeper layers, which tightens tissue and stimulates new collagen [5]. Today, the most widely used form is the fractional CO2 laser, which treats only a portion of the skin at a time, leaving surrounding tissue intact to speed healing [8].
For depressed acne scars, a meta-analysis of 6 studies and 467 patients found that ultra-pulse fractional CO2 laser produced better skin smoothness scores compared to other treatments [1]. When compared to microneedling for atrophic and hypertrophic scars, 60% of reviewed studies found no significant difference between the two methods, with both showing 70% or greater improvement [2].
For burn scars, CO2 laser resurfacing is the most widely used laser modality for reducing scar thickness, improving texture, and treating contractures that limit movement [7].
For skin rejuvenation (wrinkles, sun damage, skin laxity), an expert consensus panel of 21 dermatologists and plastic surgeons described fractional CO2 laser as a popular and effective treatment with minimal downtime [3]. Many experts also combine it with other treatments, such as neuromodulators or fillers, to maximize results [3].
What this means for you
CO2 laser can be a strong option for a range of cosmetic concerns, but it is not a one-size-fits-all treatment. Key points to know before considering it include:
- Skin type matters: Experts recommend adjusted settings for people with darker skin tones (Fitzpatrick types III and IV) to reduce the risk of pigmentation changes [3].
- Recovery takes time: Re-epithelialization (skin healing) typically occurs between 8 and 42 days after treatment [3].
- Combination approaches may help: Adding treatments like stem cell-derived exosome gels after CO2 laser for acne scars showed greater improvement and shorter recovery in one randomized trial [4].
- Contraindications exist: Active facial infections, recent sun exposure, burns, and pregnancy or breastfeeding are generally considered reasons to avoid or delay treatment [3].
What to ask your surgeon
Before your consultation, consider asking your provider these questions:
- Am I a good candidate given my skin type and medical history?
- Will you use fractional or traditional CO2 laser, and what is the expected recovery?
- Are any combination treatments recommended for my specific concern?
- What pre-treatment steps (such as antiviral medication or sun avoidance) are needed?
- What results are realistic for my scar type or skin concern?
This information is general education only. Always discuss your individual situation with a qualified, board-certified provider.
Caveats
Much of the available evidence comes from smaller cohort studies and short follow-up periods [5][6]. The meta-analyses supporting CO2 laser for acne scars included only 6 studies each, limiting how confidently we can generalize the findings [1][2]. The expert consensus panel was small (21 clinicians), so some recommendations reflect professional opinion as much as strong trial data [3]. Long-term outcomes and comparative effectiveness across all CO2 laser uses are still being studied.