Fractional Co2 Laser Skin Resurfacing Treatment

Fractional CO2 laser treatment is one of the latest advances in laser resurfacing of acne scars. The CO2 laser with the longest wavelength is known for performing the best skin resurfacing for acne scars. It can be used safely for people with darker skin tone using appropriate settings. Fractional CO2 Laser for acne scars gives optimum results, if performed by an expert dermatologist.


  • Laser energy in ablative fractional lasers like Fractional CO2 Laser is fractionated either optically (by subdividing the conventional bulk laser beam into many microscopic beams) or through scanner.
  • This pixelated form of energy passes vertically downward into the skin as microscopic channels and is absorbed by target chromophore water in the tissue (epidermis and dermis), to generate heat which thermally damages or destroys it.
  • Multiple vertical microscopic three-dimensional small columns of coagulated and necrotic tissue are created and are referred to as microthermal/microscopic treatment zones (MTZs).
  • Each MTZ is substantially surrounded by undamaged skin. Thus, only a fraction of the skin (fractional) is exposed to light (photo) to thermally damage or destroy (thermolysis) the small treatment zone and hence named Fractional Photothermolysis (FP).
  • The MTZs induce a wound healing response consisting of rapid eipthelialization, tissue repair through neocollagenesis, and dermal remodelling from the surrounding viable tissue.
  • Contraindications:
    • Keloidal tendency
    • Infection
    • Connective tissue disorders
    Patient Selection:
    1. The fairer the patient, the better the results. Though it gives great results for people with darker skin tone also, with appropriate laser settings, required skin care & precautions by the patient.
    2. Emotionally balanced with realistic expectation.

    Patient Information

    Patient should be well informed about the following facts:
    • Realistic expectation of the outcome: 40-80% improvement depends on the condition to be treated and there’s no complete elimination. Multiple sittings of fractional CO2 laser treatment may be required for enhanced results.
    • Postoperative sequelae, side effects, and complications.
    • Postoperative sun protection for 3 to 6 months.
    Preoperative work:
    • Medical Tests - CBC, blood sugar etc.
    • Ancillary preoperative procedures - These are done 6-8 weeks before the laser ablation.
    • Consent and photographs.
    • Preoperative preparation (cream programme) to prevent or reduce postoperative adverse reactions. Sunscreens, topical creams etc. are advised for 4-6 weeks before the surgery.
    • Preoperative medications (Oral & Topical) to be started 15 days before the procedure and continued for the next 7-10 days.
    • Stop shaving or removal of excess hair just before getting the laser resurfacing done.
    1. Gloves and goggles
    2. Topical anesthesia (TA) - Cream applied under occlusion for 1-2 hours before the procedure.
    3. Preparation for the laser
    4. Set the parameters of the laser
    5. Technique for Acne scars:

    The laser is set in desired mode and its parameters are set to moderate-to-high density of MTZ/cm2 along with high energy in a small circular or square geometrical pattern (to match the shape of the scar base so as to suit all the scars in general). Skin surface along with scars is then stretched and the base of the individual scar is laser impacted once or twice depending on its morphology. All the scars are treated, one by one in a similar manner.

    Postoperative Management:

    a. Antibiotic creams & other serums are prescribed by the dermatologist to be used for the first 7 -10 days till flakes or crusts are gone. Patients are encouraged to wash the face repeatedly followed by application of antibacterial ointment. Reepithelialization process starts and is usually completed in 7-10 days.

    b. Postoperative programme consisting of sunscreens, emollients etc. is usually started after 2-3 weeks and is continued for next 2-4 weeks.

    1. Total sun avoidance for 7-10 days and sun restriction for further 1-2 weeks. Patient is instructed to use broad-spectrum sunscreens. Every 2 hours, once the crust falls and reepithelialization is completed (7-10 days).
    2. Proper skin care.
    3. 3. Oral medications: are prescribed to reduce the post laser discomfort.
    4. 4. Face is not covered with any dressing; only topical preparations as guided by the dermatologist are applied all over.
      1. Usual events: Transient edema, erythema, localised urticarial, punctuate bleeding, discomfort, flaking, crusting, and bronzing.
      2. Side effects: Persistent erythema and post inflammatory hypo/hyper-pigmentation can happen (Only if the patient doesn't follow post laser skin care properly including the use of a good sunscreen religiously).
      1. Good to excellent aesthetic results.
      2. Simple office procedure.
      3. All scars and wrinkles can be treated at one time.
      4. Can be combined with scar revision, face lift etc.
      1. Transient edema, erythema, PIH
      2. Multiple sittings (2 to 6 sessions at 1 month’s gap) are required to achieve good results.