CO₂ Laser Resurfacing: What You Really Need to Know

If you tuned into Episode 1 of Aesthetically Speaking, you already know we dove into one of the most effective treatments in aesthetics: the CO₂ laser. But for those wanting a more technical breakdown, this post is for you.

What Is CO₂ Laser Resurfacing?

CO₂ laser resurfacing is a fractional ablative treatment using a 10,600 nm wavelength that targets water in the skin. It works by breaking up the beam into microbeams to deliver the amount of desired energy in order to vaporize the targeted tissue, triggering a cascade of collagen production and skin remodeling. Modern fractional CO₂ lasers create microscopic thermal zones (MTZs), surrounded by healthy tissue, which allows for faster healing and reduced downtime compared to older full-field lasers.

Best for treating:

• Deep wrinkles & fine lines

• Acne scars & surgical scars

• Sun damage & actinic keratoses

• Uneven texture, tone & enlarged pores

• Skin laxity and crepiness

Why the 10,600 nm Wavelength?

This wavelength is highly absorbed by water, making it ideal for controlled ablation of the skin’s surface layers. As the laser vaporizes tissue, it also creates thermal injury zones beneath the surface, stimulating fibroblasts, increasing collagen, and tightening skin.

Key Parameters That Affect Results

Here’s a deeper look into what determines your outcome:

• Spot Size:

  • Smaller spots (e.g., 120–250 microns) = higher precision, better comfort

  • Larger spots = quicker coverage, but more intense sensation

• Pulse Duration:

  • Shorter pulses (<1 ms) = more ablation

  • Longer pulses = more coagulation and tightening

• Energy & Density:

  • Higher settings = stronger results (Remember, you'll have longer downtime and little room for mistakes with higher settings and more density)

  • Must be customized based on skin type, concern, and healing capacity

🎯 Pro Tip: For areas around the eyes, a smaller spot size enhances patient comfort without compromising effectiveness, making it safer for delicate areas.

🧬 Healing Timeline & Downtime

Expect a real recovery process:

• Days 1–3: Swelling, oozing, and redness. Stay moist.

• Days 4–7: Peeling and crusting. No picking!

• Weeks 2–6: Redness fades. Results evolve for months.

Must-haves: Avoid sun, sweat, and actives in your skincare. Stick to wound-healing products like Neova Tissue Repair, iS Clinical Sheald Recovery Balm, or just Vaseline or Aquaphor and follow your provider’s post-care strictly. Vinegar soaks are preferred and help to re-acidify the skin and prevent infection.

🔄 Combining CO₂ with Other Treatments

CO₂ laser isn’t always a solo act. It pairs beautifully with so many treatments:

• Non-ablative lasers – may help to improve pigment issues.

• PRP, PRF, or exosomes – speed healing and boost results

• Biostimulatory treatments – for enhanced collagen production

• Other energy-based modalities – builds collagen in deeper layers

• IV therapy – supports internal recovery

By combining modalities, you can treat multiple skin layers for a truly comprehensive transformation.

Is CO₂ Resurfacing Right for Everyone?

Not always. It may not be ideal if you:

• Have active infections, open lesions, or cold sores (HSV1 & 2) outbreaks

• Are on isotretinoin (Accutane) or recently stopped

• Are prone to keloids or delayed healing

• Have Fitzpatrick IV–VI skin without proper prep

🧪 Alternative options like fractional Er:YAG or non-ablative 1927nm Thulium lasers like LaseMD Ultra may offer safer solutions for those with darker skin types or sensitive conditions.

Final Thoughts

CO₂ laser resurfacing is still the gold standard in skin rejuvenation—but its effectiveness depends on the skill of the provider, the customization of parameters, and a commitment to healing.

If you're a patient, consult with a skilled provider who can tailor your settings based on skin type and goals. If you're a practitioner, understand the nuances that make this technology both powerful and safe when used correctly.

🎙 Listen to the Full Podcast Episode

Don’t miss Episode 1 of Aesthetically Speaking for a real-world conversation about CO₂ laser resurfacing, clinical pearls, and patient experiences with Clinical Trainer Carissa McCormack. Available now on Spotify, Apple Podcasts, and YouTube.

🎧 Click here to listen

📝 Got Questions or Topics?

We want to hear from you! Send in your aesthetic questions, treatment ideas, or device debates to be featured in an upcoming episode or blog post.