Laser and energy-based: treatment guide

CO2 laser resurfacing: what it is, results, side effects and cost

Q: Can CO2 laser treat acne scars?

Yes, CO2 lasers are used to treat scars. Dermatologists use lasers to resurface skin with acne scars, but laser treatment makes a scar less noticeable rather than removing it.

What is CO2 laser resurfacing?

CO2 laser resurfacing uses a carbon dioxide laser to remove thin layers of skin very precisely, with minimal heat damage to the surrounding tissue.^[1] It is an ablative treatment, meaning it removes the outer layers of skin, and it is used for wrinkles, sun damage, scars and some skin growths.^[1][3] It can also be delivered as a fractional treatment.^[2]

Medically reviewed by Jeremy Warner, MD, FACS, Clinical Medical Director, double board-certified plastic surgeonLast updated October 30, 202620 sources

In the SkinSync AI app

Coming soon

CO2 laser in the SkinSync AI app

What the CO2 laser simulation will cover:

Deeper wrinkles
Texture irregularities
Acne scarring

Coming soon. CO2 laser simulation is coming soon to the SkinSync AI app. Today you can already scan your face, see neurotoxin and filler simulations, find a clinic and book.
See a simulation today. Scan your face and preview an illustrative neurotoxin or filler simulation on a 3D model, from the front and both sides.
Find a clinic. Browse participating clinics and providers, with their availability and pricing.
Book when you are ready. Book a consultation, in person or virtual, or a treatment directly in the app.

Simulations are illustrative and do not predict results. The app does not give medical advice; a licensed provider determines appropriate treatment.

CO2 laser quick facts

What it is	An ablative laser that removes the outer layer of skin and part of the layer beneath it^[3]
What it treats	Wrinkles, sun damage, scars, warts, birthmarks (linear epidermal nevi) and enlarged oil glands on the nose (rhinophyma)^[1]
Forms	Traditional CO2 resurfacing, which treats the whole area evenly, and fractional CO2 resurfacing, which treats narrow columns of skin^[2]
Anesthesia	Local anesthesia, usually with sedative medicine; general anesthesia may be used for the full face^[1]
Treatment time	About 30 to 45 minutes for part of the face, and 1.5 to 2 hours for the full face^[1]
Healing	Treated areas generally heal in 10 to 21 days; stronger settings mean longer recovery^[1]
Redness afterward	Usually fades in 2 to 3 months, but can take up to 6 months^[1]
How long results last	Skin can keep improving for up to a year, and results can last for years, though normal aging continues^[2][8]
Cost	Varies by clinic and area. Depends on the provider's expertise, the type of procedure, the time it takes and the location.^[10]
Insurance	Not covered when done as elective cosmetic treatment^[2]

How CO2 laser resurfacing works

Laser resurfacing sends short, concentrated pulses of light at irregular skin and removes damaged skin one layer at a time.^[6] The laser removes the outer layer of skin, the epidermis, and heats the layer underneath, the dermis. This stimulates new collagen, and as the area heals the new skin is smoother and firmer.^[2][6]

Laser resurfacing began in the 1980s with continuous-wave CO2 lasers. Because of side effects including scarring, pulsed and rapidly scanned CO2 lasers were developed to remove skin in a precisely controlled way.^[4] Today's CO2 lasers use very short pulses of light to remove thin layers of skin with minimal heat damage to nearby tissue.^[1]

There are two forms. Traditional CO2 and erbium lasers treat the whole area. Fractional CO2 resurfacing instead treats many narrow, microscopic columns of skin and leaves the skin around them intact, which lowers the risk of side effects.^[2]

A review of the literature describes fractional resurfacing as a significant advance over older ablative treatments, which were complicated by long-lasting redness, delayed lightening of the skin and scarring.^[5] For a gentler option, see our erbium laser and Fraxel guides.

What to expect, step by step

Before your consultation: see what the app offers todayCO2 laser simulation is coming soon to the SkinSync AI app. Today you can already scan your face, see neurotoxin and filler simulations, find a clinic and book a consultation. A simulation does not predict an outcome, and your provider decides what is appropriate for you.
ConsultationYour doctor chooses the type of laser resurfacing after a full review of your medical history, current health and goals.^[2] Tell the provider if you get cold sores, have a medical condition such as diabetes, smoke, or take any medicines or supplements.^[12]
PreparationYour doctor may start you on skin treatments several weeks before the procedure to prepare your skin. If you have had cold sores in the area, you may be given antiviral medicine to start before treatment.^[1][2]
Treatment dayThe procedure is usually outpatient, with local anesthesia and sedative medicine; general anesthesia may be used for the full face. Areas around the eyes, mouth or forehead can be treated on their own, or the whole face can be treated.^[1]
Right afterA protective dressing covers the treated areas at first. You then clean the areas two to five times a day with saline or a diluted vinegar solution and apply an ointment or other protective treatment as directed, which helps limit the crusts and scabs that can raise the chance of scarring.^[1]
HealingThe skin resurfaces in about eight days, and redness and peeling can last up to about three months.^[2]
ResultsYou may see a difference right away, and skin can keep improving for up to a year. Wrinkles and expression lines return with normal aging, and treatment can be repeated.^[8]

Side effects and who should avoid CO2 laser resurfacing

Common side effects

Right after treatment, skin is red and sensitive. Depending on the treatment, it may ooze, crust and have pinpoint bleeding.^[2][7] Swelling is expected.^[1]

Milia, small white bumps or cysts during healing^[1]
Acne flares^[1]
Darkening of the skin (hyperpigmentation), or more rarely lightening (hypopigmentation), which is harder to treat^[1]
Cold sore reactivation, especially when skin around the mouth is treated^[1]
Bacterial infection, which an antibiotic can help prevent^[1]
Scarring, which is rare^[1]

In a split-face study comparing CO2 with an erbium laser, redness at 2 weeks was seen on 20 of 21 CO2-treated sides and 14 of 21 erbium-treated sides, and skin lightening on 9 CO2-treated sides versus 1 erbium-treated side.^[16] People with darker skin tones have a greater risk of healing with darker pigmentation.^[1][9]

Do not pick at healing skin

Do not scratch or pick at skin that crusts, because this can cause scarring or lead to an infection.^[2]

Who should avoid CO2 laser resurfacing or talk to a provider first

Active acne^[2][11]
Very dark skin, which usually makes someone a less suitable candidate^[2][11]
Deep wrinkles or excess sagging skin, which laser resurfacing is not ideal for
A tan or sunburn, which rules out treatment that day^[12]
A history of cold sores or shingles in the area, which calls for antiviral medicine^[2]
Smoking, which harms healing^[1]

Choose an experienced laser surgeon

In the wrong or inexperienced hands, laser resurfacing can be dangerous. Look for a doctor who is trained and qualified and has specific experience with this procedure.^[1][9]

CO2 laser aftercare

Follow your doctor's instructions closely. General guidance after laser resurfacing includes:^[2]

Keep the area clean as instructed, for example with gentle saline soaks.^[2]
Keep skin moist with an ointment, such as petroleum jelly, until it heals.^[2]
Reduce swelling by keeping your head raised and using cool compresses.^[2]
Skip harsh skin care such as tretinoin or glycolic acid for about six weeks, or as your doctor directs.^[1]
Do not smoke, which slows healing.
Use sunscreen every day after healing, choosing one suited to sensitive facial skin. Pinkness can take up to a year to fade, so protect your skin during this time.^[1][8]
Camouflage redness once healed with oil-free makeup; green-based makeup helps neutralize redness.^[1]

CO2 vs erbium vs Fraxel

All three are laser resurfacing treatments, but they work in different ways. CO2 and erbium lasers are ablative: they remove the outer layers of skin.^[3] Fractional delivery, which treats microscopic columns of skin and leaves the skin around them untouched, can be used with ablative or nonablative lasers.^[2][4][15]

Swipe sideways to see all three lasers.

	CO2 laser	Erbium laser	Fraxel
Laser type	Ablative. Can be delivered in a traditional or a fractional form^[2][3]	Ablative (Er:YAG). Can be delivered in a traditional or a fractional form^[3]	Fractional laser. The Fraxel laser studied in the cited research is a nonablative fractional laser^[18][19]
Effect on the skin surface	Removes the outer layer and part of the layer beneath it^[1][3]	Removes the outer layer and part of the layer beneath it^[3]	Heats narrow columns of skin while the outer layer stays in place^[4][18]
Commonly used for	Wrinkles, sun damage, scars, warts, birthmarks and enlarged oil glands on the nose^[1]	Superficial and moderately deep lines and wrinkles on the face, hands, neck or chest^[2][11]	Sun damage on and off the face, atrophic acne scars, light-colored scars and uneven pigment^[18]
Recovery, per the cited source	Up to two weeks^[2]; treated areas heal in 10 to 21 days^[1]	One full week^[2]	No downtime with a nonablative laser^[12]
Side effects compared	In a split-face study, more redness at 2 weeks and more lightening of the skin than the erbium side^[16]	Fewer side effects than CO2, such as swelling, bruising and redness^[2]	Faster recovery than ablative resurfacing^[4]
Darker skin tones	Greater risk of healing with darker pigmentation^[1]	May be a good choice for a darker skin tone^[2]	A review found fractional lasers a favorable option for skin types IV to VI, with few high-quality studies in types V and VI^[20]
Strength of results	Better overall wrinkle improvement than erbium in one split-face study^[16]	With more than 5 passes, wrinkle improvement was not significantly different from 2 to 3 passes of CO2 in that study^[16]	Nonablative and fractional resurfacing do not produce results comparable to ablative resurfacing^[4]

How the laser is used matters too. In a smaller side-by-side study, when CO2 and erbium lasers were set to cause an equivalent injury, healing and wrinkle improvement were equivalent.^[17]

Which laser suits you is a decision to make with a licensed provider.

Frequently asked questions about CO2 laser

How long is recovery after CO2 laser resurfacing?

Expect up to two weeks of recovery for CO2 resurfacing, with treated areas generally healing in 10 to 21 days. Stronger settings mean a longer recovery.^[1][2]

How long does the redness last?

Redness generally fades in two to three months but can take up to six months, and it tends to last longer in people with blonde or red hair.^[1]

Does CO2 laser resurfacing hurt?

The treated area is numbed with a local anesthetic, usually along with sedative medicine, and general anesthesia may be used for the full face.^[1]

How long do CO2 laser results last?

Skin can keep improving for up to a year, and results can last for years. Normal aging brings new lines, which can be treated again.^[2][8]

What is fractional CO2 laser?

Fractional CO2 treats many narrow columns of skin and leaves the skin around them intact, so less skin is injured. Because the light goes deeper, there is a greater risk of complicated healing and scarring.^[2]

CO2 or erbium laser: which is better?

It depends on your skin and goals. In one split-face study, CO2 gave better overall wrinkle improvement, while the erbium side recovered faster with less redness and skin lightening.^[16] See our erbium laser guide.

Can CO2 laser treat acne scars?

Yes, CO2 lasers are used to treat scars.^[1] Dermatologists use lasers to resurface skin with acne scars, but laser treatment makes a scar less noticeable rather than removing it.^[12][14]

Is CO2 laser safe for darker skin?

People with darker skin tones have a greater risk of healing with darker pigmentation after CO2 resurfacing.^[1] Very dark skin usually makes someone a less suitable candidate for laser resurfacing, so talk with a dermatologist experienced in darker skin.^[2][13]

How much does CO2 laser resurfacing cost?

Varies by clinic and area. Your price depends on the provider's expertise, the type of procedure, the time and effort it takes and the location.^[10]

Does insurance cover CO2 laser resurfacing?

Insurance does not cover laser resurfacing done as elective cosmetic treatment.^[2]

Can I simulate a CO2 laser treatment in the SkinSync AI app?

Not yet. CO2 laser simulation is coming soon to the SkinSync AI app. Today you can already scan your face, see neurotoxin and filler simulations, find a clinic and book. Simulations are illustrative and do not predict outcomes.

SkinSync AI: Aesthetic Care