What Is CO2 Laser Skin Resurfacing?

CO2 laser skin resurfacing is a procedure involving the use of carbon dioxide (CO2) and a skin surface-removing laser (ablative laser) to remove scars, warts and deep wrinkles.

CO2 laser skin resurfacing is a procedure involving the use of carbon dioxide (CO2) and a skin surface-removing laser (ablative laser) to remove scars, warts and deep wrinkles.

Ablative lasers, such as a CO2 laser, work by traumatizing the skin. It removes the thin outer layer of skin (epidermis) and heats the underlying skin (dermis). This stimulates the growth of new collagen fibers. As the epidermis heals and regrows, the treated skin appears clearer, smoother and tighter. 

Non-ablative lasers, such as pulsed light (IPL) devices, do not traumatize the skin, instead they stimulate collagen growth and improve skin tone and texture. This is less invasive and requires less recovery time, but is less effective.

The surgeon chooses the laser type based on the condition being treated and the patient’s cosmetic goals.

CO2 laser skin resurfacing can be used to treat:

• Fine and deep wrinkles
• Age spots
• Uneven skin tone or texture
• Sun-damaged skin
• Mild to moderate acne scars
• Large pores
• Superficial to deep hyperpigmentation

Other uses for carbon dioxide resurfacing include:

• Seborrheic keratosis
• Verruca vulgaris/plana
• Sebaceous gland hyperplasia
• Angiofibroma (fibrous papule of nose)
• Junctional and compound nevi
• Lentigo simplex
• Small syringomas
• Epidermal melasma
• Rhinophyma (potato nose)
• Vocal cord nodules, cysts and tumors

CO2 laser skin resurfacing is not recommended with:

• Active bacterial, viral, or fungal infections
• Unrealistic expectations
• Poor general health
• Oral isotretinoin (Accutane) use within previous six months
• Fitzpatrick skin phototypes 5-6 (very dark skin)
• Other resurfacing procedures within preceding two to three months
• Unwillingness to accept possibility of complications
• Eyelid laxity
• Excessively thick or thin skin
• Collagen vascular disease
• Human immunodeficiency virus (HIV) or systemic infections
• Tendency for keloid or thick scar formation

CO2 laser skin resurfacing is usually done with anesthesia, so there is minimal discomfort during the procedure.

• Topical anesthetics are common
• Numbing cream may be applied directly onto the skin or sometimes local infiltration (injection)
• Other types of anesthesia are usually performed in individual situations and for skin conditions that need deeper penetration of the laser. These forms of anesthesia include
  • Regional nerve block
  • Intravenous (IV) sedation
  • Laryngeal mask airway
  • Combined techniques
• Post-operative pain is minimal and can be managed with oral pain killers

Avoid picking at the skin or rubbing skin vigorously when cleaning it or in the shower.

• Avoid hot showers.
• Care for the skin after laser resurfacing is similar to managing a second-degree thermal burn.
• Keeping the wound moist and dressing regularly promotes faster healing.
• Two methods of wound dressing may be used:
  • Open type: Apply an occlusive ointment (like petroleum jelly) till skin heals. Avoid topical antibiotics.
  • Closed type: Apply semi-occlusive biosynthetic dressing until skin heals. It is painless and promotes faster healing. It is expensive, however, and requires frequent clinic visits and increases the chance of infection.
• Antibiotics, painkillers and anti-itching medications can be administered if necessary.

• Recovery from CO2 laser resurfacing of the entire face is seven to 14 days, depending on the depth.
• Post-resurfacing swelling is expected. It peaks at day two or three, and then usually subsides by days five or seven.
• Redness and itching are common.
• During the first week, there are varying degrees of oozing and crusting depending on the dressing used.
• Apply dressings (open or closed) until complete healing takes place.
• Start applying a light water-based moisturizer for the next two to three weeks.
• The doctor may recommend post-procedure skin reconditioning early during the healing process.
• Avoid products that contain acids such salicylic acid, glycolic acid, etc., until the skin has completely regenerated, healed and skin tolerance has returned.
• Use sunscreen once healing occurs.
• Doctor visits may be required at two to three days, one week, three to four weeks, three months, six months, and one year after resurfacing.

Transient side effects (resolve spontaneously or with medication):

• Swelling
• Erythema (redness)
• Itching (pruritus)
• Acne flare
• Post resurfacing hyperpigmentation
• Infection (bacterial, viral, yeast, fungal)
• Contact dermatitis
• Serious complications
• Hypopigmentation (loss of skin pigment) 
• Sharp demarcation lines
• Hypertrophic scars and keloids
• Tooth enamel injury
• Eye abrasion/injury
• Post-inflammatory hyperpigmentation (PIH)
   

Results of CO2 laser resurfacing are good to excellent, depending on the indication for which the procedure was performed. Sun damage improves the most with laser resurfacing. Wrinkles may improve by 60% to 80% in some people, while scars improve to a lesser degree.

Most patients are satisfied with the aesthetic improvement, and the surgery results in minimal recovery time and a low incidence of complications.