Last updated August 2023

Quick Facts

 

What is a carbon dioxide or CO2 laser?

The carbon dioxide (CO2) laser has a 10600 nanometre wavelength that is attracted to water.  As water is one of the main constituents of the skin, when the laser interacts with it, a layer of skin is heated and vapourised. The heat energy causes contraction (tightening) of the skin, and the vapourised skin helps to remove surface issues such as wrinkles. This laser has been used for many years to resurface the skin and to reverse the effects of ageing and sun exposure. It improves skin texture, reduces wrinkles, and reduces pigmentation caused by sun exposure.

What is the difference between fractional and non-fractional treatment with the CO2  laser?

Fractional

In fractional mode, columns of laser energy are fired into the skin, leaving untreated skin in between. This reduces the recovery period required at the expense of the results achieved. Generally, more than one treatment is required if the laser is in fractional mode.

It is also possible in fractional mode to fire laser columns deeply into the skin. This is useful in treating scarring, where deeper collagen remodelling is required.

Finally, fractional CO2 can create deep channels in the skin to deliver drugs such as cortisone. This is effective for hypertrophic or keloid scarring or burn scars. The cortisone reduces the excess collagen production in scar tissue and improves the appearance of the scarring.

Non-fractional

As opposed to fractional mode, the CO2 laser treats 100% of the skin’s surface in non-fractional or full-field mode.  Furthermore, more than one pass of the laser can be performed for greater results. This treatment requires a significant amount of recovery time. 

What is Active Fx and Deep Fx?

Active Fx and Deep Fx are the names of the two handpieces that can be utilised with the Lumenis Ultrapulse laser.

The difference between the two handpieces is primarily in the size and depth of the columns of laser fired. The Active Fx handpiece emits laser columns with a diameter of 1.3mm and a depth of up to 0.2mm.  This handpiece treats more superficial skin problems such as fine wrinkles, superficial sun damage, pigmentation, and skin sallowness.

The Deep Fx handpiece emits laser columns with a diameter of only 0.15mm, penetrating deeper, up to 2mm into the skin. This density or surface area covered is much less and ranges from 5 to 25%. This handpiece is used to treat deeper problems within the skin, such as acne scarring. The channels in the skin created by this handpiece can be used to deliver drugs to the skin. For example, cortisone can be delivered through these channels to help treat scars.

What is the difference between modern CO2 laser technology and older CO2 lasers?

CO2 lasers have been used for resurfacing the skin for over 30 years. Over time both the laser technology and the treatment techniques and methods have evolved,  both helping to balance the potential risks and benefits of the treatment.

The introduction of fractional technology has improved the flexibility and uses of the CO2 laser. Fractional lasers fire small laser columns into the skin, leaving intact skin in between to help heal and reduce the risk and recovery from the laser. The CO2 laser can be used in fractional and non-fractional modes. This provides a significant advantage to traditional carbon dioxide lasers.  Fractional CO2 technology also allows for deeper penetration of the laser into the skin, and the treatment of a greater variety of skin conditions.

Previously, many practitioners used the CO2 laser overly aggressively, and this produced unnatural-looking results, with skin often appearing hypopigmented (a decrease in skin pigmentation). As techniques have evolved, practitioners now better understand that a compromise is required, using less aggressive settings to achieve results that appear more natural and have fewer side effects or complications.

In summary, the main differences include;

Traditional carbon dioxide laser Lumenis Ultrapulse carbon dioxide laser
Fully ablates skin in the treatment area Can be used in fractional or non-fractional modes
Shallow penetration into the skin Depth of penetration into the skin is adjustable
Prolonged recovery periods Potentially shorter recovery periods
May cause a waxy unnatural appearance to the skin More natural-looking results
Higher risk of scarring Lower risk of scarring
Progressive hypo-pigmentation (over-whitening of skin) Significantly reduced risk of hypo-pigmentation

What is the difference between the Fraxel, Pearl fractional, other fractional lasers, and the Lumenis Ultrapulse laser?

There are other fractional carbon dioxide lasers from other manufacturers, however, at 60 watts, the Lumenis Ultrapulse is the most powerful. The other fractional carbon dioxide lasers including the Deka Smartxide, the Medart 610 laser, Ellipse Juvia, and the Fraxel re:pair laser. However, we have chosen the Lumenis Ultrapulse because of its superior flexibility and power to the other fractional carbon dioxide lasers.

The Fraxel re:store laser is also a fractional laser, but not a carbon dioxide laser. Instead this laser emits laser energy at 1550 nanometres. At this wavelength, no tissue is actually ablated (vapourised) and only tissue heating occurs. This can help with problems such as acne scarring, but tends to be a less effective treatment than fractional carbon dioxide laser which both ablate and heat tissue to maximise the results.

Pearl fractional (2790 nanometres) and Pixel (2940nm) are also both fractional lasers, but again are not carbon dioxide lasers. The laser wavelengths of these two machines tend to ablate columns of skin, but unlike fractional carbon dioxide lasers, do not heat the skin to any large extent. As it is the heating which causes collagen contraction/skin tightening, these two lasers are limited as they do not cause much skin heating and are not used at Victorian Cosmetic Institute.

Case Studies

Full face CO2 laser resurfacing case 1

This 57 year old female presented to the Victorian Cosmetic Institute with concerns about her skin texture, wrinkles, skin pigmentation, and a naevi (mole) on her lower right cheek/jowl area. She had a non-fractional high-level treatment with the CO2 laser. This was done under intravenous sedation and local anaesthetic. The recovering pictures show the patient’s face after 2 days and after 1 month. The social downtime was approximately 10 days in this case. The residual redness took several weeks to disappear.

She also had dermal fillers and anti-wrinkle injections in addition to the laser.

co2 laser beforeco2 laserco2 laser after

 

Full face CO2 laser resurfacing case 2

This patient presents to Victorian Cosmetic Institute with concerns about her skin. CO2 laser and erbium laser together under a general anaesthetic. The post picture was taken three months after the treatment. The residual redness often takes several months to subside.
before and 3 months after co2 laser resurfacing

Am I a suitable candidate for CO2 laser treatment? 

CO2 fractional laser resurfacing is suitable for those who want to:

Who cannot have treatment with this laser?

We recommend those who are pregnant, breast-feeding, are prone to keloid scars, and those who have taken isotretinoin (Accutane, Roaccutane) in the past 6 months to avoid treatment.

The laser can also be used on most skin types from fair to dark, however, darker skin types may not be able to be treated with as aggressive non-fractional settings as the fairer skin types due to the increased chance of darker skin types to have pigmentary disturbances post-laser.

What can be treated with this laser?

The non-fractional, high-level CO2 treatments with the Active Fx handpiece are generally restricted to the face only and for those with fairer skin types. This treatment suits facial wrinkles, sun damage, and skin tightening.

CO2 fractional laser with the Active Fx handpiece is commonly used as a lower-intensity treatment for the same concerns but has less downtime and risk.

CO2 fractional laser  with the Deep Fx hand-piece (the deeper penetrating fractional hand-piece) is used for scarring and can be used on fair to darker skin types. Using the Deep Fx, we significantly improved scar texture, colour, and skin flexibility. Laser helps to remodel the scar tissue. 

Topical cortisone (Kenacort) may be applied to the skin post-laser for hypertrophic or keloid scars, and this infuses into the channels created by the laser. The cortisone helps to reduce scar tissue activity and improve the appearance and flexibility of the scar. The laser therefore also not only remodels the scar, but provides a conduit for the delivery of medication through to the scar tissue. This may be a preferred alternative to injecting cortisone, which can, when delivered this way, cause atrophy of the scar or fat resulting in an indentation in the area.

Recovery from this treatment for scars is significantly less than the recovery from skin resurfacing for wrinkles using the same laser.

Because the carbon dioxide laser is able to ablate (vapourise) skin tissue, certain skin lumps and bumps can be treated with this laser, including benign nevi (moles).

Rhinophyma, an enlargement of the sebaceous glands on the nose that leads to a bulbous nose, can also be treated with the carbon dioxide laser. Rhinophyma is usually caused by an underlying skin condition called rosacea. The carbon dioxide laser can ablate the excessive sebaceous tissue and return the nose to its normal size and shape.

How do I prepare for Co2 laser? 

The first step of treatment involves preparing the skin for laser treatment. A good skincare regime with medical-grade ingredients can help to prepare the skin. Topical retinoids used on the skin prior to laser resurfacing can help to improve skin turnover and have been shown to reduce the time of re-epithelialisation (regeneration and reformation of skin) post-laser.

Especially for non-fractional high-level treatments, antiviral medications or antibiotics may need to be taken prior to and after the procedure to prevent infections.

What should I expect during the treatment? 

The anaesthesia for the treatment will depend on the level of treatment required. For lighter treatments, a topical anaesthetic agent may be used without any other forms of anaesthesia. This will need to be applied at least 60 minutes prior to the onset of the procedure. Non-fractional high-level treatments are mostly performed under general anaesthetic.

During the treatment, your eyes will be covered, and for treatments around the eye area, corneal shields may need to be inserted under the eyelids to protect the eyes.

What happens after CO2 laser?

The treated areas appear red and swollen after the treatment, and the small columns of the laser can be seen on the face in a grid-like pattern of dots. The treated areas also feel quite hot after the procedure. To reduce this, we offer you a Zimmer cooler, a machine which blows cold air through a hose that can be directed at the areas to be treated.

Full recovery takes from 4 to 14 days approximately depending on the level of energy used in the treatment and whether the laser is used in fractional or non-fractional mode. Off-face areas usually take longer to heal than the face, and only fractional treatments at lower settings can be used for these areas.

There is a period where the skin appears quite red. Usually, this subsides within 1 week in lower energy level treatments but may take up to one month to fade for more aggressive treatments. Swelling of the face/eyes may occur for a few days, and sleeping on a 45-degree angle or greater can help to reduce this. There may be a mild acne-like break out (small white pustules) on the face after 3 days as the skin regenerates. The skin may scab, peel and flake and this occurs over one week.

For high-level non-fractional treatments, the skin’s barrier is significantly compromised. Vaseline needs to be applied consistently post-treatment until the skin re-epithelialises. Usually, for these treatments, we advise face washing and re-application of Vaseline 3 times a day. Antiviral medications or antibiotics are required for this treatment, and we closely monitor you for any signs of infection. On average 7-10 days at home are required to recover from the high-level non-fractional treatments.

Fractional CO2 laser treatments typically take a lot shorter time to recover. The recovery time will depend on the percentage of skin coverage as well as the intensity at which the laser is set.

What are the risks and side effects of Co2 laser? 

There are a few risks and side effects associated with Co2 fractional laser. These include:

  • Milia – small white bumps that occur in the healing phase after Co2 laser. These can be easily removed by cleansing with a face cloth or by visiting a dermatologist who will use a blade to nick the surface
  • Acne – it is possible for acne to occur after laser resurfacing. These generally resolve themselves
  • Hyperpigmentation 
  • Cold sores – taking antiviral medication prior the treatment and continuing for 7 to 10 days after treatment can help prevent this
  • Bacterial infections – taking antibiotics prior the procedure and continuing for 7 to 10 days after treatment can help prevent this
  • Scarring – this may occur following the treatment but is quite rare

FAQ 

How much does Co2 laser cost?

The price of Co2 fractional laser will depend on whether it is high level treatment or low level treatment and what area of the face is treated, as well as the size of the area to be treated. Click here for our full price list.

 

How long does it take to heal from Co2 fractional laser?

After Co2 laser treatment, it takes 1 to 2 weeks for the skin to heal. During this time the skin will be very sensitive. 

 

How do I prepare for the procedure?

Prior to the treatment, regular use of a SPF50+ broad spectrum sunscreen and limiting direct sunlight exposure is highly advised. Your doctor will advise you if other skin preparation products are required.

 

Is Co2 laser resurfacing painful?

The pain is minimal, with a sensation similar to pricking. However, the treatment involves anaesthesia to the treatment area, so the face would be numb, ensuring a painless procedure.

 

How many treatments of Co2 laser do I need?

This will depend on your skin concerns, including the extent of your wrinkles, scarring or sun damage. It will also depend on how much downtime you are after. Generally one treatment of Co2 fractional laser is enough to achieve long term results.  

Why choose Victorian Cosmetic Institute as your provider for Co2 Laser?

At Victorian Cosmetic Institute, we use the latest laser technology to perform your treatment. The Co2 fractional laser is the gold standard for resurfacing the skin, improving skin texture and smoothing fine lines.  Our doctors are also highly experienced in laser treatments, and will be able to give you the best advice for your treatment.

If Co2 laser is not suitable for you, we have a variety of lasers to choose from for the treatment of your skin. This allows us to choose the best laser treatment suited for your concerns.

The first step is simply contacting us for your initial laser skin rejuvenation consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your laser treatment.

Making that first phone call can be a confronting task – many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate. 

It’s as easy as clicking the “book online” button above and completing the provided form. 

Otherwise, you can phone us directly on 1300 863 824.