Dr. Goldman has over 20 years’ of experience with a myriad of surgical lasers. The CO2 laser is generally considered the most powerful laser for skin resurfacing, treating wrinkles, age spots, sun damage, and other signs of dermal aging. The CO2 laser releases heat within the skin, producing a controlled, superficial dermal burn. The resultant healing response increases collagen, elastin, hyaluronic acid, and other components, tightening and smoothing the skin and evening out pigmentation and skin tone.
Older CO2 lasers (called confluent lasers) treated the entire surface of the skin. Fractional lasers leave a fraction of the skin untreated by using a pattern of tiny dots, like a grid, to laser the skin’s surface. The areas of the grid that are not zapped by the laser can speed healing of the skin’s surface. Fractional lasers can also be used without general anesthesia in most patients, have less recovery time than confluent lasers, and less risk of hypopigmentation (of producing lighter areas of skin).
Your journey begins with an initial consultation, in which one of our experienced team will conduct a thorough assessment of your medical history, including dermatologic treatments, clarify your aesthetic goals, and examine your skin. We’ll discuss possible treatment options, including the specifics of fractional CO2 laser treatments, if applicable, and create a personalized treatment plan tailored to your needs.
On the day of your procedure, your skin will be cleansed, and a topical anesthetic is applied for about 45 minutes to minimize discomfort. Most patients take oral narcotics and a valium-like mild sedative. During the procedure, the laser will be used to deliver precisely amounts of light energy to your skin in the dot-like fractional pattern. Full face treatment takes about 30 minutes. Small areas take just a few minutes to treat. The neck and chest can be treated in 15-20 minutes. There is some discomfort associated with the procedure, but most patients prefer not to have general anesthesia.
You can expect pinpoint bleeding, significant swelling, and redness for about 5 days after the procedure. This can look dramatic but is associated with minimal pain. It is unusual for patients to require pain medicine. Most patients do not go out in public for 4-5 days but do have friends over and can work from home. Most patients return to work and exercise in 6-7 days. Mild redness persists for a few weeks.
Our team gives you detailed instructions (verbally and in writing) and close follow-up after the procedure, ensuring proper post-laser care to speed and optimize healing.
Ablative lasers, like CO2 and Erbium lasers, lightly burn the skin in a controlled fashion to stimulate healing and tightening. Non-ablative lasers pass through the skin itself to target other structures, like hair follicles, blood vessels, or tattoo pigment. Because non-ablative lasers don’t heat the skin itself, there is much less tightening or improvement in skin texture, so ablative lasers are best for rejuvenation.
CO2 lasers are generally not used on darker skin types. CO2 and other ablative lasers can alter pigmentation of any skin type, but darker skin has a higher risk of pigmentary change and such changes are more noticeable in darker skin. Lightening (hypopigmentation) or darkening (hyperpigmentation) can occur.
Patients with olive skin tone can be safely treated with fractional CO2 laser but generally must pre-treat with hydroquinone cream for 6 weeks or more prior to laser, which suppresses pigment production and makes pigmentary changes less likely. Traditional confluent CO2 lasers could generally be used on olive or darker skin.
Immediately after fractional CO2 or other ablative laser treatments, patients will have some pinpoint bleeding, swelling, and redness. Patients have to use occlusive ointment dressings for the first few days. After this early phase of healing (called reepithelialization), patients will still have some redness and swelling that resolves over 2-3 weeks in most patients. Patients can see early results during this redness phase, but ongoing healing, with increase in collagen, elastin, and other factors, continues for up to 6 months, so the final results are seen at about 6 months.
Because CO2 laser treatments are aggressive, they are usually administered as a single treatment session, not a series of treatments. However, because lower treatment settings must be used on the thinner skin of the neck, chest, and eyelids, these areas may have repeat treatments to optimize results. Areas of deeper wrinkles around the mouth may also benefit from more than one treatment.
For the first 4-5 days after fractional CO2 treatment, the skin typically shows pinpoint bleeding, significant swelling, and redness. The skin must be kept moist with occlusive ointment, like Aquaphor. The first few days look dramatic, even scary, but patients typically have minimal to no pain. Narcotics are not needed. Most patients are out of the house after 4-5 days and back to work in a week.
Results from fractional CO2 treatments typically last a few years. As aging proceeds, wrinkles, pigmentary changes, and other signs of skin aging do recur over time, especially if patients have significant sun exposure, smoke, or lose weight. Repeat CO2 laser treatment may become beneficial. Because fractional CO2 treatments can be performed awake and have less down time than older technologies, many patients do like to repeat the treatments every few years.
Medical grade skin care, including sun block and retinoids, along with a healthy lifestyle can prolong the results of your fractional CO2 laser treatment to keep you looking fresh and young.
At Beachwood Plastic Surgery, Westlake Plastic Surgery, The Surgeon's Spa - Beachwood, and The Surgeon's Spa - Westlake, we have over 20 years’ experience of with fractional CO2 lasers. We also have one of the most experienced skin care teams in the nation, to help you optimize your laser results. And we have an extensive array of additional options for facial rejuvenation, including other lasers (like the Halo laser), injectable treatments, non-ablative skin tightening technologies (like Morpheus and Sofwave), and surgical options, like Dr. Goldman’s deep plane facelift.
Our unparalleled team will help you determine if the CO2 laser is a great option for you. Please feel free to contact us or, even better, come in for a consultation if you have any further questions.
