Fractional CO2 laser resurfacing is a laser skin resurfacing treatment that can improve sun damage, brown spots, fine lines, uneven texture, and certain types of acne scarring—but it comes with real downtime and isn’t ideal for every skin type. In this blog post, we cover the various CO2 refurfacing laser pros and cons you should know before pursuing treatment.
At Youthful Reflections Facial Plastic Surgery near Nashville (Brentwood), TN, double board-certified facial plastic surgeon Michael A. Boggess, MD, customizes your laser treatment depth and aftercare to match your goals, skin type, and tolerance for visible healing.
Fractional CO2 Laser Resurfacing: Quick Facts
| Detail | Typical range (varies by treatment depth) |
|---|---|
| What it targets | Texture, tone, fine lines, sun damage, some scars |
| Treatment style | Fractional (treats “columns” of skin, leaving surrounding skin intact) |
| Downtime tradeoff | Bigger change than many light lasers, but more downtime |
| Visible/social downtime | Often ~1 week; deeper treatments can be longer |
| Redness | Can last weeks; sometimes longer depending on depth and skin type |
What Is Fractional CO2 Laser Resurfacing?
Fractional CO2 laser resurfacing uses a carbon dioxide laser (10,600 nm) to create microscopic treatment zones in the skin rather than treating the entire surface at once. Those controlled micro-injuries stimulate collagen remodeling and skin renewal, which is why it’s often used to treat texture concerns, fine lines, and sun damage.
Why “fractional” matters: Because the laser creates micro-zones rather than blanket coverage, the skin recovers more effinciently than fully ablative (non-fractionated) laser resurfacing.
What Are the Advantages of CO2 Laser Resurfacing?
The biggest “pro” is that fractional CO2 can create a noticeable improvement in skin texture and tone when topical skincare and lighter treatments aren’t enough. Laser skin resurfacing benefits commonly include:
1. It can address multiple skin concerns at once
Fractional CO2 laser resurfacing may help improve:
- Fine lines and wrinkles (often around the mouth and eyes)
- Sun damage and rough texture
- Brown spots, blotchiness, and uneven tone
- Unwanted pigmentation
- Mild to moderate acne scarring (depending on scar type)
- Certain scars in select patients (requires individualized evaluation)
- Actinic keratosis or precancerous growths
2. It’s customizable (depth, density, and downtime can be tailored)
One of the practical advantages of laser skin resurfacing is its flexibility: The settings can be adjusted to balance results vs. downtime, which is why two patients can have very different recoveries from the “same” laser type.
3. It’s Suitable for Many Types of Skin
We can use fractional CO2 laser resurfacing on almost everyone without worrying about the skin’s safety. However, those with darker skin tones need to be treated more conservatively to avoid changes in skin pigmentation.
4. It can complement surgical facial rejuvenation
Fractional CO2 laser resurfacing is commonly paired with facial rejuvenation procedures to address surface-level aging (tone/texture) alongside structural changes. At Youthful Reflections, it may be combined with Dr. Boggess’ signature facelift procedure, the Reflection Lift, eyelid surgery, or facial fat transfer when appropriate.
What Are the Limitations of CO2 Laser Resurfacing?
The “cons” of laser skin resurfacing mostly come down to downtime, aftercare discipline, and pigment-risk considerations. Common tradeoffs include:
- Discomfort during treatment: although we do everything we can to keep you comfortable, the procedure involves some discomfort (similar to a rubberband snap against the skin)
- Visible healing time: peeling/crusting and a “sunburned” look are common early on
- Social downtime: many patients plan about a week; deeper settings can mean longer
- Exercise pause: you may need to avoid strenuous activity for a period while healing
- Cold sore reactivation risk: heat/trauma can trigger outbreaks in people with a history of HSV (tell your provider early)
- Redness: can persist for weeks; sometimes longer depending on depth and individual response
- Not a loose-skin solution: laser resurfacing can improve texture and fine lines, but it doesn’t replace lifting for significant laxity
Laser resurfacing can also cause the treated skin to become darker or lighter than before (post-inflammatory hyperpigmentation or hypopigmentation). The risk is higher for some skin types/tones, so settings and modality choice matter.
How much downtime should you plan for?
Downtime after laser skin resurfacing depends on the intensity of your treatment. In general:
- Some people return to most normal daily activities within several days
- “Camera-ready” or social downtime can be closer to about a week (or longer if deeper settings are used)
- Redness often fades gradually over time and can persist longer in some patients
The simplest way to plan: ask your provider for a downtime estimate based on your exact settings, not a generic average.
What To Do Before Fractional CO2 Laser Resurfacing
The most important pre-step is a private consultation so your provider can match the laser settings to your skin type and goals and reduce avoidable risks. Before your appointment, be prepared to discuss:
- Any history of cold sores
- Past pigment issues after treatments
- Current skincare (especially strong actives like retinoids/AHAs/BHAs)
- Recent tanning or heavy sun exposure
- Medications and any healing problems (scarring tendencies, immune issues, etc.)
Day-of basics: arrive on time with clean skin (no makeup, lotions, or fragrance on the treatment area), and follow the prep checklist your office provides.
What To Do After Fractional CO2 Laser Resurfacing
Aftercare is where your results are protected—or compromised. The most important rules during your recovery include:
- Avoid direct sun exposure during early healing
- Use a broad-spectrum SPF 30+ once cleared to do so, and reapply if outdoors
- Don’t pick/peel healing skin
- Use only the gentle cleanser/ointment routine you’re given
- Avoid reintroducing strong actives (retinoids/acids) until your provider says it’s safe
If you can’t avoid being outside, prioritize shade and sun protection. Pigment changes after resurfacing can be stubborn, so prevention matters.
The Youthful Reflections Difference
Youthful Reflections is a trustworthy facial plastic surgery center offering personalized care and the latest technology to help you feel like a more beautiful version of yourself. Double board-certified facial plastic surgeon Dr. Michael Boggess is a nationally renowned expert in cosmetic facial procedures and will work with you at every step to ensure your comfort and satisfaction.
When Should You See a Laser Skin Resurfacing Specialist in Nashville?
If you’re in Nashville, Brentwood, or the surrounding areas, and you’re frustrated with sun damage, brown spots, rough texture, or fine lines that haven’t improved with skincare or lighter treatments, it may be time to look into fractional CO2 resurfacing.
Get Started
If you’re considering fractional CO2 laser resurfacing, request a consultation using the online form or call Youthful Reflections at (615) 942-8016 to plan a treatment approach that matches your skin, goals, and downtime window.
This blog post was originally published in September 2023 and has been updated.
