Co2 fractional laser treatments

Ablative lasers have always been the gold standard in treating deep wrinkles as well as in achieving quick results in scar treatment. The treatments include complete removal of the superficial damaged layer of skin and creation of new rejuvenated skin. Unfortunately, the risk of complications associated with the old CO2 laser technology and infections resulting from these procedures have made patients turn to non-ablative lasers, which cannot compare to the effectiveness of ablative lasers. Advancements in technology have enabled the use of ablative CO2 lasers without fear of complications in the so called fractional mode.

What is fractional laser system?

The fractional system implies the creation of microscopic holes of treated and non-treated skin. Non-treated skin is the base unit for the treated skin to recover, which reduces recovery time after the laser treatment to 5 to 7 days, while also eliminating complications.

The benefit of this system is the shortened recovery time, increased capacity for recovery of the tissue, minimal risk of infection and increased depth of treatment without complications.

What is working principle of the fractional CO2 laser?

The ablative fractional CO2 laser works on the principle of evaporating the damaged tissue and deep heating of internal skin structures. This process leads to strong stimulation of new collagen in the skin as well as replacement of damaged cells with new ones. Three months after the treatment, volumization of the entire face is visible, as is the evening out of scars wrinkles and wrinkles on the skin.

The fractional CO2 laser is not the same as the fractional erbium or Fraxel. The Laser beam of the fractional CO2 laser penetrates deeper into the skin and offers a different treatment of the skin. Collagen stimulation is much higher with the CO2 laser than with Fraxel, and the results are visible after one treatment. There is no other laser system which can produce such results after just one treatment. The only shortcoming of this treatment is that recovery time takes 5 to 14 days. The facial area takes between 5 and 7 days and includes redness over the first 2 days and mild flaking of the skin over the next 4 or 5 days. Flacking of the skin on the neck and cleavage area is expected during 10 to 14 days. One treatment is used to simultaneously treat skin discoloration, fine and deep wrinkles, uneven skin tone, sagging and thinning skin. This is the only laser system which can successfully treat large burn scar areas or transplanted skin, as well as large surfaces of stretchmarks with sagging skin.

If the patient can spare 5 to 14 days, depending on the treated area, one treatment with the fractional CO2 laser is equivalent to many treatments by other laser systems – Fraxel, fractional erbium, non-ablative lasers.

How to prepare for treatment?

The fractional CO2 laser requires preparation. Patients are advised to take as much fluid as possible during two days prior to treatment. The laser beam is absorbed by water. The more hydrated the skin, the deeper the laser can penetrate the skin. Mechanical or chemical peelings must be discontinued at least one month before treatment. If Fitzpatrick skin type III or skin prone to discoloration is being treated, 3 weeks of use of retinoid creams and hydroquinone is recommended beforehand. Their use should be discontinued 7 days prior to the treatment. Anti-viral pre-medication is used one day prior to treatment in patients prone to herpes infections. On the day of the treatment, the patient should not be wearing any makeup. At the dermatologist’s office, the face is cleaned with an antiseptic and, depending on the patient’s sensitivity to pain, a topical anesthetic cream is applied.

Is it treatment with CO2 laser painful?

During the treatment, the skin is being cooled, so the treatment itself is relatively comfortable. During the application of laser beams there is a burning sensation. The entire treatment lasts up to 30 minutes. Immediately after the treatment, the facial skin is red just like after sunbathing, with a similar skin sensation. The intensity of the burning sensation is directly proportional to the density of the applied laser beam as well as to the number of times the area is treated during one session.

The patient receives instructions on skin care over the next 7 days. During the first two days, there can be some redness of the skin and a tightening sensation. Flaking of the skin begins 24 hours after the treatment and can last 5 days in some patients and 7 to 14 days in others, depending on the area treated and the laser energy level used (always in accordance with previous consultations with the doctor).

First results are visible once the skin peels and they most resemble the results from mid-depth chemical peels. Over the next 3 months collagen production is stimulated, so the skin becomes smoother, more even and lifted. If the patient is older, the stimulation happens at a slower pace and final results can be seen after 6 months. Sun protection is necessary over 2 to 3 months after the treatment. If needed, the treatment can be repeated 2 months after the first treatment.

The fractional CO2 laser cannot be used on persons currently being treated with Roaccutane as well as up to 6 months after discontinuation of the Roaccutane treatment. It is not to be used by pregnant and breast-feeding women due to the possibility of developing hyperpigmentation resulting from high levels of estrogen. Treatments also cannot be done immediately after chemotherapy nor while taking certain anticoagulants which are phototoxic. It is also not advised for persons prone to keloids.

Spec. Dr. Svetlana Djurisic, dermatologist
Dermatological clinic DERMATIM, Belgrade