Difference Between Fractional and CO2 Lasers?

Is a Fractional non-ablative laser different than a CO2 ablative laser? Is one of these methods the best for treating acne scars? How long does the redness last?

Doctor Answers 9

It depends

A fractionated laser is one that spares portions of the epidermis to affect changes in the deeper epidermis or dermis. A fractionated laser can be either an Erbium or CO2 laser. Both are effective, the physician who is using it is more important then the actual laser. Fractionated technology is aimed at acheiving similar results to standard "resurfacing" with less downtime.

However, because the downtime is less the results are not as dramatic as with traditional resurfacing. That being said, I very rarely do any traditional true "deep" laser peels anymore because of the associated downtime and increased risk of complications. I usually do a combination of a superficial laser resurfacing followed by a fractionated laser treatment. I feel this provides the best result with minimal downtime. I customize the settings according to how many days a patient can have downtime.

The less downtime, the less dramatic the result. Hope that helps.

Seattle Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

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Fractional vs CO2

The in vogue "fractional lasers" are fractional CO2 lasers. The fractional erbium is used only by those who purchased their systems a couple of years ago when the fractional CO2 was not yet available.The fractional CO2 treatments are more superficial than traditional "full" CO2 laser resurfacing procedures. Typically we use our fractional CO2 laser for treatment of blotchy pigmentation and very fine lines. On the other hand we use our traditional CO2 laser for treatment of deeper lines, for tightening of the skin, and for acne scarring of any significance. Of course the deeper treatment mandates a longer recovery time and also there are more potential risks. In my opinion the companies and some doctors over promise when using both of these technologies especially the newer fractional systems thus leading to patient disappointment!

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Fractional versus CO2

Fractional treatments can be non-ablative or ablative. Creating small holes in the skin, non-ablative passes through the top layer of skin or epidermis and is a more gentle treatment than the ablative therapy which goes through the epidermis into the dermis. Non-ablative fractional treatments usually work over time - 4-6 treatments over a 4-6 month period of time to achieve the desired results. Ablative fractional treatments work faster, but are associated with more downtime than most non-ablative treatments. 

Michael Gold, MD
Nashville Dermatologic Surgeon
4.5 out of 5 stars 10 reviews

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Difference between fractional and co2 lasers

The Fraxel is a fractionated Co2 laser.  It is the next generation in CO2 lasers.  The older CO2 lasers were extremely aggressive, painful, poor healing, and had many complications such as hypo-pigmentation and scarring.  Along came the Fraxel CO2 laser which used fractionated technology to accomplish the same smoothing of the skin, and reduction of fine lines without the aggressive treatment or side effects.  Fraxel is ideal for treating sun damage, pigmentation, lines, wrinkles, and scars.  It is the best laser! Just find someone experienced with this laser so that you can achieve the best results.

Fractional and CO2 lasers

To answer your first question - yes, a fractional non-ablative laser is different than a CO2 ablative laser? 

First lets define our terms:

"Fractional" simply means that instead of a solid beam, the laser creates a grid-like pattern (as if you were shining a flashlight through black paper with pinholes in it). 

"Ablative" means that tissue is destroyed.  "Non-ablative" means that the tissue is just heated up.  An ablative laser treatment will leave tiny crusts.  A non-ablative treatment just leaves you red (and maybe swollen).

A CO2 laser is a specific type of laser.  CO2 lasers come in both "fractional" and "non-fractional" varieties, but they are all "ablative".


Todd Minars, MD
Miami Dermatologist
3.5 out of 5 stars 3 reviews

Difference between CO2 and fractional CO2 and fractional Erbium lasers

CO2 laser is more invasive, hurts more, and has more downtime than fractional lasers but the results are usually better with CO2 for deeper wrinkles and skin tightening.  Multiple treatments with fractional CO2 can come close to the results of CO2 especially for acne scarring.  The one area that fractional CO2 doesn't do as well as CO2 is deep wrinkles around the mouth.  You will get more bang for your buck with the CO2 but there's a lot of disadvantages such as increased risk of complications, infection, change in pigmentation.  CO2 laser causes more injury by creating a full thickness burn whereas fractional lasers causes injury to smaller areas of skin so it heals faster.  Any laser beam can be fractionated but the most common ones for resurfacing are Erbium and CO2.  Examples of fractionated CO2 are the ActiveFX, DeepFX, TotalFX (Lumenis), Re:pair (Solta), CORE (Syneron).  Examples of fractionated Erbium are Pearl (Cutera), Profractional (Sciton), Re:store (Solta), Re:fine (Solta).  Fractional CO2 lasers are more effective than fractionated Erbium devices but there is a little more pain and more prolonged redness with the fractionated CO2 lasers, but still much less than with CO2 laser resurfacing.

M. Christine Lee, MD
Walnut Creek Dermatologic Surgeon
4.0 out of 5 stars 14 reviews

Difference between fractional non-ablative and ablative lasers

    The best analogy would be to compare these to different approaches to your lawn care. If the grass cover is not in the best shape you can try to do deep plug aeration by punching lots of small holes in the lawn. This preserves the surrounding grass and the lawn recovers and rejuvenates quickly.  The other alternative is to remove the lawn all together and seed new grass. This process takes a lot longer but the new grass, when it comes in looks very nice. The same concept applies to laser resurfacing. There is much longer down time to ablative resurfacing, but for skin that is too damaged from aging or acne scarring, the fractionated treatment may not be enough to get the best results.

Joseph Shvidler, MD
Tacoma Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Difference between fractional and ablative CO2 lasers

The difference between fractional CO2 and ablative CO2 laser resurfacing is the amount of damage that is delivered to your skin. The older ablative lasers burn 100% of your epidermis (the top skin layer) while fractional CO2 lasers burn a smaller fraction, usually around 20% -the technique is like pixels on a TV screen where there is a small core of laser damage separated by healthy skin. The advantages of fractional lasers include a lower risk of scarring and skin color changes, a quicker recovery time, a more natural appearance, and the ability to treat both darker skin types and areas of the body outside the face (neck, hands, chest, arms). The biggest disadvantage of the fractional laser is the fact that it is fractional and that more than one treatment may be necessary in order to achieve the result you are looking for.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon
4.5 out of 5 stars 5 reviews


Fractional just means that the laser is not targeting 100% of the treated area, leaving portions of your skin in between treated area,  which is shown to have faster heeling time.  Other advantages are lower risk of scarring and less chance of skin discoloration, 

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.