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Best CO2 Laser Resurfacing

Is there a difference between the UltraPulse CO2 laser and Fraxel or Pixel lasers?  I'm confused by all the different names and think the doctor will try to sell me on whatever machine he has- without it necessarily being the best for me. How can I know I'm doing the best treatment?

Doctor Answers (13)

There are many types of lasers and you have to do your homework


There are a lot of laser devices out these days and you do have to do your homework to keep things straight. There are basically 3 categories of lasers: 1) Fully ablative that includes CO2 and Erbium lasers, 2) Fractional Ablative lasers that include Fraxel Repair, Lumenis Total Fx (these are both fractionated CO2), Pixel, DoT and others, 3) Fractionated non-ablative lasers such as Affirm, or Fraxel Restore

The main difference between these categories is the amount of downtime that goes along with them. The Fully ablative lasers require 1 treatment and will require 2-3 weeks to heal and possibly some redness beyond this time frame. The fractionated ablative CO2 lasers usually only take 1 treatment and reduce the healing time to about 1 week. The nonablative fractional lasers require 4-5 treatments but only have 1-2 days of redness for healing.

The other main consideration is results and what the treatment is for. A basic rule is that the more aggressive the laser, the better the results and the more the downtime. All lasers are indicated for wrinkles, acne scars, pigmentation, and sun damage. For wrinkles, more aggressive treatments are better.

This is some basic information to help you along. The other questions you should ask are what are my options. If the practice only offers one laser and one laser for everything then you should be wary. If options are presented to you with variable results and healing times then it is reasonable. Any serious laser practice will offer options or combination treatments. For example, our practice has around 20 lasers for various applications so that we can offer options to patients depending upon their needs and lifestyle (healing time tolerance).

Lastly, if you are not comfortable with a physician, get a second opinion.

Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

There is a definite difference between fractional resurfaicng and CO2 laser resurfacing


There is a definite difference between fractional resurfaicng and CO2 laser resurfacing. The CO2 laser is an excellent treatment option for deeper wrinkles, acne scarring and sun damaged skin. The fractional treatments taken the typical CO2 laser and lower the power density and spread out the beam so some of the skin is not treated and heals faster. The disadvantage is that it does not equal one treatment with the traditional CO2 laser and often is not effective for deeper lines and deeper acne scarring. Also, multiple treatments with a fractionated or Fraxel type of laser is required to achieve the same results of a traditional CO2 laser. However, I do believe it still has a usefullness for patients who have minimal lines and lesser scarring.

Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Which Co2 Laser is Best?


While I agree that on some rare occasions some doctors may recommend a laser because they have it, most doctors want their patient to achieve the best result. in addition many manufacturers make scientific claims which don't always turn out to be true, for example the Sharplan laser and the ultra pulse laser were clinically tested to be equal even though theoretically one had an advantage. I personally like the Pixel laser for heavy duty repair of wrinkles. For more mild wrinkles and acne scarring the Fraxel Restore is quite good. most important is for you to have a competent laser surgeon who you have faith in to guide you through these confusing choices. Dr Fincher gives a nice overview as to the categories of some of these lasers.

Web reference:

Long Island Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Best CO2 Laser Resurfacing


I personally prefer fractional laser resurfacing for most of my patients now, however there are several lasers that can achieve good results, depending on your examination and desired result.  You really need to go to a physician you trust, the actual laser is probably less important.

Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 13 reviews

You want to go to someone you trust


There are a lot of different lasers out there. Essentially for resurfacing, there are two lasers out there: CO2 and Erbium.

CO2 allows you to be more aggressive and you can vary the degree of this to fit anyone. Lumenis and their Active FX/Deep FX is the best in my opinion and in the opinion of the most infleuntial people out there. This is a CO2 laser.

Erbium has some limitations in that it can't go very deep and doesn't cause tissue contraction like CO2 lasers can. All other lasers such as Fraxel and Fractional lasers work by causing manipulation to the deeper layers of the skin to cause skin tightening. There are just a lot of companies out there selling them with different names. You just have to ask them what technology they are using and if they are making it complicated then I would ask someone else. These lasers take more treatments and take more time and money but have less downtime based on company reports.

However, I've heard from other patients that Fraxel and other fractionated lasers can cause more downtime than what the "people" are telling everyone.

What's the best? It depends on how significant your wrinkles are. The more significant, the more aggressive you might want to be. It also depends on your lifestyle. Does your lifestyle dictate that you can't have any downtime, if so you should consider less aggressive means.

Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 24 reviews

CO2 Lasers

The doctor will try to sell you on what they have — that only makes sense.  In essence, and in reality, the UltraPulse CO2 is the gold standard CO2 laser and everything is compared to it.  The laser doc, however, is the one who can be the artist or be the one who leaves some to be desired.  CO2 lasers create a defect caused by the laser and a thermal zone which can lead to downtime and potential adverse events. The UltraPulse is the only device that causes this thermal zone to be almost nonexistent. The Fraxel CO2 causes thermal damage and so does the Pixel CO2.  But all can hurt people, so again, make sure that they user is well skilled.
Nashville Dermatologic Surgeon
4.0 out of 5 stars 3 reviews

Best C02 LASER


There is no "best" C02 laser system.  The key is to understand the technology and how it is being applied to your skin.  There are basically two types of C02 laser technologies, fully ablative and fractionally ablative lasers.  

Fully ablative C02 laser is not used as commonly, but does have a role in specific lighter skin types.  The main issue with this technology is that the downtime can be longer than ideal and the rate of complications, such as hypopigmentation and scarring is higher than most patients and surgeons find acceptable.

Fractionally ablative C02 lasers are the laser technology of choice since they offer many of the benefits of fully ablative lasers without the downtime and the complications.  


Web reference:

Chicago Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Choosing a physician or surgeon for Fractional CO2 laser skin resurfacing


The results of Fractional CO2 depend less on the brand of laser and more on the assessment of your skin and the settings used to treat you.  I have found that in my Santa Monica plastic surgery practice, there are rarely two patients who will need the exact same settings for fractional co2 laser.  I custom tailor a computer generated laser treatment to your particular situation and requirements.  Fractional CO2 laser is an excellent modality for laser skin resurfacing and can be used successfully on most skin types.  I treat patients in the peritreatment period with Melaquin AM and Melaquin PM to reduce pigmentation from fractional CO2. 

Los Angeles Plastic Surgeon
5.0 out of 5 stars 43 reviews

The difference between lasers


All Co2 lasers are essentially the same.  The outcome is more dependent on the operator than the laser in the vast majority of the cases.  One surgeon may prefer one laser to another because of certain functions, ease of use, reliability, etc...  There is a difference between types of lasers (in contrast to brand of laser).  Fractional Erbium lasers are less likely to cause Hyperpigmentation in darker skinned individuals, but also tend to produce less of an effect per treatment.  Other types of laser therapies include Photofacial (IPL) and YAG lasers.  For fare skinned individuals, CO2 is most likely to give the best result.  Go to a surgeon that does a good deal of Fractional CO2 laser treatments, and is well trained.  Also pick one that you like personally, it will make your experience more pleasant.

Beverly Hills Plastic Surgeon
4.5 out of 5 stars 15 reviews

CO2 Resurfacing


I agree with the comments above. With respect to the ablative lasers, you have two choices, either fully ablative co2 resurfacing or fractional co2 resurfacing. With fully ablative resurfacing, you will have weeks of downtime, more pain, and increased risk of side effects. I prefer the fractional because it has less risk of side effects, more tolerable, less pain, and less downtime. A lot of companies will claim less pain, swelling or downtime with their fractional co2 laser. However, I have used many of them, including the Fraxel CO2, Active FX, Smart Dot... etc. I believe that they are all pretty much very similar if you are aggressive enough. To see good results, you need to be moderately aggressive with the settings, and the more aggressive you are, the more the downtime. I would be cautious of a clinic trying to sell one laser for every skin problem.

Santa Monica Dermatologic Surgeon
5.0 out of 5 stars 2 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.