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Laser Resurfacing Wrinkles - Around Eyes and Mouth

I am considering Laser Resurfacing for lines around my mouth and around my eyes. Would CO2 Laser resurfacing or the newer Total FX be more effective? I would like to know the pros and cons of each procedure.

Doctor Answers (13)

Fractional Laser Resurfacing for Mouth and Eyes

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TotalFX IS CO2 laser resurfacing delivered fractionally to facilitate shorter post treatment recovery, while maintaining the benefits of CO2 laser treatment.

TotalFX combines narrow column delivery of CO2 laser energy to the dermal layer (DeepFX) for long term collagen remodeling and more shallow, epidermal delivery for skin surface refinement. TotalFX can be used effectively in one treatment session to improve lines and wrinkles around the mouth and eyes.

Seattle Facial Plastic Surgeon

Fractional CO2 for Wrinkles Around the Mouth and Eyes

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Thank you for the great question. There are many brands and models of CO2 laser, and though there may be subtle differences in the delivery systems or power, the technology is very similar. Fractional CO2 is my go-to treatment for fine lines, wrinkles, and pigmentation issues around the moth and eyes. It can be used alone or in combination with other surgical on non-surgical rejuvenation procedures. Recovery is generally about a week, depending on how aggressive the treatment is. Pre- and post-laser care are generally easily managed. Best of luck!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

Combined non-ablative and Ablative Erbium Laser resurfacing

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Older flat beam CO2 laser resurfacing removes lines and wrinkles but recovery is horrible and the skin is usually left white or hypopigmented.

Most experienced doctors today are using fractional laser resurfacing--the active FX and Deep FX are fractional CO2 lasers.

I have used most of the lasers that have been available in the last 15 years and continue to work hard to improve results, lessen downtime, and avoid complications.

Like Dr. DiBernardo I now use Fractional Erbium, because it is effective and pain and downtime are significantly less than with fractional CO2.

Recently we have achieved the best wrinkle removal and skin rejuvenation results that I have ever achieved by combining Non-ablative fractional 1540 Erbium resurfacing with ablative fractional 2940 erbium laser resurfacing done at the same session.

Recovery time is 5-7 days, only topical anesthesia is required and the results are excellent. 

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It depends on several factors..

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This is a tough one to answer because we do not have the photos. CO2 fully ablative has advantages over Total FX in fractional mode- namely if performed correctly, only one treatment is needed. The disadvantage isthat downtime is longer, and risks are greater. 

TOTAL FX in deep fractional mode treats more deeply, with a higher safety margin, however you may need several treatments for optimal outcomes. 

How do I approach this common question of which is better?  I conduct a fusion of Ebrium laser to reduce the depth of wrinkles, THEN perform CO2 Fractional straight after to achieve collagen contraction and stimulation - all in the one treatment. 

See my before and afters in my gallery for a full explanation. 


Dr Davin Lim 
Laser Specialist, Brisbane 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 3 reviews

Laser treatments of fine lines and wrinkles

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This patient recognizes that there are several lasers that can help fine lines around the mouth and eyes.  These areas are very different in need and thickness and will require different laser techniques.  Since most lasers are versatile and very adjustable the laser treatment can and should varied between the two areas. There would be much (legitimate) debate as to which laser is best and the outcome would probably depend more on the skill and experience than the laser used.

Although there are many treatments for fine lines and wrinkles few can compare with the laser. Peels, dermabrasion as well as fillers have been for this. The laser because of its versatility can treat both deep and shallow levels of skin, meaning collagen as well as pigment and lesions.

It should be noted though that the laser is simply another instrument in the armamentarium of the practitioner and thus its benefit is only as good as the person doing the treatment. Lasers work by generating heat when the beam strikes the skin. The heat will cause a wide range of responses depending on a number of factors including the energy level, the wave length of the laser, the duration and concentration of the laser beam. All of these except the wave length of the laser can be adjusted. Responses vary from redness and swelling to micro ablations of tissue with most showing some coagulation of the protein (collagen and elastin of the skin). Collagen is shortened when heated as in a coiled bed spring. Furthermore over ensuing months new collagen may be produced to replace the lost and damaged collagen of the aging skin. There is a limit as to how deep and aggressive a treatment the skin will tolerate, which is a very good reason to choose your laser surgeon carefully.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 5 reviews

Laser Resurfacing Wrinkles - Around the Mouth?

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Lines around the mouth are often deep and a difficult area to treat. Considerations for treatment around the mouth include:

  • The skin around the mouth is relatively thick and requires different laser settings to be effective. 
  • Laser resurfacing of this area may need to be coupled with additional treatment such as volume enhancement around the lips. Volume enhancement around the lips can be non-surgical with a hyaluronic acid filler or surgical with fat transfer.
  • Lines around the mouth are generally more challenging to treat that lines elsewhere on the face and a discussion of realistic expectations from the treatment.

Laser resurfacing around the eyes and mouth

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Periorbital and perioral Fractional CO2 laser resurfacing (around the eyes and mouth, respectively) can be quite satisfactory. There is really no need to consider the traditional CO2 laser resurfacing as the additional clinical benefit does not quite justify much prolonged recovery period, demarcation of treated areas and increased risks of infection and/or scarring. The make of a FDA-approved Fractional CO2 laser resurfacing does not make as much difference as the experience of the board-certified aesthetic physician as there are subtleties of depth of penetration and/or energy emitted of Micro Fractional CO2 laser resurfacing.

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Laser resurfacing for wrinkles around eyes and mouth

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The thickness of the skin is different on the eyelids and on the lips.

The results in both areas are far superior with the old fashioned traditional CO2 Lasert han with the fractional CO2 Laser. However, the traditional CO2 Laser  resurfacing  requires a 7-9 days recovery time.

Using a combination of low power traditional CO2 Laser followed by the fractional CO2  laser can give the best results.

A rare patient will not respond to 4 consecutive (every 4 weeks) Fractional CO2 Laser treatments and then respond to one additional  low power Traditional CO2 laser treatment followed by a fractional CO2 treatment.

Always make sure that you are treated by a Board Certified Dermatologist or Plastic Surgeon with experience in this field.


Eugene Mandrea, MD
Chicago Dermatologist
4.5 out of 5 stars 4 reviews

Best Lasers for around the Eyes and Mouth

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I use both an Erbium laser and a Microfractional Carbon Dioxide to get the Best results. The erbium laser gently planes down the ridges or hills on each side of the "valley" and the Microfraction co2 laser provides the tightening and removes pigment. This  "Microfractional Plus"  treatment can reduce lines up to 90%.

Michael Tomcik, MD
San Ramon Dermatologist
4.0 out of 5 stars 4 reviews

Laser around the mouth

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Laser around the eyes and mouth is excellent but the two big factors to keep in mind are:  1) use either the new CO2 fraxel or The Erbium laser only. 2) Have it done by an experienced surgeon in this type of laser work. The Erbium can go from very mild to very deep depending on the setting and the number of passes made. I personally use low energy and multiple passes to paint the area and get just the right amount of smoothing and tightening. This can be very precise around the eyes when done carefully. It can be disasterous when done poorly. Also laser around the eye will cause smoothing and tightening but not remove any fat pads or fullness.The same holds true for around the mouth only here deep wrinkles or fissures made need the addition of a filler besides laser. I use a slightly higher energy around the mouth and make more passes with the Erbium as the skin is much thicker in this area.

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.