When Will the Redness and Dents After Fractional CO2 Laser Heal?

Question

Four weeks ago, I had done Fractional CO2 Laser procedure done on my face to get rid of acne scars. Now, the redness and dents are still there. When will these heal, and will they heal normally?

Cameron Chesnut, MD, FAAD, FACMS · Answer

Acne scarring is one of the most challenging conditions to address. Lucky for you, fractionated CO2 resurfacing tends to have the best results, although it may take multiple treatments to get there.As I'm sure your physician mentioned to you, a good result is about 50% improvement in your acne scars. Read: they will never be 100% better, or you will never have completely normal skin there again. You need to decide going into your treatment that a 50% improvement will make you satisfied.Redness after CO2 is a very common and actually encouraging reaction. As your body creates new collagen it requires a lot of energy to do so, and that energy comes from blood vessels, which are of course red. Depending on the aggressiveness of your treatment, that redness can occasionally extend up to eight weeks or more. Once outside of that eight week window, we consider that to be prolonged redness and will start looking for other causes which can come in the form of topical medications, excess sun exposure, etc.To ensure you are receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Jeff Angobaldo, MD · Answer

Thank you for your question. CO2 is used to tighten the skin and reduce pigmentation. it is recommended to pretreat with a topical hydroquinone to prevent hypopigmentation. wait 6 months to see if your concerns resolve. co2 results take up to 6 months.

Edward P. Miranda, MD, FACS · Answer

Depending on the particular settings of the laser treatment, skin type, and your own body's ability to heal, the time will vary. Typically redness and uneven texture resolves in the course of 2-4 weeks, however for some this can take longer. The most important thing is to avoid sun exposure and wear sunscreen daily and avoid any skin irritants. Over the course of several weeks, your body will synthesize new collagen in the areas of the "dents" from acne scars to create a smoother texture. Additionally, the majority of people will require 3-5 sessions of CO2 laser therapy to obtain their desired result. If the texture irregularities persist, adding other therapies such as subcision (inserting a hypodermic needle underneath areas of acne scars to release tethering to underlying subcutaneous tissues) and Bellafill (a long lasting filler) may be beneficial.

Brian K. Machida, MD, FACS · Answer

Redness is common during the postoperative period. You may have dents due to residual acne scarring.  It's best to follow up with your treating physician for repeat evaluation if you have a question.

Raffy Karamanoukian, MD, FACS · Answer

After fractional co2, you may need a combination of pulsed dye laser and application of Plato's Scar Serum to help improve the scars and redness. Best, Dr. Karamanoukian

Eugene Nowak, DO · Answer

Thank you so much for sharing - I find Fractional CO2 laser treatments & recovery can vary so tremendously, I enjoy the opportunity to share what 20+ years of dermatological experience has shown me.  CO2 laser procedures are one of the most corrective procedures for skin irregularities, texture issues, acne scarring and the like.  However, this level of correction can be maximized with minimum recovery time if proper skin care is utilized during both the pre & post treatment time frame.  With all of my CO2 patients, I not only include preparatory & post-procedure skin care regimens, but also a series of facials to be performed in the office within the first 10 days after the CO2 to help expedite recovery & reduce post procedure complications.
In regards to the residual scarring you still notice on your skin - remember, it can take a full 6 weeks for the skin on the face to fully turn over - and after a CO2 - you will continue to see improvement for the months following.  As others have mentioned though, a dynamic issue like acne scarring cannot be 100% corrected with just a single procedure.  Although this procedure can greatly enhance the appearance of the skin & scars, it is important to maintain realistic expectations (also remember that continued medical grade skin care, other resurfacing treatments, and/or serial CO2 treatments can continue to improve your results after you have reached your new baseline!)
To address your continued erythema (redness) present on the skin, hopefully it has continued to improve (when compared to immediately after your procedure) as some patients may continue to have transient redness at this stage.  Many things can be contributing factors: current skin care regimen, compliance to avoiding UV exposure, pre-existing conditions (rosacea etc.), underlying skin tone and more.  Without knowing more about your clinical case, I would encourage you to evaluate your sun exposure first and foremost.  Be sure to use a physical barrier (hat, scarf, buff etc.) in addition to a minimum 40 SPF daily - with re-application every 2 hours.  Then consider your current skin care regimen: irritating agents, alcohols, retinols etc. that may be causing redness.  Also consider adding soothing agents to reduce redness.
If you cannot determine a causative agent, or if you simply wish to ensure how to proceed with your post-procedure care - I encourage you to seek consult with a board-certified dermatologic cosmetic surgeon who is very experienced with performing these procedures to discuss & develop a personalized plan for you.  There are a LOT of options available - so do not get discouraged!  I wish you luck on your recovery & hope this response was helpful.

Genevieve F. Caron, MD · Answer

Thank you for your answer,
I agree with my dermatologist colleague comment, Acne scar are not an easy condition to treat with laser. You will need many treatment...The redness after a treatment depends on many factors such as: the depth of the laser, your skin quality, your type of shin, the condition you are trying to treat. 4 weeks is not anormal. Make your you follow up with your doctor.
Dr Genevieve F. Caron, Board Certified Plastic Surgeon
Montreal. Canada

Yael Halaas, MD · Answer

Fractional C02 delivers a pulse of energy to areas on your skin in order to stimulate the growth of new collagen. Essentially your skin is renewing itself, the redness and dents are normal for such a short period of time after the procedure. Within a few months these issues should begin to go away, as your skin restores itself. Of course, you should consult the doctor from whom you received the treatment.

Gustavo A. Diaz, MD · Answer

Hi. You have a very valid and common question. As a Board Certified Facial Plastic Surgeon and advance physician trainer for the Lumenis CO2 Active/Deep FX, I have been asked this question very frequently.
Acne scaring is the most difficult problem to solve with any type of resurfacing. It requires several treatments to really be able to improve significantly on this condition. Do not expect resolution or major improvements from only one procedure. This is the reason you are still seeing some of the acne scars. Also you are judging the results too soon. 
Four weeks is too soon to really see the improvements that resurfacing can do. As a rule, you need about six months to allow collagen to be produced by your skin after resurfacing. This translate into waiting about six months to be able to see the maximum effects that a resurfacing can do.
The redness could be caused due to different causes:

Early during the healing process after resurfacing, the skin will be red due to healing. There is nothing that you can do to improve this quickly. only time will take care of this. Usually it last about 3-4 weeks.
If you are still red after 4 weeks, it could be possible that you have irritated the resurfaced skin. Many things could irritate the skin. Soap, perfume, pet dander, hair spray, tartar control tooth paste, colognes, deodorant, ammonia, detergents, etc. Make sure that you have no contact with those and wash your hands before you touch your face. The faster you identify what is irritating your face and quit exposing it to that irritant; the faster your face will stop being red.

Remember to always talk to your physician about any concerns that you have. Trust your face to a Facial Plastic Surgeon.

Cory Torgerson, MD, PhD, FRCSC - Account Suspended · Answer

Each person heals differently. It is very
important that you follow the skincare instructions you were given, as the new
layer of skin will be sensitive while it is healing. The treated surface area
of the face and neck will be red immediately following the treatment, then turn
pink before returning to normal. The dead skin will gradually form a crust and
fall off with each cleansing. Even though the downtime is longer than
other lasers, the results of a fractional C02 treatment are unparalleled and are absolutely
worth it. You may need additional treatments to achieve the results you're looking for. Consult your doctor if you are concerned, as she/he knows your
specific case.

When Will the Redness and Dents After Fractional CO2 Laser Heal?

Answers (11)