The treatment itself takes about two hours; one hour for the topically applied anesthetics to work, and the second hour to treat, and cool the skin after treatment with ice, making sure that the patient is feeling fine before leaving. The hot, burning sensation lasts about 2-3 hours then disappears. Depending on the strength of the treatment, there is usually redness, swelling, and perhaps some bruising. The swelling worsens for a few days, and is most noticable in the mornings. The skin normally peels dramatically on or about post-op day 5. For a good, strong treatment, we advise taking a week off, if you are working with the public. That being said, many patients return to work on post-op day 4, recognizing that they will look like they are recovering for a bad sunburn, with redness and peeling expected. If the treatment uses gentle settings, such as in younger patients or for just skin color improvement, then the down time will just be a few days.
Yes, it is very normal for the pain to dramatically subside 2-3 hours after a fractional CO2 laser treatment. Our office advises that the skin be kept moist with a product such as Biafine, or Aquaphor healing ointment, applied frequently for at least a week. The dots are microscopically tiny, with most laser platforms, spaced about 350 thousands of an inch apart, or less, and visible with the naked eye if you look closely. We love the CO2 laser, and the results we have seen with it are astonishing.
We have found that the skin is quite sensitive to injury for patients while they are on accutane and for several months afterwards. After 6 months we will do gentle laser treatments, but prefer to wait 12 months for stronger treatments such as fractional CO2 laser. The gentle laser treatments for acne scarring include cooltouch laser, smoothbeam laser and affirm multiplex laser. Fraxel 1500 (re:store) is fairly strong so waiting a year after your last pill would be better before having a Fraxel treatment. Microdermabrasion is wonderful, but it cannot change the appearance of a structural acne scar.
