How painful is the CO2 laser?

 There are numerous ways to approach anesthesia during CO2 laser resurfacing. I prefer an approach that involves oral sedation where you are still conscious but relaxed, topical anesthesia, and local nerve blocks. This makes the procedure quite comfortable.  Most patients rate the discomfort between 2 to 5 out of 10 on a pain scale, meaning it is not completely without discomfort, but is very bearable.  Each practitioner that you encounter will likely have their own way of providing anesthesia. Mine has evolved over many, many cases to what it is today, and  provides a very  comfortable level of anesthesia. Some patients prefer to skip the oral sedation, and they do very well also, but if you have any anxiety preceding the procedure, it is worth adding on that oral medication. 

When I do my combination procedure of CO2 and TCA peel, my patients are under twilight sleep sedation. The whole procedure can be done in under 20 minutes and patients do not feel uncomfortable.

Many dermatologists offer a variety of options for excellent comfort during a fractional CO2 procedure.  At my office, I offer light sedation ("twilight anesthesia" with an anesthesiologist present), nerve blocks, and topical numbing medicine.  The most comfortable for patients is the light sedation.  However, many choose to have a combination of nerve blocks and topical numbing.  These patients do extremely well with mild discomfort is a few areas.  Most patients who only choose topical numbing medication suffer unnecessarily.  Best of luck,Suneel Chilukuri, M.D.