How many CO2 Ablative treatments is too much?

Question

I've had (3) CO2 ablative treatments to treat acne scarring in the last 27 yrs, the last 2 were done 8 yrs ago. I have tried other treatments for scars but nothing comes close to improving my skin like CO2 ablative. Is having a 4th treatment too much? My skin is fair but thick.

Shanthala Shivananjappa, MD · Answer

This is a great question, and I appreciate you bringing it up. Since your last CO2 laser treatment was eight years ago, and you’ve already undergone three ablative CO2 treatments over the past 27 years, it’s understandable that you’re wondering if a fourth session is the right choice.
Should You Consider Another CO2 Treatment or a Newer Technology like Laser-Coring?
While CO2 laser resurfacing has been the gold standard for scar remodeling, a more advanced technology called UltraClear Laser-Coring has changed how we approach scar treatment.
Here are three key reasons why UltraClear Laser Coring may be a better option for you:
	1.	Latest Laser Technology – UltraClear Laser Coring is the most advanced resurfacing laser available today. It delivers remarkable scar remodeling with minimal downtime and fewer side effects compared to traditional CO2 laser.
	2.	Safer for Different Skin Types – Unlike traditional CO2, which can pose higher risks of hyperpigmentation and prolonged redness, UltraClear Laser Coring is safer for a wider range of skin types, making it a more versatile option.
	3.	Better Long-Term Results with Combination Treatments – One of the most effective approaches for deep scars is to combine Laser-Coring with biostimulators (such as PLLA ) and subcision. This combination helps break up tethered scar tissue, stimulate collagen production, and provide smoother, long-term results. Both Laser-Coring & Biostimulators can be performed on the same day.
If you haven’t looked into UltraClear Laser Coring, I highly recommend doing so before committing to another CO2 treatment. Many patients who previously relied on CO2 lasers have seen dramatic improvements with UltraClear Laser-Coring, often in just one or two sessions.
For the best results, I would suggest consulting with a specialist experienced in Laser Coring and combination scar treatments to determine the most effective approach for your skin.
Hope this helps, and I wish you the best on your journey to achieving your desired results! Please visit our website to learn more about Laser-Coring for acne scar patients.

Monika Kiripolsky, MD · Answer

Hi SA,
A fourth treatment is definitely not too much! A lot of it depends upon how powerful the laser is (some CO2 lasers are a lot stronger than others) as well as the doctor doing the laser procedure. Knowing how to tweak all of the laser parameters to give the greatest results (safely) is priceless.
 Patients with severe acne scarring may need multiple treatments to get the best results.  I typically give patients at least 6 months between treatments to allow their cells to build collagen & elastin before determining if they would benefit from an additional treatment. It’s really the gold standard for acne scarring treatments. 
Hope this helps!
Dr. Kiripolsky

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Having a fourth CO2 ablative treatment, especially after an extended period and with your history of significant improvement from previous treatments, could be a reasonable approach if you’re seeking further enhancement of your acne scars. Given that your skin is fair but thick, it may tolerate the procedure well, though individual responses can vary. CO2 laser resurfacing is effective for deep scars because it removes damaged skin layers and stimulates collagen production, leading to smoother skin over time. However, it’s essential to consider several factors before proceeding. Assess how your skin has healed from previous treatments and whether you’ve experienced any issues such as prolonged redness or sensitivity. I use CO2 lasers all the time and absolutely love the results over time with consistent treatments. I hope this helps and best of luck!

Ryan Welter, MD · Answer

A fourth CO2 ablative treatment isn’t necessarily too much, especially considering the long gap between your treatments and the improvements you've seen. Given your fair but thick skin, it should tolerate the procedure well. CO2 lasers are highly effective for acne scarring by stimulating collagen production and removing damaged skin layers, often requiring multiple sessions for the best results.

Make sure to assess how your skin has healed from past treatments—if you've had no major issues like prolonged redness or sensitivity, another session could be beneficial. As always, follow up with your provider to ensure the timing and settings are optimal for your skin.

Viva Eve Dermatology - New York · Answer

Hi!
This is a great question! CO2 laser treatments work by resurfacing the superficial layers of the skin, thus improving collagen production as the skin heals. It is one of the best treatments for many types of scarring, and is extremely customizable to the patient's needs.
As we age, collagen production decreases and halts, leading to loss of skin support and elasticity. CO2 lasers help to restore the collagen and elastin in the skin, thus preventing thin skin and also treating textural issues such as acne scarring. Treatment with CO2 laser will help to restore some collagen, and the resulting collagen formed is yours to keep, however as we continue to age, collagen is still lost; therefore, to maintain results, maintenance sessions are required. 
That being said, proceeding with another CO2 laser treatment is likely a beneficial option for you! It is not too much, and in the hands of the right provider, should be safe with great results.
As always, this is a general response and an in-person consultation is required to fully evaluate and explain all treatment options that are right for you. 
Best,Eleni SgantzosBoard-Certified Dermatology PAViva Eve

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