CO2 Lasers for Facial Wrinkles and Skin Tightening?

I'm a 40-year-old chinese woman who has sagging skin, nasolabial folds, and marionette lines. Will CO2 Lasers work on these problems and tighten skin as well?

Doctor Answers 18

CO2 laser for tightening and wrinkle reduction

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To properly address this question, one needs to understand the aging process from top to bottom. Starting at the top, our skin ages from environmental insults and time, which causes wrinkles, pigmentation, and lack of elasticity. This portion of aging is best addressed with resurfacing, whether that is peels or laser. CO2 laser is hands-down, without question, the gold standard when it comes to resurfacing. In addition, technology with CO2 lasers, that includes fractionation, has made them significantly more effective with fewer side effects than they had when originally developed and put into practice. Results with proper use of a CO2 laser are both dramatic and stunning.

When it comes to tightening, the CO2 laser vaporizes tissue and causes collagen remodeling, which no doubt give some tightening and significant wrinkle reduction. If you are after strictly tightening, there may be better options that you could speak with your physician about. That being said, I have definitely had patients who needed a facelift but did not want to take even a minimally invasive surgical route, so we decided to do CO2 resurfacing, and although they probably still would have benefited from a lift afterwards, they were very pleased with their overall results and tightening.

The sagging of our midface, lower face, and neck actually results more from the soft tissues and bone below our skin aging. Our soft tissues lose volume, what volume is left in there redistributes to a lower position, and the entire fat pads descended down our face. This is addressed with surgical lifts and with revolumization.

The bottom line is, yes you can get some tightening from a CO2 laser, but that may not be your best option if that is your main goal. With Asian skin especially, you need to seek out someone who is a true expert (as opposed to a self proclaimed expert), as pigmentation changes are more common with even slightly darker skin types.

To guarantee you're 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.

Spokane Dermatologic Surgeon
4.9 out of 5 stars 123 reviews

CO2 laser for sagging skin, nasolabial folds & marionette lines

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The fractional CO2 laser is a great laser because it allows for treating pigmentation, wrinkles and general sun damage on the face. The laser also causes vaporization of the skin, which will lead to tightening. I am always cautious when patients come in for a consultation and say they want the fractional CO2 exclusively for sagging skin. Although it does help tighten the skin, it works well in patients who just need a little bit of tightening. Patients who have significant sagging of skin will be very disappointed if they do the CO2 exclusively for that purpose. In addition, deep Nasolabial folds and marionette lines are secondary to bone, muscle and fat loss that have occurred over the years. The fractional co2 laser treat the superficial portion of the skin, it does not address the losses that have occurred. Although I do see quite a bit of improvement in the marionette lines after a fractional co2 treatment, the result int he Nasolabial fold is not as great. I would highly recommend a combination treatment of fractional co2 and fillers.

Ben Behnam, MD
Santa Monica Dermatologic Surgeon

C02 laser for Asian skin

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C02 laser for Asian skin can  be used, especially if it used as a fractional resurfacing mode.  Erbium laser is typically preferred for Asian skin.  In some instances, a combination of both can help as well. Seek consultation from a laser expert in Asian skin to help discuss the risks and benefits for laser resurfacing for your specific skin.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Ablative, CO2 laser vs Nonablative Lasers

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Hello and thank you for your question.  Laser resurfacing can be broadly classified into ablative and nonablative; the CO2 lasers are the most aggressive ablative lasers on the market today.  With only a single treatment, they are excellent at eliminating fine lines, wrinkles, age/sun spots, and marionette lines.  However, because they are the most aggressive, they also have the most risks and longest downtime.  Hyper and hypo-pigmentation to the skin can be problems, especially in patients who have inherently darker skin tones.  After CO2 treatments, the swelling, redness, and blistering can last up one month.  CO2 laser treatments are usually performed after sedation, either oral or IV, is given to patients.  

Nonablative lasers are also effective at improving skin texture, tone, fine wrinkles, sun spots.  They are less aggressive, have less side effects/complications, but require 3-5 treatments to see the best results.  They are performed in an office setting, using numbing cream applied directly to the skin.  The treated areas are usually red and may blister for 3-5 days, but the healing time is markedly less compared to the CO2.  

Having said this, and in the setting of severe jowls, wrinkles, and deep nasolabial folds, facelift surgery is also an option.  I will often combine facelifts with a TCA peel or nonablative laser resurfacing for optimal results.  Good luck!

Laser and facial aging

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The laser will help yes. It globally tightens the skin. For moderate to significant aging or sagging skin though the best results are obtained with a combo of procedures. Either fat transfer or a facelift greatly augment the results of laser. 

It all depends on your expectations and how much improvement we are trying to obtain. It starts with a good facial analysis and discussion. 

I hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews


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CO2 is a total rejuvenation for the face, neck, decollete, and hands- Effective permanent results with proper skin care and protection. The CO2 fraxel laser is the most suggested treatment for wrinkles and skin tightening for immediate results! There is downtime involved up to 3-5 days. After just a few days you will notice a more even skin tone, smoother skin texture,and healthier looking skin. Your skin will be looking and feeling just like a babies bottom! :) I hope this helps you on your journey!

Chaitali Nangrani, MD
The Woodlands Family Physician
4.2 out of 5 stars 25 reviews

Not for significant sagging skin

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Although the CO2 laser does a wonderful job at fine lines and wrinkles, its primary purpose is not for significant sagging skin, nasolabial folds or marionette lines. The latter two would be best treated by fillers or facelift.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 24 reviews

CO2 laser for skin tightening and wrinkles

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The fractionated CO2 laser will do wonders for the skin.  I would not, however, bank all your hopes on this procedure.  If you have deepening nasolabial folds and marionette lines, then I would recommend dermal fillers or fat grafting in conjuction with the CO2 laser (usually done afterwards).

C02 Laser for Asian Skin Tightening

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Fractionated C02 can be performed on Asian skin, however, it is really important to go to an experienced specialist with a reputable practice. If you are looking for solely a non-surgical option to tighten skin, C02 laser can help. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles, and scars, remove brown spots and other irregularities. It also stimulates formation of new underlying collagen to continue improvement over time for a skin tightening effect.
However, if skin tightening was one of your main concerns and you wanted it to be done non-surgically, I would likely recommend a combination treatment plan of C02 laser, Ulthera and some injectable Fillers.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 170 reviews

Facial Skin Tightening

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Thank you for your question. I would suggest Ultherapy for facial skin tightening. Ultherapy deposits focused ultrasound energy below the surface of the skin to stimulate the body’s creation of new collagen. As a result, skin will actually begin to lift and tone over time. Collagen is a natural protein that gives skin its youthfulness by keeping it firmed, toned and elastic. Plus, the treatment is completely non-invasive and does not require downtime. I have seen excellent results with the treatment.

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.