Scar and line on lip after C02 laser - how can this be treated? (Photos)

Question

Please help! I had C02 laser done early April as I wanted to improve the skin & have ended up with hyperpigmentation, scaring and a deep lip line. The nurse is taking zero accountability and I do t know what to do. I'm only in my late 30's and I feel like a old lady now

Mahmood Siddique, DO · Answer

What likely happenedAfter ablative CO₂, some people develop post-inflammatory hyperpigmentation (PIH) and a linear scar/contracture at the upper lip (a high-movement area). At ~4 months out, pigment can still be active, while scars start to “set.”
Do now (next 8–12 weeks)
Sun block, daily: Broad-spectrum SPF 50+, reapply; strict hat/sun avoidance.
PIH topicals:
Hydroquinone 4% nightly for 8–12 weeks (then break), or azelaic acid 15–20% if sensitive.
Tretinoin 0.025–0.05% 2–5×/wk to remodel collagen (skip if too irritated).
Add niacinamide 4–5% for barrier + pigment control.
If raised/thick: Silicone gel/sheets daily. If nodular or itchy, ask about intralesional triamcinolone ± 5-FU.
Redness: Pulsed-dye (PDL) or 532-nm KTP can calm vascular redness and soften early scars.
Procedures once pigment is quieter (usually ≥3–6 months post-laser, with test spots first)
For the vertical lip line/scar:
RF microneedling (low–moderate energy, 2–4 sessions) or fractional non-ablative 1550/1540 nm to improve texture without rekindling PIH.
Subcision if the line is tethered, sometimes followed by micro-aliquots of soft HA filler along the white roll to smooth the groove.
Micro-Botox (very low units) to reduce pursing that etches lines (avoid over-relaxing).
For residual brown pigment: cautious 1927-nm thulium or low-fluence QS/picosecond 1064 nm; higher PIH-risk skin needs very conservative settings.
Avoid for now
More ablative CO₂/erbium in that area, harsh peels, or unprotected sun.
“Border-only” filler boluses that can look shelfy on the upper lip.
When to seek help urgently
Rapidly thickening, painful, or spreading plaques; yellow crusting; or nerve pain&mdash;rule out infection/biofilm.
If you’re prone to cold sores and had lip involvement, ask about antivirals around procedures.
Practical next steps
Get a second opinion with a dermatologic laser specialist; bring your treatment record (device, density, energy, passes).
Start the PIH + collagen-remodeling topical plan now.
Plan vascular laser first if redness is prominent, then RF microneedling/non-ablative fractional for the line, and targeted HA micro-filler/subcision if needed.
Bottom line: This is fixable in stages. Lock down pigment and inflammation first, then use low-downtime texture devices + precise filler/subcision for the lip line. Expect gradual improvement over several months rather than a single quick fix.

Scar and line on lip after C02 laser - how can this be treated? (Photos)

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Scar and line on lip after C02 laser - how can this be treated? (Photos)

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Everything you need to know about CO2 Laser

Our mission is to create a world where every investment in modern beauty is Worth It.