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

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—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.

Hi! Dr Peterson here – I’m really sorry you’re going through this, especially since you were trying to improve your skin. CO2 can be very effective but when healing doesn’t go as planned, it can sometimes leave behind pigmentation changes, texture irregularities, or even scarring. The good news is there are options. Vascular or pigment-targeting lasers (like Vbeam or Pico) can help with redness and dark spots, while fractional resurfacing or microneedling with radiofrequency can gradually smooth texture and soften lines. For true scars, subcision or very focal fillers may help to lift the area. It often takes a layered approach and multiple sessions, but with the right plan you can see real improvement. I’d recommend seeing a board-certified dermatologist or laser specialist who treats complications like this regularly so you have a clear roadmap forward.