Difference Between Fractional and CO2 Lasers?

Question

Is a Fractional non-ablative laser different than a CO2 ablative laser? Is one of these methods the best for treating acne scars? How long does the redness last?

Hooman Khorasani, MD · Answer

That is a good question! There are several types of fractional non-ablative using Erbium or thulium and ablative using CO2.  The fractional component allows allowing for greater treatment area with decreased bulk heating.  The way to think of the non-ablative vs ablative is that the non-ablative does not compromise the epidermis. There is less downtime then the ablative version but is not as good at tightening/textural change associated with deeper acne scars. Downtime can last up to a week or two. As others have pointed out the most important thing is to have a consultation with a Board Certified Plastic Surgeon or Dermatologist prior to deciding on a treatment plan.

Matthew Richardson, MD · Answer

In most cases, when you hear the term "fractional laser" today, this refers to a fractional CO2 laser. A fractional laser only treats a fraction of the skin, whereas the older CO2 lasers treat the entire surface area of the skin. Fractional lasers drill microscopic holes into the skin in a pattern (either regular or random), and leave normal skin in between the holes. This has been shown to result in less pain, faster recovery, and a lower risk of complications. The trade-off is that the results are sometimes less than the traditional CO2 fully ablative laser treatments.That being said, I believe that the fractional CO2 laser can achieve extremely nice results very similar to traditional CO2 laser (I have used both) with a much easier recovery and lower risk of complications. We tailor the fractional CO2 laser treatment to each patient's skin type and goals of treatment in order to achieve the best results for each individual. I also utilize an Erbium:Yag laser in my practice for skin resurfacing, but reserve this for only certain skin types/patients. Fractional CO2 laser resurfacing is one of my favorite treatments because we can achieve amazing results when performed properly.Best,

R. Brannon Claytor, MD, FACS · Answer

Fractional 1540 Non-Ablative Laser Resurfacing works by heating up the targeted tissue, without actually destroying it. This process stimulates your body's collagen production to fill in unwanted skin imperfections such as fine lines and wrinkles. Has less downtime and less inflammatory response. Great treatment for those who are Fitzpatrick Skin Type III-IV therefore it is recommended for all skin types. Less likely to have Post Inflammatory Hyperpigmentation. Treats sundamage, melasma, acne scarring, crepey sagging skin on face, neck, chest and body. Produces collagen remodeling and skin tightening. Treatment produces it's own growth factors within the skin and clears environmental damage. Ablative Laser Resurfacing (CO2) Carbon Dioxide treatment vaporizes the outer layer of the skin where the Non-Ablative Laser Resurfacing, the skin surface remains largely intact.

Mike Majmundar, MD · Answer

Fully ablative CO2 laser treatments were at one point very common.  The issue with the treatment was the prolonged downtime, redness, and the pasty white skin that followed after the healing.  Healing could be 3-4 weeks to 3-4 months with this device but the results were amazing in terms of tightening and helping with scars and pigment.In recent years, most individuals don't have 3-4 weeks of downtime to take from work (let alone 3 months) so a fraction of the original CO2 laser energy was utilized to create fractionated CO2 lasers.  Downtime was reduced to 7-14 days and the appearance of white pasty skin was eliminated.  Of course, the results are not as amazing but individuals still enjoy an improvement in fine lines, scars, pigment, pore size, and breakouts and can be repeated easily in 1-2 years if desired with a week or 2 of downtime.Fractionated lasers are ablative lasers but the laser only ablates a fraction of the skin surface unlike fully ablative CO2 lasers.  I hope that helps.

Johnny Mao, MD, FACS · Answer

Laser terminology can be extremely confusing.  I will try to simplify it for the purpose of acne scar treatment.  Fractional simply means only "fractions" of the area treated is actually targeted by the laser so there are healthy areas of the skin "in between the dots" to help you heal.  Ablative vs Non-Ablative laser is an important difference to understanding scar treatment because you would want to "ablate" or "remove" or "physically vaporize" the skin cells of the scar so it is more smooth.  Ideally you would want to "resurface" or "ablate" the acne scars so the skin surface is more smooth.  Fractional CO2 laser resurfacing is one of the best methods to treat acne scarring and the redness usually lasts 7-10 days depending on the setting.  Higher settings can result in prolonged redness and more complications/discoloration/browning effect.

Brian K. Machida, MD, FACS · Answer

CO2 lasers have come in ablative and non ablative fractional forms. The fractional laser is a much safer form. CO2 lasers have been historically the gold standard.

Joseph Shvidler, MD · Answer

The best analogy would be to compare these to different approaches to your lawn care. If the grass cover is not in the best shape you can try to do deep plug aeration by punching lots of small holes in the lawn. This preserves the surrounding grass and the lawn recovers and rejuvenates quickly. The other alternative is to remove the lawn all together and seed new grass. This process takes a lot longer but the new grass, when it comes in looks very nice. The same concept applies to laser resurfacing. There is much longer down time to ablative resurfacing, but for skin that is too damaged from aging or acne scarring, the fractionated treatment may not be enough to get the best results.

Julian De Silva, MD · Answer

Older CO2 laser were effective however had longer recovery and downtime with greater chance of redness and pigmentation after treatment. Fractionated laser are more modern lasers than enhance recovery by sparking portions of the skin to laser. A fractionated laser can be either an Erbium or CO2 laser. Both are effective, the physician who is using it is more important then the actual laser. Fractionated technology is aimed at achieving similar results to standard "resurfacing" with less downtime. Dr. De Silva prefers to use a combination CO2 and Erbium laser, as CO2 laser tightens deeper skin and the Erbium laser tightens more superficial skin

Recovery can be further enhanced with the use of bio-technology and PRP treatments, that utilise your own growth factors in the area of treatment to enhance recovery.

Recovery can be further enhanced with the use of bio-technology and PRP treatments, that utilise your own growth factors in the area of treatment to enhance recovery.

M. David Cole, MD, FAAD · Answer

A Fractional/Fractionated non-ablative laser works by heating up the dermis in columns rather than diffusely.  It doesn't damage the epidermis, or the top layer or skin, but rather works deeper in the skin, in the dermis, to encourage the growth and remodeling of collagen.  An ablative CO2 laser targets water in the skin, and basically serves to vaporize the epidermis and part of the dermis.  However, since the hair follicles track deep into the dermis, and are not damaged when such a procedure is done correctly, they provide for the recovery and rejuvenation of the skin, including both the dermis and epidermis.  The result is usually more dramatic, but the redness will last longer.

Michael H. Gold, MD · Answer

Fractional treatments can be non-ablative or ablative. Creating small holes in the skin, non-ablative passes through the top layer of skin or epidermis and is a more gentle treatment than the ablative therapy which goes through the epidermis into the dermis. Non-ablative fractional treatments usually work over time - 4-6 treatments over a 4-6 month period of time to achieve the desired results. Ablative fractional treatments work faster, but are associated with more downtime than most non-ablative treatments.

Difference Between Fractional and CO2 Lasers?

Answers (18)

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