Difference Between Fractional and CO2 Lasers?

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?

Doctor Answers 14

Fractional vs CO2

The in vogue "fractional lasers" are fractional CO2 lasers. The fractional erbium is used only by those who purchased their systems a couple of years ago when the fractional CO2 was not yet available.The fractional CO2 treatments are more superficial than traditional "full" CO2 laser resurfacing procedures. Typically we use our fractional CO2 laser for treatment of blotchy pigmentation and very fine lines. On the other hand we use our traditional CO2 laser for treatment of deeper lines, for tightening of the skin, and for acne scarring of any significance. Of course the deeper treatment mandates a longer recovery time and also there are more potential risks. In my opinion the companies and some doctors over promise when using both of these technologies especially the newer fractional systems thus leading to patient disappointment!

Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

It depends

A fractionated laser is one that spares portions of the epidermis to affect changes in the deeper epidermis or dermis. 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 acheiving similar results to standard "resurfacing" with less downtime.

However, because the downtime is less the results are not as dramatic as with traditional resurfacing. That being said, I very rarely do any traditional true "deep" laser peels anymore because of the associated downtime and increased risk of complications. I usually do a combination of a superficial laser resurfacing followed by a fractionated laser treatment. I feel this provides the best result with minimal downtime. I customize the settings according to how many days a patient can have downtime.

The less downtime, the less dramatic the result. Hope that helps.

Samson Lee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Difference between fractional and ablative CO2 lasers

The difference between fractional CO2 and ablative CO2 laser resurfacing is the amount of damage that is delivered to your skin. The older ablative lasers burn 100% of your epidermis (the top skin layer) while fractional CO2 lasers burn a smaller fraction, usually around 20% -the technique is like pixels on a TV screen where there is a small core of laser damage separated by healthy skin. The advantages of fractional lasers include a lower risk of scarring and skin color changes, a quicker recovery time, a more natural appearance, and the ability to treat both darker skin types and areas of the body outside the face (neck, hands, chest, arms). The biggest disadvantage of the fractional laser is the fact that it is fractional and that more than one treatment may be necessary in order to achieve the result you are looking for.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Laser Differences

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.

M. David Cole, MD, FAAD
Newport Beach Dermatologist
5.0 out of 5 stars 4 reviews

Fractional CO2 vs Ablative CO2 lasers

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. 

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

Fractional vs. CO2 lasers

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.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

Difference between fractional and co2 lasers

The Fraxel is a fractionated Co2 laser.  It is the next generation in CO2 lasers.  The older CO2 lasers were extremely aggressive, painful, poor healing, and had many complications such as hypo-pigmentation and scarring.  Along came the Fraxel CO2 laser which used fractionated technology to accomplish the same smoothing of the skin, and reduction of fine lines without the aggressive treatment or side effects.  Fraxel is ideal for treating sun damage, pigmentation, lines, wrinkles, and scars.  It is the best laser! Just find someone experienced with this laser so that you can achieve the best results.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

What is the difference between Fractional and CO2 lasers?

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.

Julian De Silva, MD
Birmingham Ophthalmologist
5.0 out of 5 stars 148 reviews

CO2 can be either

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.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Fractional versus CO2

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. 

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

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.