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.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

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.

Hannah Vargas, MD · Answer

Fractional just means that the laser is not targeting 100% of the treated area, leaving portions of your skin in between treated area, which is shown to have faster heeling time. Other advantages are lower risk of scarring and less chance of skin discoloration,

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.

Difference Between Fractional and CO2 Lasers?

Answers (18)

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