How Do You Get Rid of Demarcation After CO2 Laser Resurfacing?

Having had laser resurfacing with C02 laser over 10 years ago, there is still a very distinct demarcation line all along the jaw line. The facial skin got lighter. All along where the resurfacing stops, the skin actually is much darker. Lustra was tried for lightening, as well as fraxel, neither worked.
How can I get rid of this demarcation?

Doctor Answers 5

Demarcation resulting from CO2 laser. Improving hyperpigmentation from laser treatment.

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CO2 laser can cause hyperpigmentation or hypopigmentation. The goal of management is to determine which one you have and to treat the area accordingly. Fine telangiectatic blushing may also occur post laser or solar damage and this will also need to be treated, preferably with a pulse dye laser.

Fraxel, despite all of that is written about the laser, is not a cure all for all scars.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

CO2 laser demarcation

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CO2 laser, when aggressively performed (as was often the case 10 years ago), destroys dermal pigment cells and the skin becomes lighter. Because the skin of the neck was not lasered, there is a demarcation.

By using fractionated laser at the jawline, you can sometimes blend the areas. Also fractionated laser in the neck and decollete as well can help to minimize the color difference.

Remember how deep the original CO2 was, so to get all your skin the same color, a similarly deep resurfacing would also be necessary. This is of course not indicated on the neck, and could risk scarring.

Loss of pigment is best avoided ahead of time by conservative resurfacing.

Your post will help many readers who are contemplating having phenol peels or deep peels of any type in an attempt to eradicate wrinkles, rather than to reduce wrinkles to a reasonable level but preserve natural architecture and pigment.


Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Fraxel re:pair or Chemical peel might help.

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Unfortunately, little can be done to restore pigment to your facial skin. Although it is preferable to feather a CO2 laser procedure of the face with a light, single pass with a CO2 or Erbium laser of the neck at the time the face is treated, it might be worth trying the Fraxel re:pair which is a fractionated CO2 laser to the neck. Alternatively, a medium-depth chemical peel such as TCA 20% to the neck may feather and soften the demarcation line considerably.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

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Demarcation line from CO2 Laser

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Demarcation lines along the jaw lline do happen with all types of laser peels. The goals is to blend or feather the laser a bit so that the line is not distinct.  This still can be done for your situation in a similar fashion.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fractional laser or medium depth chemical peel

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The demarcation line you experienced results from a loss of pigment in the laser treated area as opposed to the untreated area. There are several options to try to help the area but all would be aimed at decreasing the amount of pigment in the originally untreated area. This can be accomplished with a fractional CO2 laser or medium to deep chemical peel. The idea would be to feather the area to be treated for a more natural appearance.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

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.