Best CO2 Laser Resurfacing

Is there a difference between the UltraPulse CO2 laser and Fraxel or Pixel lasers?  I'm confused by all the different names and think the doctor will try to sell me on whatever machine he has- without it necessarily being the best for me. How can I know I'm doing the best treatment?

Doctor Answers 23

There are many types of lasers and you have to do your homework

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are a lot of laser devices out these days and you do have to do your homework to keep things straight. There are basically 3 categories of lasers: 1) Fully ablative that includes CO2 and Erbium lasers, 2) Fractional Ablative lasers that include Fraxel Repair, Lumenis Total Fx (these are both fractionated CO2), Pixel, DoT and others, 3) Fractionated non-ablative lasers such as Affirm, or Fraxel Restore

The main difference between these categories is the amount of downtime that goes along with them. The Fully ablative lasers require 1 treatment and will require 2-3 weeks to heal and possibly some redness beyond this time frame. The fractionated ablative CO2 lasers usually only take 1 treatment and reduce the healing time to about 1 week. The nonablative fractional lasers require 4-5 treatments but only have 1-2 days of redness for healing.

The other main consideration is results and what the treatment is for. A basic rule is that the more aggressive the laser, the better the results and the more the downtime. All lasers are indicated for wrinkles, acne scars, pigmentation, and sun damage. For wrinkles, more aggressive treatments are better.

This is some basic information to help you along. The other questions you should ask are what are my options. If the practice only offers one laser and one laser for everything then you should be wary. If options are presented to you with variable results and healing times then it is reasonable. Any serious laser practice will offer options or combination treatments. For example, our practice has around 20 lasers for various applications so that we can offer options to patients depending upon their needs and lifestyle (healing time tolerance).

Lastly, if you are not comfortable with a physician, get a second opinion.

Beverly Hills Dermatologic Surgeon

Difference between the UltraPulse CO2 Laser and other lasers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is an important distinction between various lasers in resurfacing, in result, downtime, pain, and sometimes in cost.  Cosmetic laser resurfacing was originally started by Dermatologist Richard Fitzpatrick with the UltraPulse CO2 laser.  This was the first laser having qualities to allow safe remodeling  of the aged, scarred skin.  Many other lasers attempted to  copy this laser, but in my opinion fell short.  Laser resurfacing has evolved over the years, yet the UltraPulse is still the gold standard.  Parenthetically, I still have my 20 year old UltraPulse laser and use it regularly even though I own several other resurfacing lasers.

In order to clarify without too much discussion the differences in the lasers, the mission of the resurfacing laser is to precisely heat the skin removing old or damaged cells and tightening the skin through shrinkage or collagen generation.  Generally, the more heating, the more tightening, rejuvenation you get (within limits) and the better the result.  However, the more heating the more painful is the procedure and the longer the recovery.  Also there is more risk with more heating.  To reduce the negative aspects of the procedure, newer lasers, newer wave lengths, etc were developed, but with lessening the improvement.  Several years ago the fractional laser was developed and again many companies copied the concept improving on it. The term "fractional" implies that the laser delivers the energy in a pattern of many tiny spots rather than a sheet like effect of the more traditional lasers. Because there is much untreated skin area between these millions of spots it heals faster and is less painful but it may mean that more than a single treatment is required.  Fractional lasers come in a variety of wave lengths, etc and applications, but for rejuvenation in most cases I believe the fractional CO2 laser (made by many companies) is still the best.  There are many manufacturers of lasers and each will claim their laser is the best.  I would argue that the surgeon or  practitioner is more important than the laser and thus should be chosen carefully.  

Richard O. Gregory, MD
Orlando Plastic Surgeon
4.6 out of 5 stars 13 reviews

There is a definite difference between fractional resurfaicng and CO2 laser resurfacing

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is a definite difference between fractional resurfaicng and CO2 laser resurfacing. The CO2 laser is an excellent treatment option for deeper wrinkles, acne scarring and sun damaged skin. The fractional treatments taken the typical CO2 laser and lower the power density and spread out the beam so some of the skin is not treated and heals faster. The disadvantage is that it does not equal one treatment with the traditional CO2 laser and often is not effective for deeper lines and deeper acne scarring. Also, multiple treatments with a fractionated or Fraxel type of laser is required to achieve the same results of a traditional CO2 laser. However, I do believe it still has a usefullness for patients who have minimal lines and lesser scarring.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Best C02 LASER

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is no "best" C02 laser system.  The key is to understand the technology and how it is being applied to your skin.  There are basically two types of C02 laser technologies, fully ablative and fractionally ablative lasers.  

Fully ablative C02 laser is not used as commonly, but does have a role in specific lighter skin types.  The main issue with this technology is that the downtime can be longer than ideal and the rate of complications, such as hypopigmentation and scarring is higher than most patients and surgeons find acceptable.

Fractionally ablative C02 lasers are the laser technology of choice since they offer many of the benefits of fully ablative lasers without the downtime and the complications.  


Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 180 reviews

CO2 Lasers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The doctor will try to sell you on what they have — that only makes sense.  In essence, and in reality, the UltraPulse CO2 is the gold standard CO2 laser and everything is compared to it.  The laser doc, however, is the one who can be the artist or be the one who leaves some to be desired.  CO2 lasers create a defect caused by the laser and a thermal zone which can lead to downtime and potential adverse events. The UltraPulse is the only device that causes this thermal zone to be almost nonexistent. The Fraxel CO2 causes thermal damage and so does the Pixel CO2.  But all can hurt people, so again, make sure that they user is well skilled.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

The difference between lasers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

All Co2 lasers are essentially the same.  The outcome is more dependent on the operator than the laser in the vast majority of the cases.  One surgeon may prefer one laser to another because of certain functions, ease of use, reliability, etc...  There is a difference between types of lasers (in contrast to brand of laser).  Fractional Erbium lasers are less likely to cause Hyperpigmentation in darker skinned individuals, but also tend to produce less of an effect per treatment.  Other types of laser therapies include Photofacial (IPL) and YAG lasers.  For fare skinned individuals, CO2 is most likely to give the best result.  Go to a surgeon that does a good deal of Fractional CO2 laser treatments, and is well trained.  Also pick one that you like personally, it will make your experience more pleasant.

Leif Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 26 reviews

You want to go to someone you trust

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are a lot of different lasers out there. Essentially for resurfacing, there are two lasers out there: CO2 and Erbium.

CO2 allows you to be more aggressive and you can vary the degree of this to fit anyone. Lumenis and their Active FX/Deep FX is the best in my opinion and in the opinion of the most infleuntial people out there. This is a CO2 laser.

Erbium has some limitations in that it can't go very deep and doesn't cause tissue contraction like CO2 lasers can. All other lasers such as Fraxel and Fractional lasers work by causing manipulation to the deeper layers of the skin to cause skin tightening. There are just a lot of companies out there selling them with different names. You just have to ask them what technology they are using and if they are making it complicated then I would ask someone else. These lasers take more treatments and take more time and money but have less downtime based on company reports.

However, I've heard from other patients that Fraxel and other fractionated lasers can cause more downtime than what the "people" are telling everyone.

What's the best? It depends on how significant your wrinkles are. The more significant, the more aggressive you might want to be. It also depends on your lifestyle. Does your lifestyle dictate that you can't have any downtime, if so you should consider less aggressive means.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Technology is important but perhaps the operator is even more important

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Having up to date equipment is important as there are limits to what old tech can do.However, with modern equipment, the skills of the operator is a large part of the equation when it comes to getting the best result.Understanding the skin and hence the need of the patient, preparing the skin for treatment, using the right settings and the right after care and maintenance are ALL important steps. And the machine figures only in one of them.

Chien C. Kat, FRCS
Birmingham Plastic Surgeon
4.8 out of 5 stars 100 reviews

Which Co2 Laser is Best?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

While I agree that on some rare occasions some doctors may recommend a laser because they have it, most doctors want their patient to achieve the best result. in addition many manufacturers make scientific claims which don't always turn out to be true, for example the Sharplan laser and the ultra pulse laser were clinically tested to be equal even though theoretically one had an advantage. I personally like the Pixel laser for heavy duty repair of wrinkles. For more mild wrinkles and acne scarring the Fraxel Restore is quite good. most important is for you to have a competent laser surgeon who you have faith in to guide you through these confusing choices. Dr Fincher gives a nice overview as to the categories of some of these lasers.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Best CO2 Laser Resurfacing

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I personally prefer fractional laser resurfacing for most of my patients now, however there are several lasers that can achieve good results, depending on your examination and desired result.  You really need to go to a physician you trust, the actual laser is probably less important.

Sam Goldberger, MD
Beverly Hills Oculoplastic 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.