What are your thoughts on Fraxel Laser vs CO2 laser?

I just with to a board certified plastic surgeon for acne scars and the wrinkles (little around my eyes, around mouth) Doctor said the c02 laser would be good about 50 shots of meds in my face while doing it, some how sounds not right. also said on special for 2,400. But said I could just have a fraxel done by his nurse with numbing cream but would take 4 to 6 treatments same price. your thoughts on the shots and?

Doctor Answers 4

Fraxel Laser vs CO2 laser

Either laser can be used to treat acne scars, wrinkles, sun damage, or texture. But CO2 is better for sun damage, wrinkles, and texture while the Fraxel laser is better for acne scars. Some patients cannot have downtime and prefer to use the Fraxel laser for wrinkles. With the Fraxel laser some patients experience a reddness and some areas are puffy for a few days. Some side effects for the CO2 laser are scarring, hypopigmentation (whitened skin), also patients reported that they can see a difference where areas of the skin that were treated compared to areas that were not, which does not blend. The recommend number of treatments for the Fraxel is 3, many patients seen a difference just have 1 treatment. 

New York Facial Plastic Surgeon
4.6 out of 5 stars 93 reviews

Treating Acne Scars and Wrinkles with CO2 versus Fraxel Laser

Treating acne scars is a complicated process.  The Fraxel laser has become the gold standard for treating acne scars because it is highly effective with little down time.  The CO2 laser is much more aggressive and also has much more down time.  Depending on your skin type you may not be a good candidate for either laser.  The fine lines that you are describing might be better suited to Botox injections.  Please consult a board certified dermatologist with experience with Fraxel lasers and scar treatments.

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

What are your thoughts on Fraxel Laser vs CO2 laser?


It is important to understand what modalities you are considering and what settings while considering the patients goals, skin type, and downtime tolerance.

A CO2 laser is much more aggressive than typical fraxel or (fractionated erbium).  It produces more collateral heat which is both good and bad. On the good side, the heat causes more thermal contraction (tightening) and more heat in the dermis which causes more collagen remodeling. On the bad, it causes persisting redness (erythema).

Depending on the exact device, erbium does not ablate (vaporize) tissue like the CO2, nor does it cause the tightening you see with the CO2, but it does have a shorter recovery.

So, depending on your goals, skin type, and down time tolerance, a choice needs to be made in your best interest.

I would highly suggest visiting with an experienced dermatologist who can help guide you through this most important decision and give you more information than you have currently been given.

Dr. Malouf

Peter Malouf, DO
Dallas Dermatologist
4.7 out of 5 stars 87 reviews

In my opinion it is not just a choice between CO2 and Fraxel. You need the right treatment for your type of Acne Scars.

The most common type of acne scar is the rolling scar commonly located on the mid cheek and temple area. Pitted scars are difficult and take special treatment.  Keloid scars can be a multiple treatment challenge, but will improve with persistent treatment.  Red and brown scars require an all together different approach using visible laser light and or nonablative lasers.

In my hands, rolling scars are best treated with a combination of tumescent anesthesia, subcision and either Fractional CO2 or Fraction Erbium depending on the type of scar.  Large pits need to be excised. Keloid and hypertorphic scars can be treated with a combination of nonablative fractional lasers and intralesional steroids or 5FU.  Box Scars often need to be excised.

Bottom line:  Scars need treatments customized to the type of acne scar!

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 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.