Fractional co2 vs. Picosure focus for acne scar?

Doctors, can someone tell me the difference between the two lasers in terms of result, number of tx required, collagen remodelling capability, etc? I understand that picosure has zero to minimal downtime and does not use heat energy. Are both lasers equal in terms of end result? Will lets say 3 pico is equally the same with 3 fractional co2? Or if one of the laser yeilds faster results in days/weeks/months?

Doctor Answers 4

Fractional co2 vs. Picosure focus for acne scar?

Thanks for your query. Picosure  penetrates the skin to create areas of localized thermal damage. However, PicoSure technology combines a dual approach when treating skin conditions: a photo thermal process and a photomechanical impact based on ultra-short pulse duration. This combination of photothermolysis and intense photomechanical impact, known as Pressure Wave™, breaks up the intended target while allowing the surrounding area to remain undamaged. With the addition of the FLA, each pulse is redistributed into microscopic patterns of ultra-high fluency tightly focused regions, embedded in a low fluency background . It is this combined effect that restores normal skin elasticity in the scar tissue and thus reducing the appearance of the scar, whereas c02 fraxel works on the principle of micro needling which creates injury to the skin which helps in collagen remodeling and resurfacing , thus works on acne scars. For acne scars fraxel still holds an edge as it clears of the skin faster but it comes with downtime. 3 pico might be equal to 2 fraxel. Hope it helps.

All The Best


India Plastic Surgeon
4.9 out of 5 stars 132 reviews

Co2 vs Pico fractional devices for acne scarring

Bottom line, Co2 works much better, however side effects in ethnic skin types are higher- namely PIH or skin darkening. I do use PICOSURE FOCUS for early scars, or dark scars in ethnic skin types. Video explains lasers and other methods to treat scars. All the best, Dr Davin Lim. Brisbane. Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 61 reviews

Picosure vs fractional CO2

Hi- Acne scars can be treated with a variety of lasers.  The degree of improvement you see will also depend on the type of acne scar you have and how severe the scarring is.  For this reason it would be a good idea to have a consultation with someone who specializes in laser surgery and who has several devices.  In general, CO2 lasers are the gold standard when it comes to treating scars, wrinkles and photorejuvenation; but there is more downtime associated with a fractional CO2 treatments (than a picosecond laser or nonablative laser). It typically can take weeks even months to see results and depending on how severe your scars are you may need to do a few treatments.  Picosecond lasers have also been used to treat acne scars with some success. With these lasers there is no significant downtime.  There are no published studies comparing both lasers. However, I've used both lasers and from my experience I've seen much more dramatic improvement with fractional CO2 resurfacing. If your acne scarring is more mild you may see improvement with a picosecond laser (but I would expect to do multiple treatments over the course of several months). If you're concerned about downtime with the fractional CO2 you may also want to consider microneedling, which can be a good treatment for acne scars.  Best, Dr. Chwalek

Jennifer Chwalek, MD
New York Dermatologist
5.0 out of 5 stars 2 reviews

Acne Scar Treatment -- Lasers (Fraxel, Co2, Erbium), Microneedling/PRP, Subcision, Surgical Revision

Picosure will not help acne scarring as there is no ablation, and the deep heating really only does a small amount of rejuvenation.  fractional co2 is the gold standard for acne scars but has more downtime.  I suggest seeing an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 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.