Ablative CO2 Laser Skin Resurfacing

Ablative CO2 laser uses a wavelength of 10,600 nm strongly absorbed by water, vaporizing tissue in a precise, controlled manner. Fully ablative CO2 ablates the entire epidermis and superficial dermis, while fractional ablative CO2 creates microscopic columns of thermal injury surrounded by intact skin (microscopic treatment zones), accelerating healing and reducing complication rates while preserving efficacy for deep wrinkles and scarring.

Mechanism includes immediate skin tightening from collagen contraction, followed by neocollagenesis, dermal remodeling, and improved skin texture over months. Indications include deep rhytides (perioral, periorbital, cheek), atrophic acne scars (boxcar, ice-pick, rolling), surgical and traumatic scars, photodamage, actinic keratoses, sebaceous hyperplasia, rhinophyma, and benign growths. Contraindications include active herpes infection, isotretinoin within 6 months, recent radiation, history of keloids, very dark skin types (IV-VI relative due to dyspigmentation risk), and unrealistic expectations.

Pre-procedural assessment includes skin typing, photographic documentation, antiviral prophylaxis (valacyclovir 500 mg twice daily starting 1 day before through 7-10 days post), antibacterial coverage as indicated, and skin priming with retinoids and bleaching agents. Anesthesia uses topical, regional nerve blocks, or oral sedation. Post-procedure care includes occlusive dressings, frequent vinegar soaks or saline compresses, bland emollients, strict sun avoidance, and follow-up to manage erythema, post-inflammatory hyperpigmentation, and rare complications such as infection or scarring.