CO2 Laser Resurfacing Treatment: Risks, Costs

Jennifer Sullivan answers all your beauty-related questions with practical advice and zero judgment.

Jennifer Sullivan answers all your beauty-related questions with practical advice and zero judgment.

Dear Beauty Editor,

I know CO2 lasers can really improve your skin, so I’m thinking of getting a treatment. But I also saw a doctor on social media talking about how they’re not good for people in their 20s or 30s. Will getting a CO2 laser treatment mess up my skin down the line?

—Anon.

“CO2 are the big-gun lasers,” says board-certified dermatologist Tiffany Libby, M.D., the director of Mohs micrographic and dermatologic surgery at Brown Dermatology. And their reputation may be part of the reason they’re controversial. Some doctors think the majority of the skin concerns common for people in their 20s and 30s are unlikely to warrant the side effects and risks (which I’ll get to below). Meanwhile, there are other experts who think the newer CO2 lasers, when used on specific types of skin — strategically, and by experienced practitioners! — are beneficial. Whether or not these lasers are right for you will depend on your skin type and tone, your specific concerns, and your medical history. But I’ll give you more details below that may help you when you’re discussing this with a doctor.

Some people call any device that treats skin with a focused beam of energy a laser, whether it’s emitting visible or infrared light, radio frequency (e.g., Morpheus8), or ultrasound (e.g., Ultherapy Prime). But if we’re just talking about light-based devices, then there are two general types of lasers: non-ablative and ablative. Non-ablative lasers send their energy into the middle (dermis) layer of your skin without damaging the top (epidermis) layer; ablative lasers destroy the top layer while also sending energy deeper. Lasers can also be non-fractionated, so they treat the entire surface area where they’re positioned, or fractionated, which means they fire in specific patterns, leaving some skin untouched.

“CO2, or carbon dioxide, lasers are ablative, with a beam of light that targets water molecules, causing them to heat up and vaporize. “CO2 lasers remove the outer layers of skin, typically in controlled zones or columns — i.e., fractionated — stimulating collagen production and triggering the wound healing process,” says Libby. “Technically, it causes an intended controlled injury to your skin that stimulates your body’s immune response to repair and regenerate the skin, subsequently laying down new, healthy collagen and elastin, and clearing out old, damaged collagen and elastin.”

Dermatologists and plastic surgeons usually use CO2 lasers to treat people with severe textural skin concerns, such as pitted acne marks, scars, deep wrinkles and sun damage. “Additionally, they can improve stretch marks and even remove precancerous cells that may lead to skin cancers,” says board-certified dermatologist Howard Sobel, M.D.

Morgan Rabach, M.D., the co-founder of LM Medical NYC, says she might also consider CO2 laser treatment as a targeted approach to help treat sun damage and prevent certain types of cancer in a patient with light-colored skin and a history of skin cancers. “There’s research to suggest that if you do CO2 lasers, even the ablative ones, specifically, it actually cuts down on the number of basal and squamous cells that you get in a lifetime,” she says.

Let’s be clear: All lasers have potential side effects and risks. But CO2 laser treatments are more painful and generally require more downtime than other types of lasers. The procedure and healing time will differ depending on how the laser is used, but for more intensive treatments, it can require anesthesia and several weeks for the skin to recover. Treated areas will be red and raw for at least a week, and itchiness, redness, and a rough texture may last for several weeks. There’s also a risk of infection. But the big reason many doctors are wary of treating people with CO2 laser unless it’s absolutely necessary is their potential for causing skin lightening or skin darkening, especially for patients who are Fitzpatrick skin type III (medium-beige or light olive) or higher.

A post shared by Dr. Shereene Idriss (@shereeneidriss)

“The old CO2 lasers, when they weren’t fractionated, they just sort of blasted the melanocytes, leaving the skin porcelain looking — not in a good way,” Rabach says. “Some of that scare factor may be left over today.” But she doesn’t think doctors should rule out a treatment just because of someone’s age, and has been using CO2 lasers to do something she calls “CO2 dusting,” on some of her patients under 40. “It’s not that traditional treatment where people think, Oh, you’re going to be down for two weeks, and your face is going to look like Samantha’s chemical peel from Sex and the City,” she says. “I adjust the settings so you don’t have the same downtime or risks,” she says. But, she points, the treatment is not for everybody.

Libby believes CO2 is probably “overkill” for the majority of people in their 20s or 30s. “It’s likely more aggressive than necessary, which may potentially lead to unnecessary risks such as prolonged recovery, redness, scarring, or pigmentation issues,” she says. “But if a CO2 treatment were the right fit for a 20- or 30-year old patient — for let’s say severe acne scarring — then I would recommend it.”

And Sobel says he’d probably turn to another laser for his patients under 40. “There are less invasive treatments of non-ablative resurfacing lasers such as the Fraxel 1550 nm to generate heat deep below the skin without injuring or ablating the skin’s surface,” he says. Or, he might recommend CoolPeel. ‘It’s a light-based energy that targets water in the tissue, stimulating collagen production, causing the skin to look youthful and healthier over time,” he says. While CoolPeel is technically considered a CO2-based, ablative treatment, it doesn’t cause thermal damage. (Confused yet? You should be! And this is why you want to get any laser treatments done under the supervision of a board-certified physician who practices aesthetic medicine.)

If you are under 30, probably not. If you are over 35, I suggest you start by identifying the specific aesthetic concerns you have, and then go talk to a board-certified dermatologist or plastic surgeon to see what treatment they’d recommend for you. There are plenty of trustworthy dermatologists who will give out generic one-video-suits-all advice on TikTok and Reels, but they’re often going to be conservative with their recommendations, since they have to speak to a wide audience.

Send your questions to [email protected]. (By emailing, you agree to the terms here.)

By submitting your email, you agree to our Terms and Privacy Notice and to receive email correspondence from us.