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After treatment and risks
ASPS: some people see a difference right away, and improvement continues for up to a year. Results last for years, but lines return with normal aging. After CO2 resurfacing, wrinkle improvement held at an average 24 mont
After treatment
AAD advises stopping smoking at least 2 weeks before, stopping retinoid or glycolic acid products 2 to 4 weeks before, avoiding sun and tanning, and taking cold-sore medicine if prone to cold sores. ASPS: a skin-care regimen may start 6 weeks or more before.[1][2]
Outpatient, 30 minutes to 2 hours. Local anesthetic, sometimes a sedative, or general anesthesia for extensive resurfacing. A dressing covers the treated skin afterward.[1]
Treated skin feels like a mild sunburn, with redness, swelling, itching or stinging. After deeper treatment the skin may ooze, blister and crust. It is cleaned 2 to 5 times a day with saline or dilute vinegar. Around day 5 to 7 the skin dries and peels.[1]
ASPS: up to two weeks after CO2 and one week after erbium. After fractional 1,550 nm, the surface healed within 1 day.[1][2]
New skin is pink and lightens over 2 to 3 months. After CO2 resurfacing, redness lasted an average of 4.5 months in 500 patients. Retinoid and glycolic acid products may restart around 6 weeks.[1][2]
Pinkness can take up to a year to fade, longer in blondes and redheads. Skin can be sun-sensitive for up to a year, and daily sunscreen is required. Improvement continues for up to a year.[1][2]
Risks
After CO2 resurfacing, 37% of 500 patients darkened, more often in darker skin types. After fractional CO2 in skin type IV, 92% of patients darkened at some session and it cleared in about 5 weeks. After fractional 1,550 nm in skin types IV to VI, 4% of 115 sessions were followed by darkening. ASPS: darker skin carries a greater risk.[1][2][3]
Hypopigmentation occurred in under 1% of 500 CO2 patients. Another CO2 series reported a significant risk of it. It was the most common long-term side effect in 104 patients followed 2 years. Phenol peel caused less intense lightening than the CO2 laser in a split-face study.[1][2][3]
Herpes simplex followed 7.4% of CO2 treatments, regardless of prior history, and 1.77% of 961 fractional 1,550 nm treatments. In 60 patients given famciclovir 250 mg twice a day for 14 days, starting the day before, none had a reactivation.[1][2][3]
17 of 395 CO2 procedures (4.3%) had culture-proven infection, starting on days 2 to 10. Pseudomonas was found in 41%, Staphylococcus aureus in 35% and Candida in 24%. Infection was more common after full-face resurfacing and with a sealed (occlusive) dressing.[1]
Scarring occurred in under 1% of 500 CO2 patients. One of 111 treated areas in the 1996 CO2 study formed a raised scar. In 961 fractional 1,550 nm treatments, no complication led to scarring.[1][2][3]
Every CO2 patient had redness, lasting an average of 4.5 months. In a split-face study, laser redness lasted 4.5 months and medium-depth peel redness 2.5 months.[1][2][3]
Acne flares, milia (small white bumps) and dermatitis occurred in 10% to 15% of CO2 patients. Acne-like breakouts followed 1.87% of fractional 1,550 nm treatments.[1][2][3]
How long results last
ASPS: some people see a difference right away, and improvement continues for up to a year. Results last for years, but lines return with normal aging. After CO2 resurfacing, wrinkle improvement held at an average 24 months in 104 patients. Fractional 1,550 nm improved wrinkle scores 18% at 3 months. One fractional CO2 or erbium session reduced periorbital wrinkle depth about 20%.[1][2][3]