Is CO2 Laser Resurfacing Worth It? Fractional vs. Ablative for Wrinkles and Scars

Few skin treatments generate as much confusion — or as many conflicting reviews — as CO2 laser resurfacing. One person calls it life-changing; the next warns about weeks of downtime. Both can be right, because “CO2 laser” describes a range of treatments that vary enormously in strength. Patients in Morristown and across Northern New Jersey come to Dr. Farhad Rafizadeh having read all of it online and ask a version of the same question, the kind that also appears on his RealSelf Q&A page.

It is a smart question, and it deserves a careful answer rather than a review-site headline. As a plastic surgeon who has spent four decades focused on natural results and who resurfaces and lifts faces regularly, Dr. Rafizadeh’s view is specific: a CO2 laser is superb at improving the quality of your skin — wrinkles, texture, sun damage, scars — and completely wrong for lifting skin that has sagged. Confusing the two is where patients get disappointed.

Dr. Rafizadeh’s Short Answer

A CO2 laser is one of the best tools we have for resurfacing skin — softening wrinkles, evening out sun damage, smoothing scars. But it resurfaces; it doesn’t lift. The word “CO2” covers everything from a light fractional treatment with a few days’ downtime to a fully ablative pass that’s essentially two weeks of healing. The right version depends on your skin, your skin tone, and how much recovery you can accept. On the right patient it’s remarkable. Matched to the wrong problem, it disappoints.

In other words: the CO2 laser is a precision instrument, not a cure-all. Understanding exactly what it fixes — and how it’s delivered — is the whole decision.

What a CO2 Laser Actually Does

A CO2 laser is an ablative laser: its beam is absorbed by the water in your skin, which lets it vaporize the outer, damaged layers with precision while heating the dermis underneath. That controlled injury does two things at once — it removes weathered surface skin, and it triggers the body to heal with fresh collagen. The result, as the skin recovers, is a smoother surface, more even tone, and firmer texture.

Because it reaches deeper than superficial treatments, a CO2 laser is one of the most powerful resurfacing options in existence. It sits alongside the deep chemical peel at the aggressive end of the resurfacing spectrum — and, like a deep peel, its power is exactly why how it is delivered matters so much.

Fractional vs. Fully Ablative: The Distinction That Changes Everything

This is the single most important thing to understand before you read another review, because the two modes are almost different procedures:

• Fully ablative CO2 removes the entire surface of the treated area in one pass. It produces the most dramatic single-session result — and the longest, most demanding recovery, on the order of two weeks of active healing.
• Fractional CO2 treats microscopic columns of skin and deliberately leaves healthy, untreated tissue in between. Those islands of intact skin act as a reservoir for healing, so recovery is faster and the risk of complications lower. The trade-off is that fractional treatment is gentler per session and often needs a series of treatments to match what one aggressive fully ablative session achieves.

Most modern practices lean toward fractional CO2 for the great majority of patients, because it offers a better balance of results, safety, and downtime, and reserve fully ablative treatment for select, deeper concerns. When someone online raves about their result or warns about brutal recovery, the very first question is: which version did they have?

What It Fixes — and What It Doesn’t

This distinction comes back to a simple idea: a laser changes the quality of your skin, not its position.

A CO2 laser is excellent for:

• Fine and moderate wrinkles, especially around the mouth and eyes where skin is thin and etched lines settle in.
• Sun damage, uneven pigmentation, and rough texture, including some precancerous actinic changes.
• Enlarged pores and certain scars, including atrophic (depressed) acne scars, where fractional CO2 has strong evidence behind it.

What it cannot do is just as important:

• It does not lift or tighten sagging tissue. Jowls, a heavy neck, and hooded eyelids are structural — loose skin, descended fat, lax deeper layers — and no laser reaches or repositions those layers.
• It does not restore lost volume. Hollow cheeks and deep folds from age-related fat loss need fat grafting or filler, not resurfacing.

So when someone asks whether a laser is “better than a facelift,” they’re comparing two things that don’t compete. A laser and a facelift fix different problems. For many patients over 50 the ideal plan combines them: a lift for the sagging, and a laser or peel for the fine perioral lines a lift can’t reach.

CO2 Laser vs. Chemical Peel

A deep chemical peel and an ablative CO2 laser are genuine alternatives for the same goal: resurfacing wrinkled, sun-damaged skin. Both remove the outer skin in a controlled way so it heals smoother — one with heat, one with a chemical. The honest, evidence-based summary:

• Effectiveness is comparable for deep wrinkles, especially in the thin-skinned areas of the face. Head-to-head research has found a deep phenol peel about as effective as a CO2 laser at softening lines around the mouth.
• Control differs. A laser lets the surgeon dial depth precisely and treat zones with fine adjustability; a peel is controlled chemically, through formula and technique.
• Cost and setting differ. A deep peel can be very cost-effective, while a full-face phenol peel requires cardiac monitoring; a laser has its own equipment and safety considerations.
• Both carry real downtime and pigment risk in medium and darker skin. Neither is a lunchtime procedure.

If you want the full comparison, see our companion article on the deep phenol-croton oil peel vs. laser resurfacing and a facelift. Dr. Rafizadeh’s approach is to match the tool to the skin type and the problem rather than crown a universal winner. The right question isn’t “which is better?” but “which is better for you?”

Downtime: The Honest Timeline

This is where reviews diverge most, and it comes straight back to which version you had. There is no way around the fact that meaningful resurfacing means meaningful healing, and any provider who minimizes it isn’t being straight with you.

• First 2–4 days: the peak. The skin is red, swollen, and oozes or crusts. For a fully ablative or deep fractional treatment, this is the most intense stretch.
• Through week one to two: the surface finishes its initial healing and peels, revealing new pink skin. A lighter fractional treatment may be through this in just a few days.
• Weeks to months after: the new skin is pink to rosy as it matures, fading gradually and easily camouflaged with makeup once healed. Fresh collagen keeps improving the result over the following months.

Strict sun avoidance and meticulous wound care are non-negotiable throughout. Most people plan an aggressive treatment around a stretch of time away from work and social life.

Is It Safe? The Risks Worth Knowing

In trained, experienced hands and on an appropriately chosen patient, CO2 laser resurfacing is well-established and safe. But it is a real medical procedure with real risks that deserve a straight conversation:

• Prolonged redness is expected after deeper treatments and settles over weeks to months.
• Pigment change — temporary or, less often, lasting — is the risk that most limits laser choice in medium and darker skin tones.
• Infection and cold-sore reactivation can occur; antiviral medication is often prescribed to prevent the latter.
• Scarring is uncommon but possible, especially if the setting is too aggressive for the skin or aftercare is neglected.

Careful energy settings, sterile technique, appropriate patient selection, and diligent post-treatment care are what keep these risks low. This is a large part of why the operator matters as much as the machine.

Who Is — and Isn’t — a Candidate

The ideal candidate is a healthy person with fair to medium skin and wrinkles, sun damage, or scars that lighter treatments no longer improve. Skin tone matters a great deal: because ablative CO2 injures pigment-producing cells, medium and darker complexions carry a higher risk of post-inflammatory hyperpigmentation or lighter patches. That doesn’t rule out treatment, but it calls for conservative settings, sometimes pre-treatment with skin-lightening agents, or a gentler non-ablative fractional option.

CO2 laser resurfacing is usually deferred or reconsidered in people with:

• A tendency toward keloid or hypertrophic scarring (see our guide to scar revision and keloids).
• Active skin infection, a recent course of isotretinoin, or pregnancy.
• A primary concern of sagging rather than surface aging — better addressed by a facelift.

As with newer skin treatments such as Renuvion skin tightening and LED red light therapy, the decision is never one-size-fits-all — it depends on your skin, your health, and exactly what’s bothering you.

How Dr. Rafizadeh Thinks About It

When a patient asks about a CO2 laser, the conversation follows a simple logic:

• Diagnose the problem first. Is the concern wrinkling, texture, and sun damage, or is it sagging? A laser treats the former; a facelift treats the latter. Many people have both — and are best served by a combined plan.
• Match the depth — and the mode — to the skin. Fair skin with etched lines may do beautifully with a deeper treatment; darker skin or milder concerns are better served by gentler fractional or non-ablative settings.
• Respect the recovery. Aggressive resurfacing means real downtime; a lighter series trades stronger single results for easier healing each time.
• Set honest expectations. Days of raw healing, weeks of fading pinkness, and months of collagen-driven improvement — in exchange for a result that genuinely improves skin quality.

Used this way — the right mode, at the right depth, on the right patient — a CO2 laser is one of the most rewarding tools in facial rejuvenation. Chosen for the wrong problem, it disappoints no matter how good the device.

People Also Ask

Common Questions Patients Search About CO2 Laser Resurfacing

How many CO2 laser treatments are needed for wrinkles?

It depends on the mode. A single fully ablative CO2 session can deliver a dramatic result but with a long recovery. Fractional CO2, which is gentler per session, is often done as a series — commonly two to four treatments spaced weeks apart — to reach a comparable improvement with easier downtime each time. The right number is set at consultation based on your skin, the depth of the wrinkles, and how much recovery time you can accommodate.

What’s the best laser for deep wrinkles?

For deep, etched wrinkles, ablative lasers — classically the CO2 laser, and to a somewhat lesser depth the erbium (Er:YAG) laser — remain the most powerful options, and a well-performed CO2 treatment is often the benchmark. A deep chemical peel can be comparably effective for deep lines around the mouth. Non-ablative and lighter fractional lasers suit fine lines and prevention. The best choice depends on wrinkle depth, skin tone, and downtime tolerance, which is what a consultation sorts out.

What is the best laser treatment for sagging jowls?

No laser truly fixes sagging jowls, because jowling is a structural problem of descended fat and lax skin and deeper tissue that resurfacing does not reach. Some energy-based tightening devices produce modest firming of mild laxity, but they cannot reposition tissue. True jowling is corrected by a facelift or neck lift. A CO2 laser can be a superb complement to a lift — improving surface lines a lift can’t touch — but it is not a substitute for one.

What’s the worst day after a CO2 laser?

For most people the peak of swelling and discomfort comes in the first two to three days, when the skin is reddest, most swollen, and oozing or crusting before it begins to peel. After a fully ablative or deep treatment, days two through four often feel the most intense. It then steadily improves, with the surface typically finishing its initial healing by roughly one to two weeks. Following your surgeon’s wound-care instructions closely makes those early days far more comfortable.

How long does it take to look normal after a CO2 laser?

The raw healing phase — redness, swelling, oozing, and peeling — usually resolves within about one to two weeks for an ablative or deep fractional treatment, and a few days for a lighter fractional one. At that point most people are presentable and can camouflage residual pinkness with makeup. That rosy tone then fades gradually over several weeks to a few months, while new collagen continues to improve the result.

Is there anything better than a CO2 laser?

There is no single “best” — the right treatment depends on the problem. For deep resurfacing, a CO2 laser is a benchmark, but an erbium laser, a deep chemical peel, or fractional resurfacing may fit better depending on skin tone and downtime tolerance. For sagging, a facelift outperforms any laser. For lost volume, fat grafting or filler is the answer. “Better” is defined by what you’re trying to fix, which is why an individualized exam matters more than chasing a single device.

What is the downside of CO2 laser resurfacing?

The main downsides are downtime and skin-tone limits. An ablative CO2 treatment means up to about two weeks of visible healing followed by weeks to months of fading redness, and it carries a real risk of pigment change in medium and darker skin, so it’s best suited to fair to medium tones. It’s a cosmetic procedure not covered by insurance, and deeper results may require either significant single-session downtime or a series of gentler treatments. For the right patient, those trade-offs buy a powerful, long-lasting improvement in skin quality.

The Bottom Line for North Jersey Patients

A CO2 laser is one of the most powerful resurfacing tools in facial rejuvenation — genuinely capable of softening wrinkles, evening out sun damage, and smoothing scars that lighter treatments won’t touch. But “CO2 laser” is not one procedure: a light fractional treatment and a fully ablative pass differ enormously in results and recovery. It resurfaces skin, it doesn’t lift it; it’s best on fair to medium skin; and, done well, it asks for real healing time in exchange for a lasting improvement in skin quality. Chosen for the right problem, at the right depth, in the right hands, it is remarkable. Chosen carelessly, no device makes up for the mismatch.

If you have wrinkles, sun damage, or scars and you’re weighing a laser, a peel, or a lift, the most useful next step is an honest, individualized exam. Dr. Rafizadeh will tell you plainly which tool — or combination — actually fits your skin and your goals.

Sources & References

1. Agrawal K, et al. “Evaluating the Pros and Cons of Fractional CO2 Laser Versus Microneedling.” 2024. PubMed Central
2. Mayo Clinic. “Laser resurfacing.” Oct 2024. mayoclinic.org
3. American Society of Plastic Surgeons. “Laser Skin Resurfacing Recovery.” plasticsurgery.org
4. Cleveland Clinic. “Laser Skin Resurfacing.” clevelandclinic.org
5. Memorial Sloan Kettering Cancer Center. “Skin Care Before and After Fractionated Carbon Dioxide (CO2) Laser Treatment.” mskcc.org
6. Dr. Farhad Rafizadeh, RealSelf Q&A profile. realself.com

Related Reading From Dr. Rafizadeh’s Blog

Patients weighing resurfacing, skin quality, and facial rejuvenation in Northern New Jersey may find these articles useful:

• Deep Phenol-Croton Oil Peel vs. Laser Resurfacing and a Facelift — What Fixes Deep Wrinkles?
• Renuvion (J-Plasma) Skin Tightening vs. a Facelift — What Firms Loose Skin?
• Does Red Light Therapy Work? LED Skin Rejuvenation & Post-Op Healing
• Exosome Facials & Hair Treatments: Do They Work — and Are They FDA-Approved?
• Fat Transfer for Facial Volume Restoration — Cheeks & Beyond
• Scar Revision Surgery: Keloid & Hypertrophic Scars in North Jersey