CO2 Laser Therapy: Risks, Cost

“CO2 is the big lasers,” says the board-certified dermatologist Tiffany LibbyMD, the director of Mohs micrographic and dermatologic surgery at Brown Dermatology. And their reputation may be part of the reason they are controversial. Some doctors believe that the majority of skin concerns common to people in their 20s and 30s are unlikely to warrant the side effects and risks (which I’ll cover below). Meanwhile, there are other experts who believe that newer CO2 lasers, when used on specific skin types — strategically and by experienced professionals! — are beneficial. Whether 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 discuss this with a doctor.

Some people call any device that treats the skin with a focused beam of energy, whether it emits visible or infrared light, radio frequency (eg. Morpheus8), or ultrasound (e.g. Ultherapy Prime). But if we are talking only about light-based devices, then there are two in general types of lasers: non-subtractive and subtractive. Non-ablative lasers send their energy into the middle (dermis) layer of your skin without damaging the top layer (epidermis). ablative lasers destroy the upper layer while also sending energy deeper. Lasers can also be non-fractionated, so they treat the entire surface where they are placed, or fractionated, meaning 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 evaporate. “CO2 lasers remove the outer layers of the skin, usually in controlled zones or columns—that is, fractionated—stimulating collagen production and activating the wound healing process,” says Libby. “Technically, it causes a targeted controlled injury to your skin that stimulates your body’s immune response to repair and regenerate the skin, then leaving new, healthy collagen and elastin and clearing away the old, damaged collagen and elastin.”

Dermatologists and plastic surgeons commonly use CO2 lasers to treat people with severe skin texture problems, such as pitted acne scars, scars, deep wrinkles, and sun damage. “Plus, they can improve stretch marks and even remove precancerous cells that can lead to skin cancers,” says the board-certified dermatologist. Howard SobelMD

Morgan RambachMD, its co-founder LM Medical NYCsays he may also consider CO2 laser therapy as a targeted approach to help treat sun damage and prevent certain types of cancer in a light-skinned patient with a history of skin cancer. “There is research that suggests that if you do CO2 lasers, even the ablative ones, specifically, it reduces the number of basal and squamous cells that you get in a lifetime,” he 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 vary depending on how the laser is used, but for more intensive treatments, anesthesia and several weeks for the skin to recover may be required. The treated areas will be red and raw for at least a week, and itching, redness, and roughness may last for several weeks. There is also a risk of infection. But the big reason many doctors are wary of treating people with CO2 lasers, unless absolutely necessary, is the potential for them to cause bleaching or darkening of the skin, especially for patients who are Fitzpatrick skin type III (medium-beige or light olive) or higher.

“The old CO2 lasers, when they weren’t fractionated, just blasted away the melanocytes, leaving the skin looking porcelain—not in a good way,” says Rabach. “Some of that fear factor may have remained today.” But she doesn’t believe doctors should rule out a treatment just because of someone’s age, and uses a CO2 laser to do what she calls a “CO2 dust,” on some of her patients under 40. “It’s not this traditional treatment where people think, Oh, you’ll be down for two weeksand your face will look like Samantha’s chemical peel from Sex and the Cityshe says. “I adjust the settings so you don’t have the same downtime or risks,” he says. But, he points out, therapy isn’t for everyone.

Libby believes that CO2 is probably “too much” for the majority of people in their 20s or 30s. “It’s probably more aggressive than it needs to be, which can lead to unnecessary risks like prolonged recovery, redness, scarring, or pigmentation issues,” she says. “But if a CO2 treatment was right for a patient in their 20s or 30s—for, say, severe acne scarring—then I would recommend it.”

And Sobel says he would likely turn to another laser for his patients under 40. “There are less invasive non-ablative laser treatments such as the Fraxel 1550 nm to generate heat deep beneath the skin without injuring or removing the surface of the skin. “, he says. Or, it can recommend CoolPeel. “It’s a light-based action that targets water in tissue, stimulating collagen production, making skin look younger and healthier over time,” she says. While CoolPeel is technically considered a CO2-based ablative treatment, it does not cause thermal damage. (Confused yet? You should be! And that’s why you want to get any laser treatments under the supervision of a board-certified cosmetic medicine physician.)

If you’re under 30, probably not. If you’re over 35, I suggest you start by identifying the specific cosmetic concerns you have, then talk to a board-certified dermatologist or plastic surgeon to see what treatment they recommend for you. There are many reputable dermatologists who will give general advice on TikTok and Reels for a video, but they will often be conservative with their recommendations as they need to speak to a wide audience.

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