Fractional CO₂ Facial Resurfacing

Fractional CO₂ creates microscopic zones of vaporized tissue (microthermal treatment zones) surrounded by intact skin. These controlled injuries trigger a healing cascade and new collagen/elastin formation while preserving islands of healthy tissue to speed recovery. By adjusting pulse energy, density, and pass count, we can tune the balance between improvement and downtime for each area of the face.

Good candidates seek meaningful improvement in texture, fine lines, or scarring and can protect their skin from the sun during recovery. We generally avoid treatment during pregnancy, with active infections or open wounds, immediately after isotretinoin use, or when photosensitizing medications are present. Those with a history of cold sores may receive antiviral prophylaxis. Alternatives and complements include non-ablative fractional lasers, RF microneedling, medium/deep chemical peels, Er:YAG resurfacing, neuromodulators, fillers, and targeted pigment therapies. We individualize plans for all skin tones and may recommend alternative modalities when pigment-change risk is higher.

Visits typically take 45–90 minutes including topical anesthesia. You’ll feel warmth and a prickling or snapping sensation during passes. Expect redness, swelling, and a sandpaper feel immediately after; oozing/crusting and peeling are common for several days. Most light treatments heal in ~3–5 days; deeper sessions may need 7–10 days. Avoid strenuous exercise, hot tubs/saunas, and makeup until re-epithelialization. Strict sun avoidance and SPF are essential. Pinkness may persist for 2–4+ weeks but can be covered with approved products once the surface heals. Results continue to improve over 3–6 months as collagen remodels.

When properly selected and performed, fractional CO₂ is generally well tolerated. Expected effects include redness, swelling, tightness, and peeling. Less common risks include infection (including HSV reactivation), acneiform breakouts, prolonged erythema, milia, or pigment changes. Sun protection, gentle cleansing, bland occlusives, and avoiding irritants speed recovery. We review medical history—including keloid tendency, autoimmune disease, prior radiation, and recent procedures—to tailor depth and density. For patients with higher pigment-change risk, we may adjust settings, pre-treat, or recommend alternative technologies.