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CO2 Laser Resurfacing: Fractional vs. Fully Ablative

I frequently get asked during cosmetic consultations what is the difference between the fully ablative CO2 laser resurfacing and the fractional CO2 laser resurfacing. Both laser procedures are effective, but there are definitely differences between the two.

The fully ablative CO2 laser was a forerunner of the newer fractional CO2 laser. It is the original CO2 laser. When I use the fully ablative CO2 laser and activate the device, there is a red square that illuminates on the face of the patient and the fully ablative CO2 laser then proceeds to strip away 100% of the top layer of the skin within that box. It is then, simply a matter of lining up the squares adjacent to each other in order to get full treatment coverage of the face. It very much reminds me of the game Tetris, where the object is to stack geometric shapes closely together. The results are typically very good, but the procedure is uncomfortable requiring anesthesia and sedation. Generally, patients have been very happy with the results but there is a significant amount of downtime. The usual period of recovery is approximately two weeks. For the first 10 days or so, patients will definitely not want to be in social situations as the face recovers. There are more risks associated with this laser and typically, it is much riskier to attempt to treat areas besides the face. I am very hesitant to treat below the jawline on the neck and will not use the fully ablative CO2 laser on the chest.

While this was the main laser for resurfacing I used for many years, patient demand was high for similar results but with much less downtime and recovery. That was the impetus behind the fractional CO2 laser. It is the same CO2 laser technology and the same red square gets illuminated on the skin. However, with the fractional CO2 laser, when I activate the device, only a fraction of the top layer of skin is removed. It reminds me very much of a dot matrix printer back in the 1980’s. It prints out a pattern of closely spaced dots, but there are areas of untreated skin surrounding the treated areas. This is a much less uncomfortable procedure for patients with only about 5-7 days of downtime. One of the reasons cosmetic surgeons like it so well is the much better safety record and profile of the fractional CO2 laser versus the fully ablative. This laser is also able to be used on darker skin types that are probably not able to undergo treatment with the fully ablative CO2 laser. I can very confidently treat the full face as well as the neck and even the chest. This laser is the laser of choice to treat traumatic burn scars, even on the body.

Results are typically pretty close to that of the fully ablative CO2 laser, but perhaps not quite as much improvement when comparing individual treatments with each device. However, many patients express a desire or ability to undergo a much shorter downtime procedure and perhaps repeat it a second time as opposed to having a contiguous two week period of time for recovery. Both fully ablative CO2 laser resurfacing and fractional CO2 laser resurfacing still have their role in rejuvenation with a properly selected patient. Both devices are offered at Northeast Dermatology & Cosmetic Surgery Center. Feel free to ask for information or to schedule a consultation to discuss in more detail.


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