The CO2 laser forms an integral part in the management of moderate to severe scarring.

The Acne Specialist Clinic has Australia’s largest selection of laser and light based methods to treat acne scarring. The CO2 laser forms an integral part in the management of moderate to severe scarring. This laser is more powerful than Erbium, Pearl and the Fraxel laser. CO2 laser is ideal for certain types of acne scarring, in suitable skin types.

CO2 lasers used in dermatology for the treatment of scars and skin rejuvenation for over 20 years, and still remains an excellent modality if performed correctly.

The CO2 laser can be used in 3 main modes - full resurfacing, fractional resurfacing, and a combination of both. The mode we choose will depend on your scar type, skin type and downtime.

The CO2 laser forms an integral part of our Synergy Method of acne scar revision- it is one of the main methods we employ to treat acne scars.

IMPORTANT FACTS ON CO2 RE LASER FOR ACNE SCARS:

  • This laser is the ‘big gun’ of scar revision for acne
  • CO2 can deliver a huge improvement in acne scars
  • CO2 full resurfacing will also give the longest downtime
  • Carbon Dioxide laser is only suited for lighter skin types
  • Erbium laser is best suited for darker skin types and provides less downtime for the patient
  • We recommend different lasers for different skin and scar types to provide the absolute best results possible
  • We often combine Vascular lasers after CO2 lasers as part of our Synergy Program for acne scars
  • Specialist often combine both CO2 laser and fractional laser in the one treatment to deliver outstanding results in select patients

FREQUENTLY ASKED QUESTIONS:

Box Car Scars

Rolling & Depressed Acne Scars

CO2 or Carbon Dioxide laser is a time-tested instrument used for laser resurfacing. Due to the dynamics of this laser it can produce immense amounts of controlled thermal collagen remodelling- in another words, used correctly, it can improve scars more than any other method of scar revision- including Fraxel and other fractional devices.

Dermatologists have been using CO2 lasers for almost 25 years, and the CO2 RE is the latest evolution of lasers.

CO2 lasers in both the full resurfacing mode or Fractional settings differ from other fractional laser systems in the power and wavelength.

Lasers such as Pearl Fractional and Erbium Profractional remove columns of skin, however the power and delivery system (related to the wavelength of the laser) do not heat the dermal collagen to any large extent. In cases of deep and severe acne scarring, dermal heating and collagen remodelling is paramount for scar improvement. In summary, for certain types of acne scars, we do need the power and heat of a CO2 laser to deliver results that no other laser can deliver.

Our specialists have access to over 11 laser devices, and we will choose the safest and most appropriate method to give you the best results.

The CO2 Core laser is an excellent fractional CO2 laser resurfacer. This laser is made by Candela- Syneron and is the professional’s choice for high-end procedures such as acne scar revision. In fact, major hospitals such as the Royal Brisbane Hospital, Royal Children’s Hospital in Melbourne, and the Skin and Cancer Foundation Sydney and Melbourne all choose Candela as their preferred laser band.

The CO2 Core laser enables precise targeting of the skin’s upper, middle and deeper dermal layers with the flexibility of performing full resurfacing. The flexibility of this system is unique, and in Specialist hands will deliver the best results for acne scarring.

CO2 lasers including full resurfacing as well as fractional resurfacing has some advantages (and disadvantages) over Fraxel – Profractional- and other fractionated lasers. I usually reserve CO2 fractional lasers for very severe scarring – in some cases scarring is so deep and severe, I need maximal depth of laser penetration as well as heat to remodel collagen. Erbium laser and fractional devices cannot deliver the controlled thermal energy compared to a CO2 laser.

I also choose a CO2 laser if a downtime of greater than 7 days can be given as the recovery process is longer compared to erbium. CO2 lasers are limited to skin types 1 and 2- fair Caucasian patients.

In summary I choose CO2 over Erbium lasers in the following situations:

  • Deep scars, rolling scars
  • Fair skin patients with minimal sun exposure
  • Down time of 7 days minimum, approaching 10 days for deep treatment

CO2 lasers are safest in fair skin types. The majority of Caucasian patients will suit CO2 lasers, providing your sun exposure is minimal. Asian and darker skin races that exhibit deep acne scars are best suited to Fractional CO2 , ,Erbium laser, or Fractional RadioFrequency  treatment as the risks of skin colour changes are less. Acne scar revision using the erbium laser, or Fractional –Profractional method also has a quicker recovery time compared to CO2 lasers.

Our Specialists will tailor a method of acne scar revision based upon skin type and skin colour to deliver the best possible results with minimal risks.

CO2 lasers have been around for nearly 25 years however new version such as the CO2 CORE provide an updated version of an older system for the treatment of acne scars. In my experience, the CO2 laser is still the best way to treat severe deep acne scars in patients of fair skin types.

Deep atrophic scars, box-car scarring and shallow acne scars in skin type 1 and 2 are ideal candidates for CO2 Core lasers. Some scars extend so deeply into the dermal layers, they are beyond the reach of Fractional Erbium and Fraxel systems, and the controlled thermal delivery of a CO2 laser is unmatched.

Patients need to remember that we match the scar type, skin types and down time to achieve the best and safest outcomes for you.

CO2 laser treatments are performed in our main laser suite. This is a major procedure and patients are prepped and planned well in advance of the procedure.

Step 1

Consultation, mapping, medical history taking, planning and pre-anaesthetic checks

This is the most crucial step in acne scar treatment. During the consultation your Specialist will identify, photograph and map your acne scars. This process will determine the best way to improve your acne scars. Remember, a tailored program of scar revision is the absolute best method with the highest success rate.

We also examine your skin type, and obtain a full medical history. Based upon planning we will give you an estimate of the down time, and expected outcome of laser treatments.

Step 2

Anaesthesia and scar treatment

Following the acne scar map and consultation process we will book you in at a later date for scar revision. On treatment day, we mark out scars prior to laser resurfacing. An anaesthetic cream will then be applied, followed by a tiny injection. This injection is a form of ‘twilight sedation’ combined with a pain-killer.

Treatment time will vary between 30 minutes to 45 minutes, depending on the areas treated, and how many procedures we perform.

Step 3

Post treatment dressings

After the procedure you will be dressed in a special ointment and wrapped in dressings. You will then be guided to our laser recovery suites as the anaesthetic injection can take another 45 minutes to wear off. You will need someone to drive you home, as this procedure can be classed as medium level surgery, requiring sedation.

Step 4

Post CO2 laser follow up and recovery

CO2 laser patients are reviewed by the treating specialist for wound checks and dressing changes the next day. We will continue to monitor your recovery until your skin has completely healed- on average patients are seen 2-3 times after CO2 laser treatment.

Step 5 (For Synergy Program patients)

VBeam vascular laser and Fractional RadioFrequency Treatments for acne scars

Synergy Program patients move on to the next stage of acne scar revision. In most cases we use another laser called the V Beam Vascular laser 2 weeks after CO2 laser. Unlike the CO2 laser, the V Beam laser is a HEALING laser and does not break skin. In fact the opposite is true- this laser is used to speed up the healing process, and is used to decrease redness and further stimulate collagen. 4-6 weeks after CO2 laser resurfacing, Synergy Program patients are move on to the Fractional RadioFrequency (RF) method of acne scar revision. Unlike CO2 lasers, Fractional RF has very little if any downtime. Most patients will undergo 2-4 treatments of Fractional RadioFrequency.

This will vary depending on the level of treatment. Your Specialist will assess your scar type, skin type and discuss downtime with you. As part of the Synergy Program for acne scars, we often combine different lasers in the one session, and the recovery time will vary considerably.

As a guide- CO2 fractional lasers have a 5-7 day recovery time. This has a longer recovery time compared to Fractional erbium laser resurfacing.

CO2 full laser ablation has a downtime of 7-12 days, once again the recovery time is longer compared to Erbium laser.

Remember, everyone will have a different scar type, skin type and scar depth, an in depth assessment will give an accurate indication of the downtime.

Day 3 after medium fractional setting

Remember everyone has a different scar pattern as well as skin type, and the lasers we choose will depend on individual assessment. The negative side effect from CO2 laser is that the recovery process is longer compared to Erbium or Fraxel. The flipside is that improvement is greater with the CO2 Core compared to other lasers.

Laser type Recovery Time Skin type # of treatments
CO2 Core 7-12 days 1 and 2 only 1-3
Erbium laser 3-8 days 1, 2, 3, 4, 5 2-4
Fraxel and Fractional lasers 3-6 days 1, 2, 3, 4 3-6

As reinforced throughout this website, we treat everyone on an individual basis- acne scar treatments at a specialist level is not a cook-book procedure, we carefully assess your acne scar, skin type and down time to come up with the best solution possible.

Absolutely. Remember the best scar treatments are based upon scar types and NOT what treat is in the office of the physician. Some scars are best treated with non-laser methods.

Deep ice pick scars are best treated with TCA CROSS chemical peels.

Acne associated with scarring is best treated with non-laser RadioFrequency as part of the Acne free RF program.

Atrophic scars are best treated with dermal fillers and dermal grafts.

Skin needling has been out-dated for many years, however can still give a mild improvement in acne scarring. Needling is best suited for darker skin types, and the downtime for this procedure is only a few days at most.

This is the most frequent acne scar revision package we place patients on, and provides patients with the best results. Synergy uses different treatments to target individual acne scars. The majority of patients will have different scar types including ice pick, box scar, and rolling acne scars.

Combining treatments such as CO2 Core laser, Vascular laser, subscision, RadioFrequency, Fraxel and Fractional lasers, TCA Cross and dermal fillers will give the best results for patients. This is the basis behind Synergy Scar Treatments.

Synergy = targeted scar treatments = best scar outcomes

The first step is a discussion with a specialist in the treatment of acne scars.

During the initial visit we will examine your acne scar type, skin type and ‘map’ your scars. The best approach is an individualised method of scar treatment. Each type of acne scar will have a ‘best approach’ method to scar removal.

There are many ways to treat acne scars including TCA cross, Fractional devices such as FRAXEL, ProFractional, PEARL fractional, CO2 Fractional, skin needling, dermal grafting, subscision, full laser ablation, vascular lasers, dermal fillers, and Radiofrequency. A good specialist will find the correct method for treating your scars. In most cases, a simple treatment will give the best results!

The CO2 Core laser is the ‘big guns’ of laser scar revision and I usually reserve this treatment for deep rolling scars in patients who have skin type one or two. Due to the serious power (and conversely great results) of this laser, we recommend a washout period of at least 4-6 months after stopping Roaccutane.

If you have active acne and acne scarring the Acne Free RF Program maybe a better option.

YES - Patients who undertake full laser resurfacing of acne scars are entitled to a rebate by Medicare.

Additionally if a Specialist Dermatologist or Plastic Surgeon revises your scars, you maybe entitled to an additional medical rebate.

Treatment Treatment time # of treatments Downtime Ideal scar severity Projected scar improvement Costs
Clear Skin Program 60 min 4 Hours Mild scarring + $590
Chemical peels 15 min 4-6 Hours Mild + $95
RF RadioFrequency 15 min 4 0-2 days Mild to severe +++ $1100 for 4
Fractional, and Fraxel Dual treatment 30 min 3-5 3-6 days Mild to severe ++++ 800-1200 each
TCA cross 30 min 2-3 5-7 days Mod to severe ++++ 490-900
Synergy laser - Full laser resufacing 15 min to 60 min 3-7 1-12 days Mod to severe ++++++ 3500-7800

Westside Dermatology offers payment plans for acne scar treatments.

Due to the very lax regulations in regards to laser skin procedures in Australia, almost anyone with a laser licence can attempt to perform laser surgery for acne scars. Specialist in acne scar revision will not perform a treatment based upon what laser they have in their practice, however will recommend a treatment based upon scar type and skin type. This makes all the difference in safety, outcome and costs!

Who knows skin better than a dermatologist? Our training, experience and access to the latest in technology will ensure patients are ethically treated with the best possible outcomes for acne scar revision.

Ask your GP for an unbiased opinion in regard to whom they recommend for acne and acne scar treatments!

Dr Davin S. Lim
Laser Dermatologist
Westside Laser Dermatology
Acne Specialist Clinics

CO2 lasers, in particular the CO2 RE system provides a flexible method of acne scar revision. This laser can be adjusted to various depths and coverage, as well as the advantage of full ablation mode for shallow scars. I prefer to use the CO2 over lasers such as Fraxel and Fractional Erbium due to the power of CO2 in certain situations.

This is my preferred choice for treating rolling scars- and severe acne scarring in lighter skin types, providing patients can have a downtime of over a week. A CO2 fractional laser provides a useful treatment tool that forms part of our Synergy program for acne scarring.

For case of very severe acne scarring, I often add the vascular laser 2-3 weeks after CO2 resurfacing to reduce redness and flushing, and compound collagen remodelling with RadioFrequency scar revision. Once again, a tailored approach will give the best results.

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