Laser Skin Resurfacing Explained — CO2, Erbium, and Fractional Options Compared

Last updated: 5 March 2026

Laser skin resurfacing is a medical aesthetic procedure that uses concentrated beams of light energy to remove damaged skin layer by layer, stimulating the body’s natural healing response to produce new, healthier skin with improved texture, tone, and firmness. The three primary types of resurfacing lasers — CO2 (carbon dioxide), erbium, and fractional — each offer distinct advantages depending on the patient’s skin type, concerns, and tolerance for downtime. This comprehensive guide compares these technologies to help you understand which option may be most suitable for your skin rejuvenation goals.

How Laser Skin Resurfacing Works

All laser resurfacing technologies work on the principle of selective photothermolysis — the use of specific wavelengths of light to target chromophores (light-absorbing molecules) in the skin. When the laser energy is absorbed by water in the skin cells, it generates controlled thermal damage that removes the superficial layers of damaged skin (epidermis and upper dermis) and heats the deeper dermis to stimulate neocollagenesis — the formation of new collagen fibres.

The wound healing response triggered by laser treatment follows three overlapping phases:

1. Inflammatory phase (days 1-5): The body mobilises immune cells and growth factors to the treatment area
2. Proliferative phase (days 5-21): New epithelial cells and collagen fibres are produced, re-surfacing the treated skin
3. Remodelling phase (weeks 3-12+): Collagen fibres mature and reorganise, progressively improving skin texture and firmness

CO2 Laser Resurfacing

The CO2 laser (wavelength: 10,600nm) is the gold standard of ablative laser resurfacing and the most powerful laser used for skin rejuvenation. It vaporises thin layers of damaged skin with extreme precision whilst simultaneously heating the dermis to stimulate significant collagen production.

Indications

• Moderate to severe wrinkles and deep rhytides
• Significant sun damage and photodamage
• Actinic keratoses (precancerous sun spots)
• Acne scars (moderate to severe)
• Skin laxity
• Sebaceous hyperplasia

Advantages

• Most dramatic single-session results of any resurfacing laser
• Significant collagen contraction and skin tightening
• Can address deep wrinkles and scars that other lasers cannot reach
• Long-lasting results (5-10 years with proper sun protection)

Considerations

• Longest recovery time: 7-14 days of active healing, with residual redness lasting 4-12 weeks
• Higher risk of complications including prolonged erythema, hypopigmentation, and scarring
• Generally not suitable for Fitzpatrick skin types IV-VI due to hyperpigmentation risk
• Requires anaesthesia (topical or local) and potentially sedation for full-face treatment
• Usually performed as a single treatment rather than a course

Erbium Laser Resurfacing

The erbium:YAG laser (wavelength: 2,940nm) is an ablative laser that is more precisely absorbed by water than the CO2 laser, resulting in less thermal damage to surrounding tissue. This makes it a gentler but still effective resurfacing option with a faster recovery profile.

Indications

• Fine to moderate wrinkles
• Mild to moderate sun damage
• Superficial acne scarring
• Uneven skin texture and tone
• Age spots and pigmentation

Advantages

• Shorter recovery time compared to CO2 (5-7 days)
• Less thermal damage means lower risk of scarring and pigmentary changes
• More suitable for moderate skin laxity
• Can be used on the neck, chest, and hands
• Better safety profile for patients with darker skin tones (Fitzpatrick III-IV)

Considerations

• Less dramatic results than CO2 for deep wrinkles
• May require multiple sessions for optimal results
• Less collagen contraction than CO2

Fractional Laser Resurfacing

Fractional laser technology — pioneered by Reliant Technologies with the Fraxel system in 2004 — represents a paradigm shift in laser resurfacing. Rather than treating the entire skin surface, fractional lasers create thousands of microscopic treatment zones (microthermal zones or MTZs), leaving islands of untreated skin between them. This preserves the skin’s structural integrity and dramatically accelerates healing.

Fractional lasers come in two categories:

Ablative Fractional Lasers

These include fractional CO2 (e.g., Fraxel Repair, SmartXide DOT) and fractional erbium systems. They vaporise columns of tissue within each MTZ whilst leaving surrounding tissue intact.

• Downtime: 3-7 days
• Results: Significant improvement with a single session
• Best for: Moderate wrinkles, acne scarring, skin tightening

Non-Ablative Fractional Lasers

These include the Fraxel Dual (1550nm/1927nm), Clear + Brilliant, and similar devices. They heat the dermis without removing the surface layer, making them the gentlest fractional option.

• Downtime: 1-3 days
• Results: Subtle improvement per session; 3-5 sessions recommended
• Best for: Fine lines, mild pigmentation, skin texture, maintenance

Comprehensive Comparison Table

Feature	Full CO2	Erbium	Fractional CO2	Non-Ablative Fractional
Intensity	Highest	Moderate-High	Moderate	Low-Moderate
Downtime	7-14 days	5-7 days	3-7 days	1-3 days
Sessions needed	1	1-2	1-3	3-5
Collagen stimulation	Dramatic	Moderate	Significant	Gradual/cumulative
Suitable skin types	I-III	I-IV	I-IV	I-V
Anaesthesia	Topical + local/sedation	Topical + local	Topical	Topical or none
UK cost range	£1,500-£4,000	£800-£2,500	£500-£1,500	£300-£800
Results longevity	5-10 years	3-5 years	2-5 years	1-2 years

Choosing the Right Laser for Your Skin

The selection of the appropriate laser depends on several interrelated factors that your practitioner will assess during consultation.

Fitzpatrick Skin Type

Your skin type on the Fitzpatrick scale (I-VI) is one of the most important factors in laser selection. Darker skin types (IV-VI) have higher melanin content, which absorbs laser energy and increases the risk of post-inflammatory hyperpigmentation (PIH) and burns. Non-ablative fractional lasers and specific wavelengths are safest for darker skin, whilst full ablative CO2 is generally reserved for Fitzpatrick types I-III.

Severity of Concerns

Mild concerns (fine lines, mild texture) respond well to non-ablative fractional treatments, whilst moderate to severe concerns (deep wrinkles, significant scarring) may require ablative fractional or full CO2 treatment.

Available Downtime

If you cannot take time away from work or social commitments, non-ablative fractional treatments offer the best balance of efficacy and minimal downtime. Full ablative treatments require planning for 1-2 weeks of recovery.

Pre-Treatment Preparation

Proper preparation maximises results and minimises complications:

1. Sun avoidance: Avoid sun exposure and tanning for 4-6 weeks before treatment
2. Discontinue retinoids: Stop tretinoin/retinol products 5-7 days before treatment
3. Skin conditioning: Your practitioner may prescribe a pre-treatment skincare regimen including vitamin C, hydroquinone (for pigmentation-prone patients), and SPF
4. Antiviral prophylaxis: Patients with a history of cold sores should take antiviral medication (valaciclovir) starting 2 days before treatment
5. Avoid blood thinners: Discontinue aspirin, NSAIDs, and fish oil supplements for 1 week before treatment

Post-Treatment Care and Recovery

The recovery process varies by laser type but generally follows this pattern:

• Days 1-3: Swelling, redness, and a warm sunburn-like sensation. Cool compresses and prescribed ointments (e.g., Aquaphor, Vaseline) should be applied regularly
• Days 3-7: Peeling and flaking as the treated skin sheds. Do not pick or peel the skin manually
• Days 7-14: New pink skin emerges. Gentle cleansing and moisturising can begin
• Weeks 2-12: Residual pinkness gradually fades. Strict sun protection with SPF 50 is essential
• Months 3-6: Collagen remodelling continues, with progressive improvement in texture and firmness

For personalised aftercare guidance, our clinical team provides comprehensive post-treatment support for all laser patients.

Frequently Asked Questions

Is laser skin resurfacing painful?

Discomfort varies by laser type and individual pain tolerance. Non-ablative fractional treatments feel like a warm prickling sensation and are generally well-tolerated with topical numbing cream. Ablative fractional treatments are more intense and require topical anaesthesia, sometimes supplemented with nerve blocks. Full ablative CO2 resurfacing may require local anaesthesia or sedation for patient comfort. Post-treatment discomfort is usually described as a sunburn sensation and is managed with prescribed cooling measures and pain relief.

How many laser resurfacing sessions do I need?

This depends entirely on the laser type and your treatment goals. Full ablative CO2 resurfacing typically produces significant results in a single session. Ablative fractional treatments may require 1-3 sessions spaced 6-8 weeks apart. Non-ablative fractional lasers typically require 3-5 sessions at 4-6 week intervals for optimal cumulative results. Your practitioner will design a treatment plan tailored to your specific needs during your consultation.

Can laser resurfacing remove acne scars completely?

Laser resurfacing can significantly improve the appearance of acne scars but may not remove them completely. Clinical studies show improvement rates of 40-70% depending on the scar type, depth, and laser used. Atrophic (indented) scars respond better than hypertrophic (raised) scars. Fractional ablative lasers have the strongest evidence base for acne scar treatment, and combining laser with other modalities such as subcision, PRP, or filler can further enhance results.

Is laser skin resurfacing suitable for darker skin tones?

Darker skin types (Fitzpatrick IV-VI) can undergo laser resurfacing but require careful selection of laser type and parameters to minimise the risk of post-inflammatory hyperpigmentation. Non-ablative fractional lasers with 1550nm wavelengths are generally safest for darker skin. Ablative treatments carry significantly higher risk in these skin types and should only be performed by practitioners with specific expertise and experience treating diverse skin. Pre-treatment with skin-lightening agents and post-treatment sun protection are particularly important.

When can I wear makeup after laser resurfacing?

For non-ablative fractional treatments, mineral makeup can typically be applied the next day. For ablative fractional treatments, makeup should be avoided until the skin has fully re-epithelialised (typically 5-7 days). After full ablative CO2 resurfacing, makeup should not be applied for at least 10-14 days or until your practitioner confirms the skin has healed sufficiently. Always use clean brushes and gentle, fragrance-free mineral formulations when first reintroducing makeup.

Medical Disclaimer: This article is provided for informational and educational purposes only and does not constitute medical advice. Laser skin resurfacing is a medical procedure that carries risks including burns, scarring, infection, and pigmentary changes. Individual results and recovery times may vary. Always consult a qualified medical professional before undergoing any laser treatment. The information in this article is based on current clinical evidence as of 2025. Axiom Aesthetics is a UK-based aesthetic clinic — contact us to arrange a laser consultation with our qualified practitioners.