A CO2 facial is a skin resurfacing treatment that uses a carbon dioxide laser to remove damaged outer layers of skin and stimulate new collagen growth underneath. It’s one of the most intensive laser treatments available for the face, used primarily to treat deep wrinkles, acne scars, uneven skin tone, and sun damage. The average cost is around $1,829 per session, and results can last years for certain improvements like skin texture and fine wrinkle correction.
How It Works
Carbon dioxide lasers emit energy at a wavelength of 10,600 nanometers, which is absorbed by water inside skin cells. When the laser hits the skin, it vaporizes the outermost layers, essentially removing damaged tissue one thin pass at a time (roughly 20 to 30 micrometers per pulse). This controlled destruction forces the skin to rebuild itself from structures deeper in the dermis, including sweat glands and hair follicles.
The real payoff happens beneath the surface. The heat from the laser causes existing collagen fibers to contract and tighten immediately, then triggers a longer remodeling process where the body produces fresh collagen over the following weeks and months. This is what creates the skin-tightening and smoothing effects that make CO2 lasers more powerful than most other facial treatments.
Fractional vs. Full Ablative
There are two main approaches. Traditional (fully ablative) CO2 lasers treat the entire surface area of the skin. They deliver dramatic results but come with significant downtime and a higher risk of side effects, including scarring.
Fractional CO2 lasers are the more modern option. Instead of treating every square millimeter, they create thousands of tiny columns of treated skin surrounded by untouched tissue. This leaves healthy skin intact between treatment zones, which speeds healing considerably and reduces complications. Only a few cases of scarring have been reported with fractional CO2 treatment, compared to a more notable risk with older nonfractional lasers. Most CO2 facials performed today use fractional technology.
What It Treats
CO2 facials are most commonly used for acne scarring, deep wrinkles, sun damage, and uneven pigmentation. In a clinical study of 30 patients with acne scars who underwent three fractional CO2 sessions, about 10% saw excellent improvement (76 to 100% scar reduction), nearly 60% had good improvement (51 to 75%), and about 30% had fair improvement (26 to 50%). No patients had a poor response. Results improved progressively with each session.
For aging skin, a 10-year follow-up study of 159 patients who had full-face CO2 resurfacing found that the treatment was particularly effective at maintaining good skin texture and eliminating fine wrinkles over the long term. At the 5-year mark, 32% of patients still had noticeably improved skin texture, and 22% maintained correction of skin pigmentation. At 10 years, those numbers were 20% and 19%, respectively. Deeper wrinkles and sagging eventually returned, with 88% of patients needing further correction at 5 years and 98% at 10 years, since the laser cannot stop the ongoing aging process.
What the Procedure Feels Like
Before the laser touches your skin, a numbing cream is applied and covered with a plastic occlusive dressing. You’ll sit with this on for 30 to 60 minutes, depending on the product used. Once the numbing cream is wiped off, the practitioner moves the laser handpiece across the treatment area, firing precise pulses. You may feel warmth, pressure, or a stinging sensation even through the numbing agent.
The laser portion itself typically takes 15 to 45 minutes depending on the size of the area being treated and how many passes are needed. Between passes, the practitioner wipes away vaporized tissue with damp gauze and examines the skin before deciding whether another pass is necessary. The entire appointment, including numbing time, usually runs 1 to 2 hours.
Recovery and Downtime
This is not a lunchtime procedure. After a CO2 facial, your skin will be red, swollen, and raw. With fractional treatments, most people experience about 5 to 7 days of significant redness and peeling before the skin re-epithelializes (grows a new outer layer). Full ablative treatments can require 10 to 14 days or more before the skin heals enough to go without specialized wound care.
Redness can persist for weeks to months after the initial healing period. In the 10-year follow-up study, some patients experienced persistent erythema (redness) and visible lines of demarcation between treated and untreated skin in the first year. These issues were more common with older, fully ablative techniques. Most people plan for at least one to two weeks away from work and social commitments after a CO2 facial.
Risks and Side Effects
The most discussed risk is post-inflammatory hyperpigmentation, where the treated skin develops dark patches during healing. This occurs because the inflammation from the laser triggers excess melanin production. Reported rates vary wildly across studies, from 0% to 75%, depending on the laser settings, the population studied, and aftercare protocols.
Interestingly, skin tone alone does not appear to be as strong a predictor of hyperpigmentation as once believed. While darker skin types have traditionally been considered higher risk, several studies found no significant difference in hyperpigmentation rates based on skin phototype. One small study of patients with darker skin reported 0% hyperpigmentation, while another study of the same skin type found it in 75% of participants. Laser settings, sun exposure before and after treatment, and individual healing responses seem to matter as much as, or more than, baseline skin tone.
Other potential side effects include prolonged redness, infection during the healing window, and in rare cases with fractional lasers, scarring. Permanent hypopigmentation (lightened patches of skin that don’t return to normal color) was found in about 8.7% of patients in one long-term study and up to 19% with older-generation fully ablative lasers. This risk is much lower with modern fractional devices.
Who Should Avoid It
People who tan easily should be cautious, as the inflammatory response from the laser can trigger pigmentation changes more readily in skin that produces melanin quickly. If you’ve had significant recent sun exposure or use tanning beds, most practitioners will delay treatment until your skin returns to its baseline color.
Active skin infections, a history of abnormal scarring (keloids), and certain medications that affect skin healing can also make someone a poor candidate. Your provider will review your medical history and skin type before recommending treatment parameters or suggesting an alternative approach entirely.
Cost and Number of Sessions
The American Society of Plastic Surgeons reports an average cost of $1,829 per session for laser skin resurfacing, though this figure covers only the procedure fee. Facility costs, anesthesia, and aftercare products add to the total. Prices vary significantly by geographic region, provider experience, and how much of the face is treated.
For acne scarring, most treatment plans involve three sessions spaced several weeks apart. Fine wrinkles and sun damage may improve adequately with one or two sessions. Full ablative treatments are more commonly performed as a single session due to their intensity, while fractional treatments lend themselves to a series approach with less downtime per session. CO2 facials are almost never covered by insurance since they are considered cosmetic.