Fractional CO2 laser resurfacing is widely considered the most effective laser treatment for wrinkles, delivering around 50 to 63 percent improvement in skin texture and wrinkle depth in clinical studies. But “best” depends on your wrinkle severity, skin tone, tolerance for downtime, and budget. For deep lines and significant sun damage, ablative lasers produce the most dramatic results. For fine lines with minimal recovery time, non-ablative options can deliver meaningful improvement over multiple sessions.
Ablative vs. Non-Ablative Lasers
Every wrinkle laser falls into one of two categories. Ablative lasers vaporize the outer layer of skin by superheating water molecules in the tissue. This controlled destruction triggers the body to rebuild with fresh collagen, tightening the skin in the process. Non-ablative lasers leave the skin’s surface intact and instead deliver heat to the deeper layers, stimulating collagen production without that dramatic peel effect.
The tradeoff is straightforward: ablative lasers produce far more noticeable results but require longer recovery and carry higher risk of side effects. Non-ablative lasers offer gentler improvement with little to no downtime, but the changes are more moderate and typically require more sessions to accumulate.
Fractional CO2: The Gold Standard for Deep Wrinkles
Fractional CO2 lasers are the go-to for severe facial wrinkles, uneven texture, and significant sun damage. One study published in the Journal of Clinical and Aesthetic Dermatology found 63 percent improvement in skin texture, 57 percent improvement in skin tightening, and about 51 percent improvement in wrinkle depth two months after treatment. “Fractional” means the laser treats a grid of tiny columns in the skin rather than the entire surface, which speeds healing compared to older full-field CO2 lasers while still delivering strong results.
Recovery is real, though. Expect redness, pinpoint oozing, and a bronzed appearance as the treated layer dries and sheds over the first several days. Most people feel comfortable returning to video calls by day five and can go back to work with makeup by the end of the first week. Pinkness can linger for several weeks afterward, and strict sun protection is essential during this phase to prevent dark spots from forming.
Erbium YAG: Less Heat, Faster Healing
Erbium YAG lasers are also ablative but cause significantly less thermal damage to surrounding tissue. In a head-to-head comparison published in JAMA Dermatology, the erbium laser left roughly 30 to 50 micrometers of residual heat damage in the skin, while the CO2 laser left 60 to 200 micrometers. Less collateral heat means less swelling, less redness, and a faster return to normal.
The catch is that the CO2 side consistently showed better wrinkle improvement in the same study. Erbium YAG is a strong choice for mild to moderate wrinkles, especially around the eyes or mouth where you want precision and a shorter recovery. For deeper creases and more extensive damage, CO2 remains the more effective option.
Non-Ablative and Picosecond Lasers
If you can’t afford a week of downtime, non-ablative fractional lasers work by heating the deeper skin layers while leaving the surface untouched. They stimulate collagen remodeling gradually, improving fine lines, texture, and tone over a series of treatments. Results are more subtle per session, but the convenience factor is significant: most people return to normal activities the same day or the next.
Picosecond lasers are a newer option that deliver ultra-short pulses of energy, creating precise micro-injuries in the upper skin layers. Early research shows they can improve wrinkles with a favorable safety profile, though the collagen remodeling response appears less robust than what fractional CO2 produces. These lasers are better suited for fine lines and overall skin quality rather than deep wrinkles.
How Many Sessions You’ll Need
A single ablative CO2 session can produce visible, lasting results for many people. Non-ablative treatments typically require an initial series of sessions spaced every four to six weeks. After completing that series, maintenance treatments every one to two years help sustain collagen production as the skin continues to age naturally.
The average cost of a laser skin resurfacing session is $1,829, according to the American Society of Plastic Surgeons. That figure varies widely based on the type of laser, geographic location, and the provider’s expertise. Ablative treatments tend to cost more per session but require fewer sessions overall. Non-ablative treatments cost less individually but add up over a longer treatment course.
Skin Tone and Safety Considerations
Your skin tone plays a major role in which laser is safest for you. People with darker skin (sometimes classified as Fitzpatrick types IV through VI) have more melanin in the outer skin layer, which absorbs extra laser energy and raises the risk of burns and pigmentation changes. To reduce this risk, providers typically use longer wavelength lasers, lower energy settings, and lower treatment density for darker skin tones.
Pre-treatment with a skin-lightening cream for several weeks before the procedure has been shown to reduce the risk of post-treatment dark spots, particularly after resurfacing. Cooling the skin before or after treatment also helps protect against pigmentary changes. If you have a medium to dark complexion, non-ablative lasers generally carry less risk than ablative ones, and finding a provider experienced with your skin type is especially important.
Risks Worth Knowing About
All laser treatments carry some risk of burns, scarring, pigmentation changes, eye injury, and infection. Ablative resurfacing carries higher risk because it disrupts the skin’s protective barrier. Infection is one of the most common complications after ablative procedures. Cold sore reactivation frequently occurs after treating the area around the mouth, so antiviral medication is typically prescribed beforehand. Bacterial and fungal infections can also develop during the healing window.
Hyperpigmentation (dark spots) caused by post-treatment inflammation generally resolves within three to four months. Scarring is possible but uncommon on the face, which heals well due to its rich blood supply and high density of oil glands. The neck is a different story: it has thinner skin and fewer of those glands, so the scarring risk is notably higher when treating that area. Scarring and pigmentation issues can appear weeks to months after treatment, so follow-up appointments matter.
How to Prepare Your Skin
Most providers will ask you to apply a topical retinoid to your skin for about four weeks before the procedure. Retinoids accelerate skin cell turnover, which primes the skin for better healing and more even results. You’ll then stop the retinoid and any other potentially irritating products (like strong acids) in the days leading up to treatment.
After the procedure, you’ll avoid those same active ingredients for about six weeks to let the new skin heal without irritation. Sun protection becomes non-negotiable during recovery. The freshly resurfaced skin is extremely vulnerable to UV damage, and even brief unprotected exposure can cause lasting discoloration.