Yes, the CO2 laser is an ablative laser. It is the most widely used ablative laser in dermatology and is often considered the gold standard for laser skin resurfacing. “Ablative” means the laser physically vaporizes skin tissue rather than just heating it beneath the surface, which is what non-ablative lasers do.
How CO2 Lasers Ablate Skin
The CO2 laser emits infrared light at a wavelength of 10,600 nm. At this wavelength, the only molecule that absorbs the energy is water. Since skin cells contain a high percentage of water, the laser superheats that water so rapidly it turns to gas, vaporizing the cells in a precise, controlled peel. This is what makes it “ablative”: it removes tissue layer by layer rather than leaving the skin surface intact.
After the outer layer of skin is removed, the body regenerates it from structures deeper in the skin, including sweat glands and hair follicles. At the same time, the heat that penetrates below the vaporized zone causes collagen fibers to contract immediately, producing a visible tightening effect. Over the following three to six months, the body builds new collagen in the treated area. Studies tracking patients for a full year after treatment found they maintained about 74 percent of their initial improvement at long-term follow-up visits.
Ablative vs. Non-Ablative Lasers
The distinction matters because it determines both results and recovery. Ablative lasers like the CO2 remove the outer skin layer entirely, producing the most dramatic resurfacing results. Non-ablative lasers leave the skin surface intact and instead create controlled injury deeper in the skin to stimulate collagen remodeling. The trade-off is straightforward: ablative lasers deliver more visible improvement but require significantly more downtime and carry higher risk of complications.
Radiofrequency devices, which are sometimes grouped into the conversation, work differently from both. They pass energy through the skin surface without damaging it, heating deeper tissue more like a microwave than a laser.
Fractional vs. Fully Ablative CO2
Not every CO2 laser treatment is equally aggressive. Traditional fully ablative CO2 resurfacing vaporizes 100 percent of the skin in the treatment area. Fractional CO2 resurfacing, introduced in 2004, creates a pattern of tiny columns of vaporized tissue separated by untouched skin. Those islands of intact skin dramatically speed healing because the body can regenerate from multiple directions at once.
Fractional devices let practitioners adjust the density of treatment, meaning the percentage of skin that actually gets vaporized. Settings can range from as low as 5 percent coverage (roughly 196 tiny spots in a 10×10 mm area) up to 25 percent or higher (841 spots in the same area). Lower density means faster healing with less risk; higher density pushes closer to the results of fully ablative treatment. At the highest density settings, the laser effectively becomes fully ablative, though the depth is typically less than with traditional CO2 lasers.
What Recovery Looks Like
Because the CO2 laser removes living tissue, recovery is more involved than with non-ablative treatments. For fully ablative CO2 resurfacing, expect up to two weeks of initial healing. During the first week, the skin forms a crust that gradually falls away. Underneath, the new skin appears pink or red.
That redness is the most universal side effect. In a study of 500 patients, every single one experienced prolonged redness afterward, lasting an average of four and a half months. The pinkness can take two to three months to fade noticeably and up to a full year to resolve completely. Blondes and redheads tend to stay pink longer. During this healing window, the treated skin needs to be protected from sun exposure, and makeup should be avoided until the surface has fully closed.
Risks and Complications
Hyperpigmentation (darkening of the treated skin) is the most common complication beyond redness, appearing in 37 percent of patients in one large study. The rate is significantly higher in people with darker skin tones. For East Asian patients with medium to dark complexions, practitioners often reduce the fractional coverage rate to 15 percent or lower and may prescribe a skin-lightening agent before and after treatment to reduce the risk.
Other complications from that same 500-patient study included acne flares and small white bumps called milia in 10 to 15 percent of patients, and herpes simplex virus outbreaks in 7.4 percent (regardless of whether the patient had a known history of cold sores). More serious problems like scarring, permanent lightening of the skin, and bacterial infections occurred in less than 1 percent of cases.
Skin Tone Considerations
CO2 laser resurfacing works most predictably on lighter skin (Fitzpatrick types I and II). For people with medium to dark skin tones, the risk of post-inflammatory hyperpigmentation rises substantially. Research on East Asian patients found that coverage rates commonly used in lighter-skinned populations (20 to 45 percent) pose a significantly higher risk for darker skin types. Keeping coverage at 15 percent or below offered a better balance between visible results and avoiding pigmentation problems. Pre-treatment with a lightening agent before and after the procedure significantly reduced hyperpigmentation rates in one randomized trial.
This doesn’t mean CO2 lasers can’t be used on darker skin, but the settings, preparation, and post-care protocol need to be adjusted carefully. It’s one of the reasons fractional technology has been so important: the ability to dial down the percentage of treated skin makes the CO2 laser accessible to a wider range of skin types than fully ablative resurfacing ever was.