CO2 fractional laser scar revision is a skin resurfacing treatment that uses a 10,600 nm carbon dioxide laser to create thousands of microscopic treatment zones in the skin. Your body repairs those zones by producing new collagen, which gradually softens acne scars, surgical scars, fine lines, and rough texture. Most people need 3 to 6 sessions for acne scarring and should plan for about 5 to 7 days of redness and peeling after each one.
At H Gracefully Laser & Aesthetics on The Queensway in Etobicoke, we use CO2 fractional laser resurfacing as one of our core scar revision treatments. This guide to CO2 fractional laser scar revision explains how it works, which scars respond best, what recovery really looks like, what it costs, and how it compares with other options.
Key Takeaways
- Treats: rolling and boxcar acne scars, surgical scars, fine lines, sun damage, pores, and uneven texture.
- How it works: fractional laser columns trigger collagen remodelling over 3 to 6 months.
- Sessions: 1 for mild texture; 3 to 6, spaced 4 to 8 weeks apart, for deeper acne scars.
- Appointment: about 1 to 1.5 hours, including numbing.
- Downtime: typically 5 to 7 days of redness, swelling, and peeling.
- Cost: $280 per session, with 3-, 6-, and 8-session packages.
- Best for: healthy adults with textural scarring who can avoid sun during healing.
- Deeper skin tones: suitable with a consultation and conservative settings.
What Is CO2 Fractional Laser Resurfacing?
CO2 fractional laser resurfacing is an ablative fractional laser treatment. "Ablative" means it removes (vaporizes) a very thin amount of tissue. "Fractional" means it treats only a fraction of the skin at a time, in a grid of tiny columns, leaving healthy skin between them.
The CO2 laser emits light at a wavelength of 10,600 nanometres, which is strongly absorbed by water. Because skin cells are mostly water, the energy is converted to heat exactly where the beam lands.
The fractional approach, known in dermatology as fractional photothermolysis (first described by Manstein and colleagues in 2004), was a major improvement over older fully ablative CO2 lasers. Those older lasers removed the entire top layer of skin and often required two weeks or more of recovery. Fractional delivery keeps bridges of untouched skin that speed up healing and lower the risk of complications.
How Does CO2 Fractional Laser Scar Revision Work?
CO2 fractional laser scar revision works in three stages:
- Micro-ablation. The laser creates thousands of microscopic channels, called microthermal treatment zones (MTZs), through the epidermis into the dermis. Damaged tissue inside each channel is vaporized.
- Rapid repair. Healthy skin surrounding each channel migrates inward and closes it, usually within a few days. This is why the surface heals faster than with traditional resurfacing.
- Collagen remodelling. Heat around each channel activates fibroblasts, the cells that build collagen and elastin. New collagen keeps forming for 3 to 6 months, so results continue improving long after the peeling ends.
For scars specifically, CO2 fractional laser scar revision also helps break up the rigid, disorganized collagen bands that tether scars down, allowing the skin surface to level out.
Which Scars Respond Best to CO2 Laser?
Not every scar responds the same way. Here is what to expect by scar type:
| Scar type | What it looks like | Response to CO2 laser |
|---|---|---|
| Rolling acne scars | Broad, wave-like depressions with soft edges | Very good especially over a series of sessions |
| Boxcar acne scars | Round or oval depressions with sharp edges | Good for shallow to medium depth |
| Ice pick acne scars | Narrow, deep, pinpoint pits | Limited usually combined with other treatments |
| Surgical & injury scars | Flat, raised, or discoloured lines | Good for texture, thickness, and blending |
| Stretch marks | Streaks of thin, textured skin | Moderate best on newer marks |
| Keloid scars | Thick scars that grow beyond the wound | Not first-line requires medical assessment |
Acne scarring is very common. One frequently cited UK study (Layton and colleagues, 1994) found some degree of facial scarring in the large majority of acne patients examined, which is why scar revision is one of the most requested treatments at our clinic.
Beyond scars, CO2 resurfacing also improves:
- Fine lines and wrinkles, especially around the eyes and mouth
- Sun damage and uneven tone from years of UV exposure
- Enlarged pores and rough texture
- Skin laxity, through gradual collagen tightening
Who Is a Good Candidate for CO2 Fractional Laser Scar Revision?
You may be a good candidate if you:
- Have scarring, fine lines, or sun damage that facials and topicals haven't improved
- Have no active breakouts or skin infections in the area
- Can avoid direct sun for several weeks while healing
- Expect significant improvement, not complete erasure
Postpone or discuss alternatives if you:
- Are pregnant or breastfeeding
- Have taken isotretinoin (Accutane) recently
- Have an active cold sore, infection, or open wound
- Have a history of keloid scarring
- Have a recent tan or sunburn
Is CO2 laser safe for darker skin tones?
CO2 laser can be used on a wide range of skin tones, but darker skin (Fitzpatrick types IV to VI) has a higher risk of post-inflammatory hyperpigmentation (PIH), meaning temporary dark patches after treatment. At H Gracefully, we reduce this risk by assessing your skin type at consultation, adjusting energy and density settings, recommending skin preparation beforehand, and in some cases suggesting gentler alternatives first.
CO2 Laser vs. Other Skin Resurfacing Treatments
| CO2 Fractional | Jet Plasma | Radio Frequency | Diamond Dermabrasion | |
|---|---|---|---|---|
| Best for | Acne scars, deep texture, wrinkles | Fine lines, mild texture, tightening | Mild laxity, maintenance | Dullness, surface texture |
| Depth | Epidermis to deep dermis | Epidermis to upper dermis | Dermis (heat, no ablation) | Outer epidermis |
| Downtime | 5 to 7 days | A few days | Little to none | None |
| Collagen stimulation | High | Moderate | Moderate | Low |
| Suits deep scars? | Yes | Partially | No | No |
Bottom line: for deep or long-standing scarring, CO2 fractional laser delivers the most change per session. If you can't take a week of downtime, a lighter treatment series may suit you better, with more modest results.
What to Expect: Before, During, and After Treatment
Before your appointment
- 2 weeks before: avoid tanning, sunbeds, self-tanner, and direct sun on the treatment area.
- About 5 to 7 days before: pause retinoids (retinol, tretinoin), glycolic or salicylic acids, and other exfoliants unless we advise otherwise.
- If you get cold sores: tell us at consultation. Your doctor may recommend preventive antiviral medication.
- On the day: arrive with clean skin and no makeup.
During the procedure
Your appointment takes about 1 to 1.5 hours:
- Double cleanse to prepare the skin.
- Topical numbing cream applied and left to take effect.
- Laser treatment, about 20 to 40 minutes for a full face. Most clients describe a warm, prickling sensation and hear a light crackling sound.
- Aftercare: healing serums and a cooling mask to calm the skin.
Recovery timeline: day by day
| When | What your skin looks like | What to do |
|---|---|---|
| Days 1–2 | Red, warm, and swollen, like a moderate sunburn | Keep moisturized with the recommended healing balm; sleep slightly elevated |
| Days 3–5 | Tight, dry, bronzed, and starting to flake | Let skin shed naturally; do not pick or scrub |
| Days 6–7 | Most peeling finished; pink and smoother | Mineral makeup is usually fine once skin is fully closed |
| Weeks 2–4 | Pinkness fades gradually | Daily SPF 30+; resume gentle products as advised |
| Months 1–6 | Collagen keeps building; scars continue to soften | Book your next session as planned |
Contact the clinic if you notice: increasing pain, yellow crusting, blisters, or fever, which can be signs of infection.
Sun protection is essential. Freshly resurfaced skin burns easily and is prone to pigmentation. Use a broad-spectrum SPF 30 or higher every day, even on cloudy Toronto days.
How Many CO2 Fractional Laser Scar Revision Sessions Will I Need?
| Concern | Typical sessions |
|---|---|
| Mild texture, dullness, fine lines | 1 to 2 |
| Moderate acne scarring | 3 to 4 |
| Deep rolling or boxcar acne scars | 4 to 6 |
| Surgical scars | 2 to 4, depending on age and thickness |
Sessions are usually spaced 4 to 8 weeks apart so the skin can heal and collagen can rebuild between treatments. Your practitioner will confirm your CO2 fractional laser scar revision plan at consultation.
How Much Does CO2 Fractional Laser Scar Revision Cost in Etobicoke?
Current CO2 fractional laser scar revision pricing at H Gracefully Laser & Aesthetics:
First-time clients receive 20% off any single treatment or package, and in-house financing is available. See our current promotions or the CO2 fractional laser service page for the latest pricing.
Frequently Asked Questions
Does CO2 laser get rid of acne scars permanently?
CO2 fractional laser permanently remodels the treated collagen, so improvement in scar depth is long-lasting. However, most scars are significantly reduced rather than completely erased. Aging and new breakouts can affect skin over time, so good skincare and sun protection help maintain results.
How long does CO2 laser recovery take?
Most people have 5 to 7 days of visible redness and peeling. Mild pinkness can last 2 to 4 weeks. Many clients return to work after about a week.
Does CO2 laser hurt?
With topical numbing cream, most clients rate the discomfort as mild to moderate, describing a hot, prickling sensation. The skin can feel like a sunburn for a day or two afterward.
When will I see results from CO2 laser?
You will see smoother, brighter skin once peeling ends, around day 7. Scar improvement builds gradually as new collagen forms, with the best results visible 3 to 6 months after your final session.
How many CO2 laser sessions do I need for acne scars?
Deeper rolling and boxcar acne scars usually need 3 to 6 sessions spaced 4 to 8 weeks apart. Milder texture may improve noticeably after a single session.
Is CO2 laser safe for all skin types?
CO2 laser can treat many skin tones, but darker skin carries a higher risk of temporary hyperpigmentation. A consultation lets our team assess your skin, adjust settings, and recommend preparation or alternatives.
How much does CO2 laser cost in Toronto?
At H Gracefully in Etobicoke, a single CO2 fractional laser session is $280, with package pricing from $770 for 3 sessions. New clients receive 20% off their first treatment or package.
Can I combine CO2 laser with other treatments?
Yes, once your skin has healed. Many clients pair resurfacing with cosmetic injectables for volume or wrinkles, or with gentler facials between laser sessions. Your practitioner will advise on safe timing.
What should I avoid after CO2 laser treatment?
For at least one to two weeks, avoid direct sun, heavy sweating, swimming pools, saunas, makeup on unhealed skin, exfoliants, and retinoids. Never pick or peel flaking skin.
Book Your CO2 Fractional Laser Scar Revision Consultation
Every scar is different. Book a CO2 fractional laser scar revision consultation and our team will assess your skin and recommend a treatment plan built for you.
Please review our clinic policies before your visit. This article is for general education and is not a substitute for an individual assessment. Results vary from person to person.
Further reading: American Academy of Dermatology: Acne scars, consultation and treatment · AAD: 10 things to know before laser treatment for a scar · DermNet: Fractional laser treatment · Manstein D. et al., "Fractional photothermolysis," Lasers in Surgery and Medicine, 2004.
