CO2 Ablative Laser

What Is the CO2 Laser?

The CO2 is an ablative, carbon dioxide laser that delivers high-speed laser pulses at a wavelength of 10,600 nm, targeting both intracellular and extracellular water. Thin layers of the skin are vaporized, creating a controlled injury. As the skin heals, it produces collagen and restores the skin’s elasticity.

What Does the CO2 Laser Treat?

CO2 lasers are used for more aggressive skin resurfacing. They create significant collagen stimulation and treat more severe skin imperfections. Deeper wrinkles, skin laxity, brown/age spots, severe scarring and certain precancerous growths can be addressed with the CO2 laser. It is designed to minimize wrinkles, reduce scarring, even out skin tone, and increase dermal collagen.

Pre-Treatment

• Avoid direct sun exposure and/or artificial tanning products for at 2-4 weeks prior to treatment
• Discontinue photosensitizing topical products 1 week prior to treatment (retinol, glycolyic, salicylic, etc)
• Numbing cream will be applied to treatment area 60 minutes prior to procedure

Post-Treatment

• Expect approximately 1-2 weeks of downtime, which will include redness, swelling, itching, and peeling
• Failure to precisely follow prescribed post-op care instructions can lead to poor healing, complications and scarring

Post-Treatment Phases:

1. Immediately After Treatment (Burning Phase): 

Apply a cold gel/ice pack to your face and keep your face moist. 

After heat has dissipated (may last up to 3 hours), apply Aquaphor/laser balm

2. Day 1-2 (Re-Epithelialization/Crust Formation Phase): 

In the morning and night – cleanse face with Cetaphil gentle cleanser, then reapply Aquaphor/laser balm

Soak with diluted vinegar solution every few hours and then reapply a thin layer of Aquaphor/laser balm 

You will likely look the worst 48 hours after treatment

3. Day 3-6 (Exfoliation Phase):

At least 3 times a day – cleanse with Cetaphil and soak with diluted vinegar solution

Exfoliation/shedding will occur during this phase – don’t pick! 

Can use hypo-allergenic makeup during this period

Apply broad spectrum UVA & UVB sunblock (at least SPF 30) if planning on being outside in the sun

Aquaphor/laser balm no longer needed, but may be applied in areas of dryness

4. Day 7-14 (Final Healing Phase):

Soaking with dilute vinegar solution is no longer necessary

Continue to cleanse daily and use sunblock when outdoors

Makeup may be worn safely now on a daily basis if desired 

Any residual redness and/or itching may continue beyond 14 days and is part of the healing process

Additional Post-Treatment Instructions: 

Elevate your head by 45° using 1 pillow under the small of your back and 2 pillows under your head and shoulders to help reduce any swelling when sleeping. Placing a pillow under each elbow will help you stay in position if desired.

No alcoholic beverages for at least the first 48 hours post-op (longer is better).

 Limit activity for the first 48 hours. During this time do not participate in any strenuous exercise (such as bending, squatting, straining, or heavy lifting) and avoid activities that cause excessive perspiration. No contact sports. The less energy you use for doing things, the more energy your body will have for healing.

If the skin around the mouth is tight, minimize facial expressions until healed.

No hot tubs, jacuzzis, or swimming pools until redness is completely gone. 

You can shower or bathe at any point in time post-operatively but avoid hot showers or baths for the first 24 hours. Preferably take short, warm showers (cool showers may be soothing and help remove heat). If you take a shower during the exfoliation (peeling) phase, avoid running hot water directly on the treated area. A direct forceful stream of water can lead to the exudate being prematurely peeled off leading to scarring. After bathing, gently pat dry the treated area with a soft cloth. Never wipe hard with a towel. Wash your hair everyday with baby shampoo (or other non-irritating shampoo) until completely healed.

Cleanse/Soak/Moisturize. This will help keep the skin moist, will aid in removing any exudate build-up (crusting) and will also allow the topical moisturizers (applied immediately after soaking) to better penetrate the surface of the skin.

Cleanse: Gently wash the treated area with Cetaphil (or equivalent). Lather your hands then pat gently on your skin. Afterwards, softly pat dry your face with a clean towel or washcloth without any rubbing.

Soak:

1. Prepare a water/vinegar solution as follows: Mix 1 teaspoon (5 ml) of plain white vinegar with 1 cup of cool tap water. If this solution stings or burns, dilute vinegar solution by using 1 teaspoon to 2 cups of water. This solution may be mixed ahead of time and put in the refrigerator.
2. Take a clean washcloth or soft gauze and soak it in the water/vinegar solution. Ring out any excess liquid and then lay it over the treated area for 10 to 15 minutes. Do not rub vigorously but using the washcloth you may gently remove (don’t pick) any loose crusting.
3. When done soaking, gently pat the treated area dry with a clean, soft towel. You can’t soak too much. Soaking will reduce redness and speed healing.

Gentle cleaning and soaking with a diluted vinegar solution (which is mildly acidic) will help dissolve any unwanted material from the wounded skin, alleviate pain (soothing), promote healing, and inhibit bacterial growth (especially against pseudomonas and gram negatives). Vinegar has a tonic action that promotes blood circulation in the small capillaries that irrigate the skin. It is also antiseptic, preventing the proliferation of bacteria, viruses, or yeast that triggers infection. It can dissolve excessive fatty deposits at the skin surface, dissolve and cleanse any necrotic material, and reduce scaly or peeling conditions. Lastly, vinegar regulates the pH of the skin.

Moisturize: Re-apply Aquaphor/laser balm for first 2 or 3 days (longer, if needed)