CO2 lasers and fractional lasers for skin rejuvenation
The fractional CO2 laser is the benchmark when skin is to be truly renewed: for acne scars, surgical scars, wrinkles, enlarged pores and stretch marks. Here you will find clear answers to the questions asked before a treatment or before buying a device, from the mode of action, downtime, pain and number of sessions through to aftercare.
We also explain when a non-ablative laser is the better choice. SIACSKIN offers two devices for this: the FRACO CO2 XL as an ablative fractional CO2 laser with a gentle CoolPeel mode, and the TULIX with thulium (1927 nm) and erbium glass (1550 nm) for skin rejuvenation with little downtime.
How does a fractional CO2 laser work and what happens in the skin?
A fractional CO2 laser uses infrared light at 10,600 nm to vaporise tiny columns of tissue from the skin and leaves the skin in between intact. This wavelength is very strongly absorbed by water. Because skin consists predominantly of water, the tissue at each laser point is ablated abruptly and the edge of the column is heated in a controlled way. Starting from the intact bridges of skin, the microchannels close within a few days. In the months that follow, the skin builds new collagen and reorganises the existing collagen.
The FRACO CO2 XL from SIACSKIN is such an ablative fractional CO2 laser with a 100 W RF source. Its pulse width ranges from 0.1 to 100 ms and the spot extends up to 20 × 20 mm. Short pulses mainly ablate, while longer ones bring more heat and thus more tightening to the deeper layers.
Ablative or non-ablative: what is the difference between CO2 lasers and thulium and erbium glass lasers?
The CO2 laser ablates tissue, whereas thulium and erbium glass lasers only heat it and leave the skin surface intact. Ablative means: fine open channels are created, the effect on deep wrinkles and scars is strong and healing takes days. Non-ablative lasers create purely thermal columns. Thulium at 1927 nm acts superficially in the epidermis and refines the complexion, while erbium glass at 1550 nm reaches into the dermis and stimulates collagen there. Afterwards the skin is red and rough, but not raw. In return, more sessions are usually needed.
At SIACSKIN, the FRACO CO2 XL is the ablative device. The TULIX combines thulium and erbium glass, which can be used individually or together, and is intended as a complement to the FRACO CO2 XL: for everyone who can afford hardly any downtime.
Yes, the fractional CO2 laser is one of the most effective methods for depressed acne scars. It ablates the hard scar edges point by point and triggers new collagen formation at depth, which raises the base of the scar. Shallow, undulating and boxcar scars respond best, very narrow, deep scars only partially. What is realistic is a marked smoothing over several sessions, not flawless skin. Inflammatory acne should have subsided beforehand.
Scar treatment and resurfacing are core applications of the FRACO CO2 XL. For milder scars, or when 1 to 2 weeks of downtime are not feasible, the non-ablative TULIX is a good option: its erbium glass laser at 1550 nm works in the dermis, in other words where the scar tissue sits.
Can surgical scars be treated with a laser and when does it make sense to start?
Yes, surgical scars can be made flatter, softer and less conspicuous with fractional lasers, but they will not disappear completely. The laser breaks up the disorganised, rigid scar collagen, and the skin replaces it with more supple tissue. It makes sense to start as soon as the wound is fully closed and resilient, usually a few weeks after the operation. Young, still reddish scars respond the fastest, while old white scars need more sessions. Raised, thickened scars and keloids should be assessed by a doctor beforehand.
The FRACO CO2 XL is designed for scar treatment and is the right fit when the scar is depressed or hardened. The TULIX also lists surgical scars as an application and is the gentler, non-ablative option with little downtime.
Fractional lasers that stimulate new collagen in the dermis help with stretch marks: non-ablative lasers at around 1550 nm and fractional CO2 lasers. Stretch marks are fine tears in the connective tissue, so essentially scars. Fresh, reddish marks respond considerably better than old, whitish ones. What is realistic is that the marks become narrower, flatter and less conspicuous in colour. They seldom disappear completely. The usual course is 3 to 5 sessions at intervals of 4 to 6 weeks.
The TULIX explicitly names stretch marks as an application. Its erbium glass laser at 1550 nm acts in the dermis, and thanks to the short downtime even large areas such as the abdomen or hips can be scheduled easily. For older, depressed marks, the FRACO CO2 XL is an option as an ablative scar treatment.
How well does the CO2 laser work on wrinkles, lax skin and large pores?
The fractional CO2 laser is most effective on fine to moderately deep wrinkles and enlarged pores, and it delivers tightening to a limited extent. The heat makes existing collagen fibres contract immediately, and new collagen forms over 3 to 6 months. The skin becomes denser and smoother, and pores look smaller because their edges become firmer. Expression lines, which are caused by muscle pull, and a true descent of the tissue cannot be corrected with it.
Resurfacing, wrinkles and pores are among the applications of the FRACO CO2 XL. If redness and dilated thread veins are more of a concern than skin texture, light is the more suitable tool: the DERMAFORCE BBL PRO works with BroadBand Light instead of laser and is intended for skin types I to IV.
Which skin types is a fractional CO2 laser suitable for?
The ablative CO2 laser is most straightforward on the fair skin types I to III. On darker skin types it is possible, but requires conservative settings. The laser targets water, not pigment. The risk lies in the healing: the more melanin the skin produces, the more likely it is to respond to the inflammation with dark marks. Lower density, less energy, a test patch and consistent sun protection reduce this risk considerably.
SIACSKIN specifies the FRACO CO2 XL for all skin types. For skin types IV to VI, the non-ablative TULIX, likewise designed for all skin types, is often the more sensible starting point: the skin surface remains intact and the inflammatory reaction is milder.
Can the eyelids and neck be treated with a CO2 laser?
Yes, the eyelids and neck can be treated with the fractional CO2 laser, albeit with considerably less energy and density than the cheeks or forehead. Eyelid skin is very thin and responds well: fine crinkly lines are smoothed and slightly lax eyelid skin contracts. Protective eye shields are mandatory here. The neck has fewer sebaceous glands, from which healing proceeds. It regenerates more slowly and does not forgive settings that are too strong. Marked excess skin or fat pads on the eyelid can only be corrected by surgery.
With the FRACO CO2 XL, the heat delivery can be finely dosed via pulse widths from 0.1 ms, which is decisive in these sensitive areas. Those who want to start cautiously on the neck begin non-ablatively with the TULIX.
What is CoolPeel and how does it differ from classic CO2 laser treatment?
CoolPeel is a gentle mode of the fractional CO2 laser that works with very short pulses and therefore leaves only a little heat behind in the surrounding tissue. The surface is finely ablated and the thermal zone beneath it stays small. That means less swelling and a shorter healing time, but also less effect at depth per session. The mode is suited to skin refreshing, fine lines, pores and an uneven complexion. For deep wrinkles and pronounced scars, the classic setting remains the stronger choice.
On the FRACO CO2 XL, CoolPeel, also known as Weekend CO2, shortens healing from 10 to 14 days to 3 to 4 days according to SIACSKIN, provided suitable aftercare follows. Both variants run on the same device, and you decide according to the findings and the appointment diary.
How does intimate rejuvenation with the CO2 laser work?
In intimate rejuvenation, a slim gynaecological applicator delivers fractional CO2 laser pulses all round to the vaginal mucosa. The fine micro-injuries stimulate blood circulation and collagen formation. The aim is a thicker, more elastic and better-hydrated mucosa. The procedure is used above all for dryness and declining firmness after childbirth or during the menopause. Three sessions at intervals of 4 to 6 weeks are usual, and each takes only a few minutes. A gynaecological examination should take place beforehand.
For the FRACO CO2 XL there is a gynaecological applicator, the Femininlift, so that one device covers skin rejuvenation and intimate treatment. Who may carry out which treatment is regulated differently from country to country.
How long is the downtime after CO2 laser treatment?
After a classic fractional CO2 laser treatment, you should expect 1 to 2 weeks of downtime. In the first 2 to 3 days the skin is very red, swollen and burns as it does after sunburn. Fine brownish crusts then form, which usually come away by the end of the first week. What remains is pink skin that can be covered with make-up. The redness can persist for a few more weeks. The neck and body heal more slowly than the face.
For the FRACO CO2 XL, SIACSKIN states 10 to 14 days with the classic setting and 3 to 4 days in CoolPeel mode. Those who want almost no downtime at all are better served by the non-ablative TULIX and plan more sessions in return.
How many sessions do you need with a fractional CO2 laser?
For skin rejuvenation, 1 to 3 sessions are usually enough, and for scars it is more like 3 to 5. There are generally 4 to 8 weeks between appointments, or even three months after very intensive treatments. Collagen remodelling continues for 3 to 6 months. It is therefore worth waiting for the result before the next session is fixed. The gentler the setting, the more appointments: gentle treatments are often planned as a course of 3 to 4 sessions at monthly intervals.
The FRACO CO2 XL covers both routes, the one powerful session with longer healing as well as the CoolPeel course. With non-ablative lasers such as the TULIX, 3 to 5 sessions are usual.
Does CO2 laser treatment hurt and do you need a numbing cream?
Yes, without anaesthesia the fractional CO2 laser is clearly felt, which is why a numbing cream is almost always used. The cream is left on for 30 to 60 minutes and removed thoroughly before lasering. The pulses then feel like short, hot pinpricks. Afterwards the skin burns for 1 to 3 hours as with sunburn. Cold air during and after the treatment takes away much of this. With very intensive settings, local anaesthesia is additionally given in the medical practice.
In the CoolPeel mode of the FRACO CO2 XL, less heat reaches the tissue, and the treatment is accordingly perceived as milder. The KYROMASTER is a good fit for cooling: it cools the skin with cold air down to minus 50 °C before, during and after the session and is suitable for CO2 lasers.
How do you care for the skin after a CO2 laser and when can you go back in the sun?
After the CO2 laser the rule is: keep the skin clean and moist, do not scratch anything off and avoid direct sun for at least four weeks. In the first few days the skin is cleansed only with lukewarm water or a very mild product, and a protective, low-irritant skincare product is applied several times a day. Make-up only once the skin has closed, usually after about a week. Sauna, swimming pool and sport are paused for 1 to 2 weeks, and retinol, acids and exfoliants for around four weeks. After that, sun protection factor 50 daily for at least three months.
SIACSKIN has its own aftercare products, including the Sensitive Cream and the Suncream Sensitiv SPF50. The short healing time in the CoolPeel mode of the FRACO CO2 XL explicitly presupposes suitable aftercare. The exact sequence is set out in the aftercare guide.
Can the CO2 laser be combined with other treatments?
Yes, the CO2 laser combines well, as a rule staggered over time and not on the same day. The basic rule: the skin must be fully healed before the next treatment follows, so usually after four weeks at the earliest. Non-ablative lasers between two CO2 sessions have proved their worth for maintaining the result, as has RF microneedling when tightening at depth is also wanted. Light treatments for redness belong before the CO2 session, not on freshly lasered skin.
At SIACSKIN, the TULIX is explicitly intended as a complement to the FRACO CO2 XL. For tightening from within, RF microneedling with the EUPHEUS M8 is added. The result is a treatment plan that covers both surface and depth.
