CO2 laser resurfacing is a treatment that uses a powerful light energy tool used to vaporize damaged skin cells with extreme precision. It is extremely effective in reducing stubborn imperfections including acne scars and wrinkles while stimulating collagen production to help restore a smoother, tighter, and younger-looking result.

Dr. Joseph Michaels is a board-certified plastic surgeon who offers a comprehensive range of aesthetic and reconstructive procedures. He is the vice chair of the Division of Plastic Surgery at Sibley Memorial Hospital and serves as an instructor for residents in the Georgetown University Plastic Surgery Integrated Residency program. With expertise in facial rejuvenation, breast and body contouring, and post-weight loss procedures, Dr. Michaels leads his practice with a focus on advanced, precise techniques.

To learn more about how you can benefit from CO2 laser treatment, call (301) 468-5991 (Rockville), (703) 957-8610 (Fairfax), or schedule a consultation online.

About CO2 Laser Resurfacing

Unlike gentler lasers that only heat tissue beneath the surface, CO2 lasers are ablative. This means that they remove a thin layer of worn-out, damaged skin. This can create a more dramatic, transformative change in a single session than conventional lasers or chemical peels. Because ablative lasers remove the outermost layer of damaged skin for maximum correction, it also requires a longer healing period as fresh skin regenerates.

CO2 laser resurfacing delivers transformative results for patients seeking treatment for delicate areas, including the face, neck, chest, and hands, restoring a refreshed, youthful glow. Recognized as the gold standard in skin rejuvenation, this advanced procedure targets deep-set wrinkles, stubborn acne scarring, and severe sun damage. (1)

How Does a CO2 Laser Work?

CO2 (carbon dioxide) lasers emit a concentrated beam of infrared light that water molecules in your skin cells strongly absorb. This energy instantly vaporizes targeted damaged tissue and generates controlled heat in deeper skin layers to stimulate collagen production. (1) Dr. Michaels can deliver this energy in a fractional pattern, treating a grid of tiny micro-columns while leaving the surrounding tissue intact for faster recovery. (2) Alternatively, he can use a non-fractional, full-field pass that removes the entire surface layer for more dramatic, deeper rejuvenation, but with a longer recovery. Ultimately, both methods create a controlled micro-injury that triggers the body’s rapid healing cycle, causing the skin to shed old cells and build fresh collagen and elastin. This natural healing process helps repair and tighten the skin, resulting in a smoother, healthier, and refreshed appearance.

Benefits

CO2 laser skin resurfacing performed by Dr. Michaels offers numerous benefits, such as: (1)

  • Wrinkle and Fine Line Reduction: Softens deep lines and wrinkles, especially around the eyes and mouth.
  • Acne and Surgical Scar Revision: Breaks down and softens the look of acne and surgical scars while encouraging normal skin regeneration and renewal.
  • Sun Damage and Pigment Correction: Fades sunspots, freckles, and discoloration caused by UV exposure.
  • Boosts Collagen and Elastin: Triggers your body’s natural healing process for long-term firmness and skin tightening.
  • Improved Skin Texture: Refines rough surface texture and minimizes the appearance of enlarged pores.
  • Long-Lasting Results: Delivers transformative improvements that can last for several years, especially with proper maintenance and UV protection.

Candidates

You may be an ideal candidate for CO2 laser treatment if you want to address static wrinkles, especially around the eyes or mouth, sun damage, rough skin texture, or severe acne scars. You may also be a great candidate if you are an adult struggling with stubborn concerns like textural irregularities or age spots that do not respond to basic topicals.

Because CO2 lasers are ablative and remove a layer of skin, Dr. Michaels carefully screens patients for factors that can increase the risk of complications, such as active infections, certain medications, or healing disorders. (2)

Because deeper skin tones produce more melanin, they react strongly to the high heat of a traditional CO2 laser. This heat can trigger an overproduction of pigment, causing long-lasting dark spots known as post-inflammatory hyperpigmentation (PIH). While individuals with darker skin tones are not excluded from receiving treatment, Dr. Michaels may recommend a gentler fractional pattern or alternative treatments to prevent long-term discoloration or dark spots. (2)

Personal Consultation

During your initial consultation with Dr. Michaels, he will get to know you, and you will discuss your personal aesthetic goals together. He will review your medical and skin history, including sun exposure, previous cold sores, and past medications such as Accutane. Dr. Michaels will then perform a comprehensive skin examination to determine whether a full-field or fractional laser is safe. Based on this assessment, Dr. Michaels will then develop a tailored treatment plan designed for your specific needs. To set realistic expectations, he will outline key procedure details, including recovery timeframes, potential risks, and pricing, and address any questions or concerns you may have.

To schedule your personal consultation with Dr. Michaels, call (301) 468-5991 (Rockville), (703) 957-8610 (Fairfax), or contact us online.

Preparation

Properly preparing your skin and schedule for CO2 laser resurfacing helps minimize complications and speed healing. Once your treatment plan is finalized, Dr. Michaels will provide clear, detailed preoperative instructions tailored to your health profile and treatment plan, which typically include: (2)

  • Strict Sun Avoidance: Avoid all direct sun exposure for two to four weeks before your treatment. Wear broad-spectrum SPF 30 to 50 daily to prevent permanent skin discoloration.
  • Discontinue Retinoids and Acids: To protect your skin barrier, stop using all active skincare ingredients, including retinol, tretinoin, glycolic acid, and salicylic acid, 7 to 14 days before your procedure.
  • Take Antiviral Medication: If you have a history of cold sores, start a prescription antiviral, like valacyclovir, before your appointment, as the laser can trigger a severe outbreak.
  • Arrange a Safe Ride Home: Plan for a dependable driver to take you home after the procedure, as you may feel too disoriented to drive safely afterward or may receive oral sedatives for discomfort.

Following Dr. Michaels’s preoperative instructions closely will support the success and safety of treatment.

Procedure

On the day of treatment, Dr. Michaels will numb the treatment area and may use a mild sedative if needed to keep you comfortable throughout the process. He will also typically place specialized, sterile metal shields over your eyes before the laser begins. Dr. Michaels will then move the laser handpiece methodically across the skin, which can cause a hot sensation in the treated area. To counteract this heat and ensure you remain comfortable, he may use a machine that blows cold air onto the skin during the procedure. A full face treatment typically takes about 20 to 30 minutes, but patients should expect to be at the clinic for about 2 hours total. (1)

Immediately after treatment, Dr. Michaels will cool your skin with a soothing rinse and apply a healing ointment. You will then receive clear, detailed post-operative instructions before discharge. Following these instructions closely is essential to achieving optimal results and a safe recovery.

Recovery

CO2 laser skin resurfacing recovery varies for each patient but typically takes one to two weeks for the surface skin barrier to heal while residual pinkness and collagen remodeling can last for several months. During the first three days of recovery, as your skin begins to heal, the treated area will feel swollen, tight, and severely sunburned. By days four to seven, your skin will begin to aggressively flake and peel away, revealing a fresh, pink, and raw new surface layer. (3) With the approval of Dr. Michaels, by day seven, you may begin to use mineral makeup to conceal any irregularities that are still healing. Throughout the second week of recovery, your skin barrier will begin to close and fully heal. By the end of week two, patients generally comfortably return to public activities and light daily routines. During this time, you still may experience some lingering redness or rosiness which will gradually fade. Deep collagen remodeling occurs beneath the skin between three and six months following treatment, with final results developing gradually over time.

By removing damaged surface layers and stimulating deep collagen renewal, CO2 laser resurfacing delivers comprehensive rejuvenation. Patients can experience a noticeable reduction in fine lines, deep-set wrinkles, sun damage, and acne scarring, revealing significantly firmer, smoother, and more evenly toned skin.

Aftercare Tips for a Smoother Recovery

Achieving optimal results and supporting a smooth recovery after CO2 laser resurfacing treatment requires maintaining essential habits at every stage, including: (3)

  • Elevate the Head: During the first few nights of recovery, keep your head elevated to minimize facial swelling.
  • Keep the Skin Moist: Never let the skin dry out, particularly during the first five days. Consistently apply occlusive ointments Dr. Michaels approves, such as Vaseline or Aquaphor.
  • Cleanse Gently: To prevent crust buildup and infection, gently wash or soak the face as directed, often using recommended sterile saline or diluted white vinegar solution, two to five times a day.
  • Do Not Pick the Skin: Let the flakes and crust fall off naturally to avoid permanent scarring or dark spots.
  • Sun Protection: Avoid direct UV exposure and, once the skin barrier is closed, apply a broad-spectrum mineral sunscreen daily to prevent permanent hyperpigmentation and discoloration.
  • Avoid Active Ingredients: Until Dr. Michaels explicitly clears you, do not use retinoids, glycolic acid, vitamin C serums, or mechanical scrubs.

Cost of CO2 Laser Treatments in Maryland and Virginia

The cost of your CO2 laser treatment depends on several factors, including the technique used, the size of the treatment area, the complexity of the area being treated, the number of sessions required, and more. During your personal consultation with Dr. Michaels, you will receive a comprehensive cost breakdown that accurately reflects your treatment plan. For questions about payment and coverage, please refer to our contact page.

FAQ

Can I get Botox or fillers with CO2 laser?

Yes, you can get Botox and fillers with CO2 lasers, but they are generally done at different times rather than together. CO2 lasers can cause intense heat and swelling, so administering injectables at the same time can displace the product or interfere with your skin’s healing process. Dr. Michaels will plan the right timing for you but typically recommends spacing out treatments by one to four weeks to ensure safe, successful results.

When is the best time of year for CO2 lasers?

The best time for CO2 laser resurfacing is typically fall and winter because lower UV levels and shorter days significantly reduce the risk of post-treatment sun damage and hyperpigmentation.

Is CO2 laser the same as CoolPeel?

Both treatments use CO2, but they differ slightly in how they deliver heat and energy intensity. CoolPeel is a gentler laser treatment that targets the skin’s surface with short bursts of energy, while a traditional CO2 laser is stronger and targets deeper skin layers. While the traditional CO2 lasers penetrate deeply into the skin and require one to two weeks of downtime due to intense peeling, CoolPeel offers only about one to three days of recovery time. CoolPeel works best for patients who want to address mild-to-moderate sun damage, fine lines, enlarged pores, and overall skin-tone refreshment. In contrast, traditional CO2 laser resurfacing is ideal for targeting deep wrinkles, severe sun damage, stubborn acne scars, and mild skin laxity.

References

  1. Omi T, Numano K. The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology. Laser Therapy. 2014;23(1):49-60. doi:10.5978/islsm.14-RE-01
  2. Levy T, Lerman I, Waibel J, et al. Expert Consensus on Clinical Recommendations for Fractional Ablative CO2 Laser, in Facial Skin Rejuvenation Treatment. Lasers in Surgery and Medicine. 2024;57(1):15-26. doi:10.1002/lsm.23850
  3. 2026 American Society of Plastic Surgeons. Laser Skin Resurfacing Recovery. American Society of Plastic Surgeons. Accessed October 14, 2026. https://www.plasticsurgery.org/cosmetic-procedures/laser-skin-resurfacing/recovery