CO2 Laser Skin Resurfacing in Los Angeles

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Laser Skin Resurfacing for Acne Scars & Blemish Removal By Dr.Raffy in Santa Monica

Kare Plastic Surgery & Skin Health Center  ·  Santa Monica & Beverly Hills, Los Angeles

Fractional CO2 Laser Resurfacing in Los Angeles

The gold standard for acne scars, deep wrinkles, sun damage, and scar revision — performed by board-certified dermatologist Dr. Tiffany Sierro and board-certified plastic surgeon Dr. Raffy Karamanoukian at Kare Plastic Surgery in Santa Monica

Call (310) 998-5533 Book a Consultation
Dermatology ExpertDr. Tiffany Sierro
Plastic Surgery ExpertDR. rafffy Karamanoukian
30+Laser Platforms On-Site
FullLaser Spectrum — CO2 to No-Downtime
Santa Monica804 7th Street

The Gold Standard in Skin Resurfacing

 

CO2 Laser Resurfacing in Los Angeles: Physician-Level Expertise. Unmatched Technology. Every Skin Concern.

Fractional CO2 laser resurfacing is the most evidence-supported, most technically powerful, and most versatile skin resurfacing technology available in modern dermatology and plastic surgery — the gold standard against which every other skin rejuvenation treatment is measured. For patients in Los Angeles dealing with atrophic acne scars, deep perioral and periorbital wrinkles, significant sun damage accumulated from Southern California’s year-round UV exposure, or surgical and traumatic scars requiring surface improvement, fractional CO2 laser produces transformative results that topical treatments, chemical peels, and non-ablative laser devices simply cannot match.

At Kare Plastic Surgery & Skin Health Center on 7th Street in Santa Monica, fractional CO2 laser resurfacing is performed under the direct supervision of a physician team that combines the diagnostic precision of a board-certified dermatologist with the wound healing expertise of a board-certified plastic surgeon. Board-certified dermatologist Dr. Tiffany Sierro directs the laser selection protocol, patient preparation, and treatment execution — bringing formal dermatologic training in laser-tissue interaction, Fitzpatrick skin typing, and complication management that determines both the safety and efficacy of every resurfacing session. Board-certified plastic surgeon Dr. Raffy Karamanoukian, MD, FACS contributes his expertise in scar biology, wound healing science, and surgical scar revision — making Kare uniquely capable of treating the full spectrum of facial scarring from acne to surgical scars to traumatic injury.

With over 30 laser platforms on-site, Kare offers not just the fractional CO2 laser but the complete resurfacing spectrum — from no-downtime Clear + Brilliant maintenance treatments to fractional Erbium laser for medium-depth resurfacing, Lutronic Thulium laser for pigmentation and texture, and full fractional CO2 for the most significant improvement achievable without surgery. This spectrum of options allows every patient to receive the resurfacing technology appropriate for their specific concern, skin type, and downtime tolerance.

Skin Concerns Treated with CO2 & Fractional Lasers at Kare

  • Atrophic acne scars — boxcar, rolling, icepick, and mixed types
  • Deep perioral wrinkles (smoker’s lines) and periorbital crow’s feet
  • Forehead lines, glabellar rhytides, and neck wrinkles
  • Moderate to severe photoaging and solar lentigines (sun spots)
  • Surgical scars — facelift, eyelid, breast reduction, and tummy tuck scars
  • Traumatic and injury scars on the face and body
  • Stretch marks (striae alba) on face-adjacent and body areas
  • Sebaceous hyperplasia and enlarged oil glands
  • Diffuse uneven skin texture and large pore appearance
  • Post-inflammatory hyperpigmentation and melasma (low-energy settings)
  • Epidermal skin lesions — seborrheic keratoses, syringomas
  • Skin laxity and collagen density reduction from aging

Our Physician Team

 

Dermatologist + Plastic Surgeon: The Only Resurfacing Team That Covers Every Laser & Every Indication

Laser Medicine & Dermatology

Dr. Tiffany Sierro, MD
Board-Certified Dermatologist

Dr. Tiffany Sierro is a board-certified dermatologist whose formal training encompasses medical dermatology, surgical dermatology, dermatopathology, and laser medicine. Her clinical expertise in CO2 laser resurfacing is built on a foundational understanding of laser-tissue physics — how specific wavelengths interact with chromophores in the skin, how energy density and pulse duration determine the depth and character of thermal injury, and how Fitzpatrick skin type determines the risk of post-inflammatory hyperpigmentation at any given parameter setting.

This dermatologic knowledge is what differentiates physician-supervised CO2 laser treatment from aesthetician-administered or non-physician laser procedures. In inexperienced hands, fractional CO2 laser at incorrect settings for a patient’s skin type can cause prolonged erythema, post-inflammatory hyperpigmentation, delayed healing, and in severe cases, permanent scarring — outcomes that Dr. Sierro has seen in patients who seek correction at Kare after adverse events at other Los Angeles laser facilities. Her systematic approach to skin typing, pre-treatment preparation, parameter selection, and post-treatment wound care reflects the standard of care that only formal dermatologic training can provide.

Scar Science & Wound Healing Expertise

Dr. Raffy Karamanoukian, MD, FACS
Board-Certified Plastic Surgeon

Dr. Raffy Karamanoukian is a UCLA-trained, double board-certified plastic and reconstructive surgeon with over two decades of experience in scar management, wound healing science, and surgical skin revision. His expertise in the biology of scar formation — the phases of wound healing, the mechanics of collagen remodeling, the role of growth factors and fibroblast activity in scar maturation — directly informs the multimodal approach to acne scar and surgical scar revision at Kare, where fractional CO2 laser is integrated with subcision, punch excision, dermal fillers, and RF microneedling as components of a comprehensive scar treatment plan rather than a single-modality protocol.

For patients with surgical scars from procedures performed at Kare — facelift, breast surgery, abdominoplasty, and body contouring — Dr. Karamanoukian oversees an integrated post-operative scar management program that incorporates fractional CO2 laser resurfacing after complete wound healing, typically beginning at 3–6 months post-operatively. This surgical-then-laser approach to scar optimization is a distinguishing feature of Kare’s comprehensive skin health program that no standalone laser clinic can replicate.

“CO2 laser resurfacing is the most powerful non-surgical tool we have for acne scars and skin aging — but its power requires physician-level knowledge of laser physics and wound healing to deploy safely. The difference between a good result and an adverse event is the training of the person behind the laser.”

— Dr. Tiffany Sierro, MD & Dr. Raffy Karamanoukian, MD, FACS — Kare Plastic Surgery, Santa Monica

The Science

 

How Fractional CO2 Laser Works: Controlled Ablation, Collagen Remodeling, and Skin Renewal

The carbon dioxide (CO2) laser emits light at a wavelength of 10,600nm — strongly absorbed by water in skin cells, causing rapid heating, vaporization (ablation), and controlled thermal coagulation of the targeted tissue. In fractional delivery mode, the CO2 laser beam is divided into thousands of microscopic columns of energy — called micro-ablative zones (MAZs) or fractional treatment zones (FTZs) — that penetrate the skin to precisely controlled depths (typically 150–400 microns, or deeper for scar treatment) while leaving the intervening, untreated skin columns completely intact.

This fractional approach produces two simultaneous therapeutic effects. First, within the ablative columns, damaged, aging, or scar tissue is thermally vaporized and removed — physically eliminating the acne scar base, the wrinkled epidermal surface, or the dyspigmented solar lentigo. Second, in the thermally coagulated zones surrounding each ablative column, a wound healing cascade is initiated that stimulates fibroblast activity, new collagen synthesis, elastin production, and proteoglycan deposition within the dermis — producing progressive dermal thickening, improved skin elasticity, and surface smoothing that continues for 3–6 months after each treatment session as the collagen remodeling process matures.

The surrounding intact skin columns serve as reservoirs of viable keratinocytes that rapidly re-epithelize the ablated channels, dramatically accelerating healing compared to traditional fully ablative CO2 laser resurfacing — which removes the entire skin surface and required 2–4 weeks of complete wound healing. Fractional CO2 resurfaces the skin while preserving enough intact tissue for rapid recovery, giving patients the collagen-stimulating power of ablative resurfacing with a healing timeline measured in days rather than weeks.

10,600nm wavelength of CO2 laser — strongly absorbed by water in skin cells
7–10Days of social downtime for fractional CO2 resurfacing
3–6 moTimeline to peak collagen remodeling results
1–3Sessions typically needed for significant acne scar improvement

Clinical Indications

 

What Fractional CO2 Laser Treats at Kare Plastic Surgery

Dr. Sierro’s protocol is customized for each indication — the laser settings, depth, density, and number of sessions are selected based on the specific skin concern, its severity, and the patient’s skin type.

01

Acne Scar Revision with CO2 Laser

Atrophic acne scars — the depressed, indented scars that represent the most common long-term sequela of cystic and inflammatory acne — are among the most demanding indications for fractional CO2 laser and the most rewarding when treated correctly. Unlike hypertrophic scars, which are raised, atrophic scars represent a deficit of dermal volume — a structural loss of collagen and subcutaneous tissue that gives the scar its characteristic depression below the surrounding skin surface. Fractional CO2 laser addresses this in two ways: by ablating the sloped, irregular scar wall to smooth the transition between the scar base and the normal skin, and by stimulating new collagen synthesis that progressively fills the scar base and elevates the depressed surface toward the skin level.

Atrophic acne scars are classified by morphology — boxcar scars (sharply defined vertical walls and a flat base, most responsive to fractional CO2), rolling scars (gradual sloping walls from tethering fibrous bands, improved by combining CO2 with subcision), and icepick scars (deep, narrow, V-shaped channels extending into the dermis, best addressed by TCA cross chemical reconstruction or punch excision before or combined with CO2 treatment). Dr. Sierro evaluates each patient’s acne scar morphology at consultation and designs a multimodal protocol — which may combine fractional CO2 with subcision, punch excision, TCA cross, fillers, or RF microneedling — to address every scar subtype systematically.

Best For: Boxcar and rolling atrophic acne scars, Fitzpatrick I–III; combined with subcision for rolling scars, TCA cross for icepick scars; 1–3 sessions for mild-moderate scarring, 3–5 for severe
02

Surgical Scar Revision with CO2 Laser

Surgical scars that have healed with surface irregularity, textural mismatch, hypertrophy, or hypopigmentation relative to the surrounding skin are among the most impactful indications for fractional CO2 laser resurfacing at Kare — and an area where the combined expertise of Dr. Karamanoukian (who performed the original surgery and understands the wound healing trajectory) and Dr. Sierro (who selects the laser parameters for the specific scar characteristics) produces outcomes unavailable elsewhere.

Fractional CO2 laser scar revision is performed at 3–6 months post-operatively, after the scar has completed its active remodeling phase and settled into its mature state. The laser ablates the textural irregularity at the scar surface, stimulates collagen remodeling within the scar tissue, and normalizes the pigmentation boundary between the scar and surrounding skin. Facelift scars, blepharoplasty scars, breast reduction scars, abdominoplasty scars, and rhinoplasty scars all benefit from this approach. For traumatic scars on the face following injury or laceration, Dr. Sierro begins fractional CO2 resurfacing as early as 6–8 weeks after wound closure, exploiting the early scar remodeling window for maximum collagen influence.

Best For: Post-surgical scar surface revision 3–6 months post-operatively; traumatic facial scars 6–8 weeks after wound closure; facelift, eyelid, breast, and abdominoplasty scar texture improvement
03

Fine Line & Superficial Wrinkle Treatment

For fine lines — the superficial epidermal rhytides that represent early photoaging, repetitive facial expression, and declining collagen density — fractional CO2 laser at conservative settings produces dramatic improvement with a single session. The ablative column removes the wrinkled epidermal surface while the collagen-stimulating thermal zone thickens the dermis beneath it, simultaneously eliminating the surface irregularity and rebuilding the dermal scaffold that prevents future lines from forming at the same depth. Fine lines around the eyes (crow’s feet), the upper lip (perioral lines), and the forehead respond particularly well, with most patients achieving 60–80% improvement in line visibility after one session.

The perioral area — the vertical fine lines that develop above the lip and radiate outward, commonly called “smoker’s lines” even in non-smokers — is one of the areas where fractional CO2 laser most significantly outperforms competing technologies including RF microneedling, ultrasound, and non-ablative lasers, because only ablative resurfacing physically removes the wrinkled surface and stimulates collagen at the full depth of the rhytide.

Best For: Perioral and periorbital fine lines; diffuse facial fine rhytides from photoaging; forehead and glabellar texture; single-session significant improvement in Fitzpatrick I–III patients
04

Deep Wrinkle & Advanced Photoaging Treatment

For deeper rhytides — the nasolabial folds, marionette lines, deep forehead furrows, and neck rhytides representing decades of combined UV damage, repetitive muscular activity, and collagen depletion — fractional CO2 laser at higher energy and density settings, or multiple sequential sessions, provides the most significant non-surgical improvement available. Each session produces progressive dermal thickening and surface smoothing, with cumulative results that turn back the clinical clock of photoaging by an estimated 5–10 years of apparent skin age in optimal responders.

Full-face and full-neck fractional CO2 resurfacing — treating not just isolated zones but the complete facial surface — achieves uniformity of skin tone, texture, and reflectance that isolated treatment of individual lines cannot. Many patients who have pursued injectable treatments for deep wrinkles without adequate surface improvement find that combining filler (for volumetric correction) with fractional CO2 (for surface remodeling) produces a more natural, comprehensive result than either treatment alone. Dr. Sierro designs these combination rejuvenation protocols at consultation, sequencing the CO2 laser and injectable treatments appropriately.

Best For: Advanced photoaging with deep rhytides; moderate to severe sun damage; full-face rejuvenation; combination with injectables for comprehensive facial restoration; 1–2 sessions for most patients
05

Sun Damage & Pigmentation Correction

Los Angeles and Santa Monica’s year-round sunshine makes cumulative UV damage — solar lentigines (sun spots), diffuse dyspigmentation, rough texture from chronic photoaging, sallow or gray tone from epidermal derangement, and early actinic keratoses — among the most common resurfacing indications in Dr. Sierro’s practice. Fractional CO2 laser addresses all components of sun damage simultaneously: the ablative action removes the pigmented, dyschromic epidermal surface and the irregular superficial stratum spinosum, while the thermal coagulation stimulates new collagen in the underlying dermis that was progressively depleted by years of UV-induced matrix metalloproteinase activity. The result is simultaneously a pigmentation reset, a texture normalization, and a structural rebuilding of the photodamaged dermis.

For patients with primarily pigmentary concerns and milder texture issues, Dr. Sierro may recommend the Lutronic Thulium laser or Clear + Brilliant rather than full CO2 resurfacing — achieving pigmentation correction with less downtime and a more favorable safety profile for patients with darker Fitzpatrick skin types where aggressive CO2 resurfacing carries a risk of post-inflammatory hyperpigmentation.

Best For: Solar lentigines, diffuse sun damage, uneven skin tone and texture, chronic photoaging, Fitzpatrick I–III for full-power CO2; Lutronic Thulium for pigmentation in Fitzpatrick III–V
06

Skin Quality Enhancement & Collagen Rebuilding

Beyond the treatment of specific lesions or scars, fractional CO2 laser is the most powerful available non-surgical intervention for global skin quality enhancement — rebuilding dermal collagen density, improving skin tone uniformity, reducing pore size, firming lax epidermis, and establishing the luminous, healthy surface texture that reflects well-structured, well-hydrated dermis beneath. For patients who cannot identify a single specific concern but describe generally “looking tired” or finding that their skin has lost its youthful quality and reflectance, a full-face fractional CO2 session addresses the diffuse structural deterioration of photoaging that produces these non-specific but deeply bothersome aesthetic changes.

Because significant collagen production continues for up to 6 months after each fractional CO2 session, the full extent of skin quality improvement is not visible until the collagen remodeling process is complete. Dr. Sierro educates every patient about this timeline at consultation — setting the expectation that the skin will continue to improve progressively after treatment, rather than immediately, and that the best results are typically seen 3–6 months after the last session.

Best For: Global skin quality and collagen rebuilding; diffuse photoaging without dominant single concern; annual or biennial skin renewal treatment; combination with Morpheus8 for simultaneous deep and surface remodeling

The Complete Resurfacing Spectrum

 

Less Invasive Fractional Laser Options at Kare Plastic Surgery

Not every patient needs or wants fractional CO2 laser resurfacing. Kare Plastic Surgery offers the complete resurfacing spectrum — from no-downtime maintenance treatments to full ablative CO2 sessions — allowing Dr. Sierro to match the right technology to each patient’s skin concern, skin type, and life schedule.

Laser Platform Wavelength / Type Downtime Skin Types Best Indication
Fractional CO2 10,600nm Ablative 7–10 Days Fitzpatrick I–III Acne scars, deep wrinkles, surgical scars, severe photoaging
Fractional Erbium 2,940nm Ablative 3–7 Days Fitzpatrick I–IV Fine lines, mild acne scars, skin texture; less thermal injury than CO2
Lutronic Thulium 1,927nm Non-Ablative Fractional 1–3 Days Fitzpatrick I–V Pigmentation, mild texture, tone uniformity; safe for darker skin tones
Clear + Brilliant 1927nm / 1440nm Non-Ablative Zero Downtime Fitzpatrick I–VI Maintenance, mild texture, pore size, early prevention; all skin tones
2,940 nm — Fractional Erbium Laser

Fractional Erbium Laser

The fractional Erbium:YAG laser operates at 2,940nm — the wavelength most strongly absorbed by water in biological tissue — producing precise, shallow ablation with significantly less collateral thermal damage than CO2 laser. This reduced thermal effect means faster healing (3–7 days vs. 7–10 days for CO2), less post-treatment redness, and a wider applicability to patients with moderately darker Fitzpatrick skin types (up to Type IV) who would carry higher risk of post-inflammatory hyperpigmentation with aggressive CO2 settings.

The tradeoff is reduced collagen-stimulating effect: CO2’s greater thermal coagulation produces more pronounced dermal remodeling than Erbium alone. For patients with fine to moderate wrinkles, early acne scarring, and mild-moderate texture concerns who want meaningful improvement with a shorter recovery than CO2, fractional Erbium is Dr. Sierro’s preferred middle-ground resurfacing option. It can also be combined with fractional CO2 in a sequential protocol for patients seeking both the deep coagulation of CO2 and the precise superficial ablation of Erbium in the same session.

1,927 nm — Lutronic Thulium Laser

Lutronic Thulium (ULTRA)

The Lutronic ULTRA Thulium laser delivers non-ablative fractional energy at 1,927nm — a wavelength strongly absorbed by skin water that targets the superficial dermis and epidermis without the full ablation of CO2 or Erbium. This produces meaningful improvements in pigmentation, tone uniformity, superficial texture, pore size, and melasma-related dyschromia with only 1–3 days of mild redness and subtle bronzing rather than the significant downtime of ablative resurfacing.

The Lutronic Thulium’s particular strength is its safety profile for darker skin tones — Fitzpatrick types I through V — making it the preferred pigmentation-targeting resurfacing option for the diverse patient population of the Los Angeles area where patients of South Asian, Middle Eastern, Latino, and other heritage seek skin improvement but cannot safely undergo aggressive CO2 at full settings. Dr. Sierro uses the Lutronic Thulium as a first-line resurfacing option for pigmentation and texture in darker skin types, and as a maintenance treatment between CO2 sessions in lighter-skinned patients.

1,440 nm — Clear + Brilliant Laser

Clear + Brilliant

Clear + Brilliant (Solta Medical) is a non-ablative fractional laser available in two wavelengths — 1440nm (Original) targeting water in the superficial dermis for texture and pore improvement, and 1927nm (Permea) targeting the epidermis for pigmentation and tone. Operating at substantially lower energy than CO2 or Erbium, Clear + Brilliant produces subtle but cumulative improvements in skin quality, reflectance, pore size, and early fine line appearance with literally zero meaningful downtime — mild redness for a few hours, then return to all normal activities including makeup application.

Clear + Brilliant is Dr. Sierro’s recommendation for patients in their late 20s to early 40s who want a preventive skin maintenance program before significant photoaging has occurred; for patients who want periodic skin quality improvement without any recovery disruption to their professional or social schedule; and as a maintenance treatment between CO2 or Erbium sessions to sustain and extend the collagen remodeling achieved with more intensive resurfacing. Multiple sessions (typically 5–6 monthly) are needed to produce results comparable to a single Erbium session, but the zero-downtime profile makes this an accessible entry point to the laser resurfacing program for many patients.

How Dr. Sierro selects your laser: The choice between CO2, Erbium, Lutronic Thulium, and Clear + Brilliant is determined at consultation by three factors: the severity of the skin concern (more significant concerns require more ablative energy), the patient’s Fitzpatrick skin type (darker skin types are directed toward non-ablative or lower-energy options), and the patient’s downtime tolerance (patients who cannot take time from work or social activities are directed to the lower end of the intensity spectrum). No single laser is right for every patient — and the ability to match the laser to the patient’s specific situation is the defining advantage of practicing in a multi-platform facility like Kare Plastic Surgery.

Patient Selection

 

Who Is a Good Candidate for CO2 Laser Resurfacing in Los Angeles?

✓   Ideal Candidates for Fractional CO2 Laser at Kare Plastic Surgery

  • Patients with mild to severe atrophic acne scarring — boxcar, rolling, or mixed morphology — who have been managing their active acne for at least 6 months with clear skin and want to address the structural dermal damage left by prior breakouts
  • Adults with visible photoaging from Southern California UV exposure — solar lentigines, rough surface texture, fine to deep periorbital and perioral wrinkles, sallow tone, and generalized loss of skin luminance — who want meaningful, long-lasting improvement beyond what topical products can achieve
  • Patients with surgical scars that have healed with surface irregularity, textural mismatch, or hypopigmentation — from facelift, eyelid surgery, breast surgery, or body contouring — who want the skin surface quality of the scar improved to match the surrounding skin more closely
  • Those with lighter Fitzpatrick skin types (I–III) who are the most appropriate candidates for full-power fractional CO2 resurfacing and who will achieve the most dramatic and safest results with this technology
  • Patients who have had adequate response to topical skincare programs, chemical peels, or non-ablative lasers but want to escalate to a more effective resurfacing modality for concerns that have not adequately resolved with less aggressive treatments
  • Individuals who can commit to 7–10 days of social downtime and are able to plan their treatment around work and professional obligations — scheduling the procedure when they have a recovery window that does not interfere with critical public-facing commitments
  • Patients who are not currently taking or have not recently taken isotretinoin (Accutane) — isotretinoin use within the past 6–12 months is a contraindication to fractional CO2 laser due to the increased risk of abnormal healing and delayed re-epithelialization
  • Non-smokers or patients who have stopped smoking for a minimum of 4 weeks before treatment — smoking significantly impairs wound healing, increases infection risk, and reduces the quality of the collagen remodeling response that produces long-term results
  • Patients without active cold sore or herpes simplex virus history, or those who can be placed on antiviral prophylaxis before treatment to prevent perioral herpes outbreak triggered by laser trauma to the perioral skin
  • Those with realistic expectations that fractional CO2 laser produces progressive improvement rather than immediate overnight results, and who understand that peak collagen remodeling improvements are visible at 3–6 months after treatment

Learn Why CO2 Laser is the Gold Standard for Acne Scars: Active acne breakouts 

Your Treatment Experience

 

What to Expect: Fractional CO2 Laser at Kare Plastic Surgery in Santa Monica

 

Consultation, Skin Typing & Treatment Planning

Dr. Sierro performs a comprehensive skin examination — evaluating your Fitzpatrick skin type, characterizing your specific skin concerns (acne scar morphology, wrinkle depth, sun damage extent, scar characteristics), and reviewing your medical history for contraindications including prior isotretinoin use, herpes history, active skin conditions, and medications that affect healing or photosensitivity. She designs a personalized treatment plan specifying the laser platform, energy settings, density, and number of sessions recommended, along with a clear projection of expected improvement and timeline.

 

Pre-Treatment Preparation

Patients with Fitzpatrick skin type III–IV may be prescribed a pre-treatment course of topical hydroquinone (4%) and tretinoin (0.025–0.05%) for 4–6 weeks before fractional CO2 laser to suppress melanocyte activity and reduce the risk of post-inflammatory hyperpigmentation. Patients with a history of oral herpes are prescribed oral antiviral prophylaxis (valacyclovir) beginning the day before treatment and continuing for 5–7 days after. Sun avoidance and SPF 50+ sunscreen use are mandatory for 4 weeks before treatment. Patients are advised to stop retinoids 5–7 days before the procedure and to discontinue blood-thinning supplements for one week.

 

Topical Anesthesia & Comfort Protocol

A physician-strength compounded topical numbing cream (BLT: benzocaine, lidocaine, tetracaine or similar) is applied to the treatment area and occluded for 45–60 minutes before laser treatment, producing significant surface anesthesia that substantially reduces discomfort during the procedure. For full-face fractional CO2 resurfacing at higher settings, oral analgesics or anxiolytics may be offered for additional comfort. Protective laser-rated eyewear is provided. The treatment area is cleansed to remove all numbing cream and skincare products before the laser is applied.

 

Laser Treatment Session

Dr. Sierro delivers the fractional CO2 laser in systematic passes across the treatment area, using the parameters selected at consultation for the patient’s specific indication and skin type. For acne scar treatment, higher energy and density settings are used at scar sites, with lower settings at the peri-scar skin for a graduated blending effect. Patients experience a warm, stinging sensation during treatment that is well-controlled by the pre-applied anesthesia. A full-face fractional CO2 treatment typically takes 30–60 minutes. Immediately after treatment, the skin has a bronzed, slightly textured appearance with mild swelling — the characteristic appearance of fractional ablation.

 

Post-Treatment Healing Protocol

A physician-prescribed post-treatment wound care protocol is provided in writing. For the first 24–48 hours, petrolatum-based ointment (Aquaphor or Vaseline) is applied continuously to keep the healing skin moist. Gentle cleansing with tepid water begins on day 2. By days 3–5, bronzing and gentle micro-peeling of the treated columns is expected and should not be disrupted by picking or scrubbing. Mineral-based makeup can typically be applied by day 7–10. Strict sun avoidance and SPF 50+ sunscreen application to all treated areas is mandatory for 3–6 months after treatment, as the remodeling skin is highly susceptible to UV-induced hyperpigmentation during this window.

 

Results Assessment & Maintenance

A follow-up appointment at 4–6 weeks after each session allows Dr. Sierro to evaluate the healing response, assess the degree of improvement in the treated concerns, and determine whether additional sessions are warranted. Collagen remodeling continues for up to 6 months after each session, so the full extent of improvement is assessed at the 3–6 month mark. For acne scars, multiple sessions are typically needed and are scheduled at 6–8 week intervals. For anti-aging and general skin quality maintenance, a single annual or biennial fractional CO2 session, supplemented with quarterly Clear + Brilliant or Lutronic Thulium treatments, constitutes a comprehensive long-term skin health program.

Common Questions

 

Frequently Asked Questions About CO2 Laser Resurfacing in Los Angeles

How effective is fractional CO2 laser for acne scars?

Fractional CO2 laser is the most evidence-supported non-surgical treatment for atrophic acne scars and produces the most significant improvement of any available non-surgical modality for boxcar and rolling scar subtypes. Published clinical data consistently demonstrate 25–75% improvement in scar severity scores after a series of fractional CO2 sessions, with the degree of improvement depending on scar morphology, severity, the energy and density settings used, and the number of treatment sessions completed. Icepick scars — narrow, deep channel scars — respond less well to fractional CO2 alone and benefit from combination with TCA cross or punch excision performed by Dr. Sierro before or concurrently with laser sessions.

What is the downtime after fractional CO2 laser resurfacing?

Fractional CO2 laser requires 7–10 days of social downtime. Immediately after treatment, the skin appears red, swollen, and feels like a significant sunburn. Days 2–4 bring increasing bronzing, tightness, and the beginning of micro-exfoliation as the treated tissue columns shed. By days 7–10, most patients can apply mineral-based makeup and return to social activities, though residual pinkness to redness persists for 2–6 weeks and gradually fades. SPF 50+ application is mandatory throughout the healing period. For patients who cannot afford 7–10 days of downtime, fractional Erbium (3–7 days), Lutronic Thulium (1–3 days), or Clear + Brilliant (no downtime) provide meaningful results with less recovery.

Is fractional CO2 laser safe for darker skin tones?

Standard fractional CO2 laser at full power is generally not recommended for Fitzpatrick skin types V–VI and requires caution in Type IV, because the abundant epidermal melanin in darker skin tones absorbs CO2 laser energy non-selectively, increasing the risk of post-inflammatory hyperpigmentation — paradoxically darkening the skin in treated areas. For patients with darker skin tones, Dr. Sierro redirects to the Lutronic Thulium laser (1,927nm, safe up to Fitzpatrick Type V) or Clear + Brilliant (safe for all skin types), which achieve pigmentation improvement and texture refinement with a significantly more favorable safety profile. Fractional CO2 at reduced settings can be considered for Fitzpatrick Type IV patients with appropriate pre-treatment melanocyte suppression and conservative parameter selection.

How many sessions does fractional CO2 laser take for acne scars?

Most patients with mild to moderate atrophic acne scarring achieve significant improvement with 1–2 fractional CO2 sessions spaced 6–8 weeks apart. Moderate to severe scarring typically requires 2–4 sessions for the maximum achievable non-surgical improvement. Severe boxcar and rolling scar presentations with significant dermal volume loss may benefit from combining fractional CO2 with subcision (mechanical release of fibrous scar bands), TCA cross (chemical reconstruction of icepick scars), or intradermal filler to address the structural component that laser resurfacing alone cannot correct. Dr. Sierro evaluates your specific scar morphology at consultation and provides a realistic session estimate and percentage improvement projection.

What is the difference between fractional CO2 laser and Morpheus8 RF microneedling for acne scars?

Both fractional CO2 laser and Morpheus8 RF microneedling stimulate collagen remodeling and improve acne scar appearance, but through different mechanisms and with different risk profiles. Fractional CO2 ablates the skin surface and stimulates collagen from the outside in, producing superior improvement in scar surface texture, pigmentation, and shallow-to-moderate scar depth — with more downtime (7–10 days). Morpheus8 bypasses the epidermis entirely and delivers RF energy at programmable depths (up to 8mm) from the inside out, making it safer for darker skin tones but less effective for surface texture and pigmentation correction. For maximum acne scar improvement, Dr. Sierro often combines both in a staged protocol: Morpheus8 first for deep dermal remodeling and collagen stimulation, then fractional CO2 for surface refinement several weeks later.

Can I get laser resurfacing if I have a history of keloids?

A history of keloid or hypertrophic scar formation is a relative contraindication to ablative fractional CO2 laser resurfacing, particularly on the chest, jawline, and other high-tension body areas where the risk of laser-induced hypertrophic reaction is highest. Dr. Sierro evaluates each patient’s keloid history carefully, noting the location and type of prior keloid formation, before making a recommendation. Patients with facial keloid history (which is rarer) may still be candidates for conservative fractional CO2 with pre-treatment and post-treatment triamcinolone prophylaxis. Non-ablative alternatives including Lutronic Thulium and Clear + Brilliant carry a significantly lower risk of hypertrophic scar induction and are the preferred approach for keloid-prone patients.

How much does CO2 laser resurfacing cost in Los Angeles?

The cost of fractional CO2 laser resurfacing at Kare Plastic Surgery & Skin Health Center in Santa Monica varies based on the treatment area (full face vs. targeted zones vs. neck and chest), the laser platform selected (CO2 vs. Erbium vs. Lutronic Thulium vs. Clear + Brilliant), the energy and density settings appropriate for the indication, and the number of sessions in the planned series. A personalized cost estimate is provided at consultation once Dr. Sierro has assessed your skin concerns and designed the appropriate treatment plan. Package pricing for multi-session treatment series is available at a more favorable per-session rate than individual treatment pricing. CO2 laser resurfacing is a cosmetic procedure and is not covered by health insurance.

Schedule Your CO2 Laser Resurfacing Consultation in Los Angeles

Whether you are concerned about acne scars, sun damage, wrinkles, or surgical scar texture, Dr. Tiffany Sierro and Dr. Raffy Karamanoukian at Kare Plastic Surgery & Skin Health Center have the physician expertise, the technology platform, and the clinical depth to deliver results that Los Angeles patients cannot find anywhere else. Contact our Santa Monica office today.

(310) 998-5533 Request a Consultation

Kare Plastic Surgery & Skin Health Center  ·  804 7th Street, Santa Monica, CA 90403  ·  (310) 998-5533

Dr. Tiffany Sierro, MD — Board-Certified Dermatologist  ·  Dr. Raffy Karamanoukian, MD, FACS — Board-Certified Plastic Surgeon  ·  30+ Laser Platforms On-Site  RealSelf 100