CO2 laser - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about CO2 laser or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
CO2 Laser
Overview: A carbon dioxide laser delivers accurate removal of skin layers and is the gold standard for resurfacing and skin tightening. This is the only device on the market that can deliver results of a face lift when you do not want to undergo surgery. This laser is also the ultimate device to treat acne scars.
Expected results: Removal of fine, intermediate and deep lines, maximum skin tightening, evening out of pigmentation, removal of brown spots (sun spots), correction of acne and other scars
Preparation: Vigorous regimen of daily sunscreens and night time retinoids for several months, no alcohol and aspirin for 2 weeks prior to the procedure, vitamin C 1000 mg daily starting 2 weeks prior to the treatment. Topical anesthetics will be applied in the office one hour prior to the procedure, facial nerve blocks are performed as needed for added pain control.
Post treatment instructions: Rigorous sun avoidance/protection for 3 months, refrain from alcohol consumption for 2 weeks after the treatment, avoid aspirin for 10 days, continue vitamin C 1000 mg daily for 3 months. Skin care in the immediate postoperative period includes the use of a very gentle non-soap cleanser, petrolatum or bio-occlusive dressing until skin renewal sets in (3-6 days), oral medications to prevent herpes reactivation and bacterial super infection. The hours following the treatment, ice should be applied for fifteen minutes every hour. That night, avoid sleeping face down to avoid swelling. Topical retinoids can be resumed when scabbing subsides (1-2 weeks after treatment).
Time to desired results: Up to 2 weeks for skin renewal, up to 6 months for skin tightening (maximum collagen production).
Duration of desired effects: Lines may recur within 10 years. This treatment can be paired with Botox injections in order to extend results. Acne scar removal is permanent. Note: Deep, pitted scars may require surgical intervention (punch grafts) prior to the procedure or fillers afterwards. One treatment is usually sufficient to achieve these results.
Contraindications: History of phenol peel, isotretinoin (Accutane) in the past 12 months, coumadin or other blood thinners, recent tan. This treatment is highly efficient in fair skin types and is usually restricted to the face.
Downtime: 7-14 days for skin renewal, gradually diminishing pinkishness for about 3-4 months
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I have smoker’s lines around my mouth and melasma. I had seen an esthetician and I am more interested in co2 resurfacing. What do you suggest?
Melasma will likely worsen with CO2 laser treatment or any laser treatment that creates heat. In this context, filler treatment is an option that does not worsen melasma. Please eek proper consultation with a experienced injector to check if the depth of your lip wrinkles lend themselves to filler treatment without causing a heavy upper lip.
I was burned by an nd Yag laser around my nose. The burns blistered and caused small atrophic scars and hypopigmentation (I lost pigment). The scars are 3 years old and I am a Fitzpatrick 2. I have tried microneedling, Morpheus8, and several non-ablative laser treatments and none have made a difference. I was told by a plastic surgeon that my only option to improve these scars is co2 laser. Can you help?
A known side effect of Nd:YAG laser treatment on the side of the nose are permanent dimples. These cannot be improved by any current laser or energy based device. Flat or raised scars often improve with several fractionated ablative and non-ablative laser treatments.
Do you do CO2 mole removal? I have an isolated skin colored, slightly raised mole in my cheek. What is the avg cost?
Mole removal is best carried out with a knife, whether for flush removal in skin level when a mole is elevated or for excision of a flat mole. The CO2 laser is advantageous for cutting when significant bleeding is expected, because its heat can stop the oozing during the cutting process. The CO2 laser is typically used to cut areas larger than the average mole. Nowadays, CO2 laser treatment (not excision) can be added within the first 3 weeks of surgery and 3 months later to prevent or minimize scar formation.
The cost of mole removal depends on its size, its location, and the type of removal (shave removal vs full excision) that is appropriate to achieve the best aesthetic outcome. It can range from $125 for shave removal on the trunk or extremities of a mole smaller than a pencil eraser to over $1100 for excision and repair of a large birthmark on the face. Scar prevention carries a flat fee of $375.
I recommend in-person consultation so that we can determine the procedure that is most appropriate for your mole, the site specific healing, and pricing of removal.
Hello
Is the ablative laser done in a surgical setting? What type of anesthesia is administered? Is it done by a doctor?
I perform full ablation only in small areas of the face such as for perioral rhytids, for rhinophyma reduction, and for superficial skin cancers. I use regional local anesthesia but not general anesthesia and perform this procedure in the office.
Can Fractional CO2 laser for used on other areas besides the face? For example arms and the backs of hands? Not to remove spots…..but to tighten the skin and remove fine wrinkles
Fractionated CO2 lasers could be used in these areas if no other technology was available. Other modalities, such as non-ablative fractionted resurfacing and Infini, achieve the same and are much safer.
I’m an African American woman with what I believe are ice pick scars on my cheeks. I’ve been dealing with this scarring for almost 19 years and would love to know if there’s an answer to my problem. I’ve been told Fraxel laser would work best for my skin. I’m nervous about additional scarring from this procedure and if the staff has experience with African American skin.
Thank you.
I believe that from our pictures you can tell that we treat scars, including facial acne scars, on people with all skin colors. However, there are indeed less options to treat ice pick scars if skin is darker than olive in color. FRAXEL can work to tighten these ice pick scars by about 40%. The original FRAXEL would take about 8 treatments to do so. With the improved version FRAXEL-repair, which is a CO2 laser with FRAXEL, this is reduced to about 3-6 treatments. In our practice, we use the Picosure laser or the Ultra Pulse DeepFX CO2 laser for ice pick scars on dark skin. The latter has been the flagship of all CO2 lasers and has been on the market longer than the FRAXEL-repair. The Picosure is a color blind laser that does not open the skin and repairs scars through a super fast pressure wave into the skin. Four to six treatments of either or their combinations will tighten ice pick scars by about 50%.
Will the Co2 laser decrease my wrinkles on my cheeks and around my mouth. What is the approximate cost of this procedure?
Thank you
Fractionated full face laser resurfacing with the CO2 laser will reduce skin laxity, stimulate collagen production and smooth fine lines including the ones on the upper and lower lip. It will generally reduce the depths of many types off wrinkles although dynamic lines that are created by repeated muscle movement will not fully go away. The cost of CO2 laser treatment is $3000. Most people will need only a single treatment and results will last 7-10 years. The same results can be achieved with about 3 Infini treatments. The latter is based on fractionated radiofrequency which does not heat the uppermost layer of the skin, the epidermis. Therefore the downtime is by far less than that with the CO2 laser. Infini treatments can be performed as early as 6 weeks apart. The cost for each Infni treatment of the face $1200. In order to find out if these procedures are for you, please set up a cosmetic consultation with me. If after reading about Infini, you might be more inclined to have Infini, you may consult with my aestheticians. The consultation with our aestheticians is complimentary whereas there is a nominal fee for consultation with our dermatologiosts
I have syringoma under my eyes – my dermatologist said that the only treatment he feels really makes a big improve my to this condition is Co2 laser therapy. He sent me to another dermatologist in the city who used a regular laser. I’ve only had one eye done (approximately 20 syringoma) with minimal effectiveness. Do you treat this condition and if so, what can I expect in results and price? I have very fair skin.
CO2 laser treatment is indeed the best treatment for syringoma under the eyes, however, it only eradicates 50-60% of all syringoma in as single treatment. The treatment can be repeated for better results. The charge is $1000 per treatment.
hi Dr. Ringpfeil,
I would like to know how many treatment for syringoma have you done using the Co2 laser. I know dermatologist who uses CO2 laser, but have not use it to treat syringoma.
Thank you!
Among all CO2 treatments, syringoma treatment is indeed less often performed due to its limited success rate. About 50% of syringoma are too deep for any currently available laser to reach and destroy them without leaving scars. Treatment by excision is most often successful but in contrast to the CO2 laser, it leaves minute scars behind. On average, I perform one CO2 laser treatment for syringoma per month.
is the co2 laser you use fractional or the traditional co2? can you please explain the difference and which one would be more recommeneded for acne scars? i have only on both sides of cheeks. would price be different if just targeting cheeks as opposed to full face? or do you recommend full face when addressing acne scarring?
The CO2 laser that we operate in the office is the Lumenis Ultrapulse Encore that allows us to operate in any mode that is appropriate for the task, namely fractional or fully ablative. Acne scar spot treatment is performed in a fractional mode. On the website price list we differentiate between skin resurfacing and acne scar treatment. Treatment of more than 10 acne scars, no matter where they are located, incurs a fee of $500 per treatment.
So if I am understanding info contained in a previous post, enlarged pores can only be improved by 30% at best? On the chart of treatment options I thought the “+++” was indicating very good results. Would a second treatment perhaps increase the total percentage improvement to 60%? In looking at the DeepFX photos I actually think the photo of the DeepFX shows larger pores in the “after” photo.
And what about icepick scars. Can you give me an estimate on the percentage of improvement I could expect to realize from their treatment with your laser recommendation?
Thank-you so much-Becky
Enlarged pores can be targeted by glycolic acid products or peels, photodynamic therapy and CO2 laser. Increasing the number of treatments can reduce the size of the pores more but it is not as linear as thinking about 60% reduction in pore size after 2 CO2 laser treatments. While many with large pores can appreciate their reduction in size, pores cannot yet be eradicated.
Ice pick scars reduce by about 50% with acne scar spot treatments, which means their diameter improves. There is no technology yet that removes scars. Most people do really well with up to 6 treatments every 3 months (currently $500 for each treatment).
Can you spot treat with CO2 laser? I have 4-5 isolated shallow scars on my cheeks. Thanks.
CO2 laser works great for spot treatment of scars.
For CO2 spot treatments, what is the risk for hypopigmentation? Thanks.
Spot treatment is carried out in a fractional manner just like resurfacing.This eliminates hypo-pigmentation which was the biggest side effect of fully ablative (not fractional) CO2 treatments.