Ablative Fractional Lasers

Compare To Other Treatments

What Is It?

Ablative fractional lasers attempt to reduce the size of raised scars by shining an intense beam of light on the scar in a dot-matrix (imagine tiny polka dots) pattern, which completely removes (ablates) the skin in this dot-matrix pattern, leaving some of the skin intact. 

Zapping away the old, damaged skin leaves a new scar behind. The newly formed scar is smaller than the old one and contains less collagen.

This treatment is normally repeated multiple times (4 times or more) in 2 to 8-week intervals. You should see gradual results with each session. After your last session, your scar(s) should continue to improve over time. However, in some cases, scars may grow back after treatment.

Scar Height Reduction

Strength of Evidence
1
2
3
4
5
Average 20% reduction in scarring

Mean improvement in VSS total score

Strength of Evidence
1
2
3
4
5
Average 50% reduction in scarring

Mean improvement in VSS pigmentation score

Strength of Evidence
1
2
3
4
5
Average 37% reduction in scarring

Mean improvement in VSS height score

Strength of Evidence
1
2
3
4
5
Average 50% reduction in scarring

Mean improvement in VSS pliability score

Strength of Evidence
1
2
3
4
5
Average 47% reduction in scarring

Mean improvement in VSS vascularity score

Strength of Evidence
1
2
3
4
5
Average 54% reduction in scarring
▸ Based on These Clinical Studies & Trials
▾ Based on These Clinical Studies & Trials
  1. Won, T. et al. The efficacy and safety of low‐energy carbon dioxide fractional laser use in the treatment of early‐stage pediatric hypertrophic scars: A prospective, randomized, split‐scar study. Lasers Surg Med 54, 230–236 (2022).
  2. Elazhary, E., Abd Al-Salam, F., Abd El-Hafiz, H. & Maghraby, H. Fractional carbon dioxide (CO₂) laser alone versus fractional CO₂ laser combined with triamcinolone acetonide or tricholoroacetic acid in keloid treatment: A comparative clinical & radiological study. Dermatol Pract Concept e2022072 (2022) doi:10.5826/dpc.1202a72.
  3. El-Azhary, E., Al-Salam, F. A., El-Hafiz, H. A. & Maghraby, H. Fractional carbon dioxide (CO₂) laser alone versus fractional CO₂ laser combined with triamcinolone acetonide or tricholoroacetic acid in keloid treatment: A comparative clinical & radiological study. Dermatology Practical & Conceptual e2022072–e2022072 (2022) doi:10.5826/dpc.1202a72.
  4. Cox, C. et al. CO2 laser resurfacing for burn and traumatic scars of the hand and upper extremity. Scars, Burns & Healing 8, 205951312110476 (2022).
  5. Cooper, L. E. et al. Analysis of the utility of CO2 and pulse-dye lasers together and separately in the treatment of hypertrophic burn scars. Ann Plast Surg 89, 166–172 (2022).
  6. Soliman, M., Etman, Y., AbdElhameed, A., Elsharaby, R. & Tawfik, A. Comparative study between Nd-YAG laser, fractional CO2 laser, and combined Nd-YAG with fractional CO2 laser in the management of keloid: clinical and molecular study. J Cosmet Dermatol 20, 1124–1132 (2021).
  7. Radmanesh, M., Mehramiri, S. & Radmanesh, R. Fractional CO2 laser is as effective as pulsed dye laser for the treatment of hypertrophic scars. J Dermatolog Treat 32, 576–579 (2021).
  8. Lee, J. H. et al. Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars. Burns 47, 1084–1093 (2021).
  9. Elgarhy, L. H., El-Tatawy, R. A., Abdelaziz, D. & Dogheim, N. N. Pulsed dye laser versus ablative fractional CO2 laser in treatment of old hypertrophic scars: Clinicopathological study. Wound Repair Regen 29, 417–424 (2021).
  10. Dai, Z. et al. Combination of ablative fractional carbon dioxide laser and platelet-rich plasma treatment to improve hypertrophic scars: a retrospective clinical observational study. Burns Trauma 9, tkab016 (2021).
  11. Tawfic, S., Sayed, S., Nada, A., Manaa, D. & Shalaby, S. High-versus low-density fractional laser in the treatment of hypertrophic postburn scars: a randomized clinical trial. Dermatol Surg 46, e38–e44 (2020).
  12. Tawfic, S. O. et al. Evaluation of fractional CO2 versus long pulsed Nd:YAG lasers in treatment of hypertrophic scars and keloids: a randomized clinical trial. Lasers Surg Med 52, 959–965 (2020).
  13. Srivastava, S., Kumari, H. & Singh, A. Comparison of fractional CO2 laser, verapamil, and triamcinolone for the treatment of keloid. Adv Wound Care (New Rochelle) 8, 7–13 (2019).
  14. Sabry, H. H., Abdel Rahman, S. H., Hussein, M. S., Sanad, R. R. & Abd El Azez, T. A. The efficacy of combining fractional carbon dioxide laser with verapamil hydrochloride or 5-fluorouracil in the treatment of hypertrophic scars and keloids: a clinical and immunohistochemical study. Dermatol Surg 45, 536–546 (2019).
  15. Patel, S. P. et al. Fractional CO2 laser treatment outcomes for pediatric hypertrophic burn scars. J Burn Care Res 40, 386–391 (2019).
  16. Miletta, N. et al. Fractional ablative laser therapy is an effective treatment for hypertrophic burn scars: a prospective study of objective and subjective outcomes. Ann Surg (2019) doi:10.1097/SLA.0000000000003576.
  17. Poetschke, J. et al. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach. Lasers Med Sci 32, 1031–1040 (2017).
  18. El-Hoshy, K., Abdel-Halim, M. R. E., Dorgham, D., El-Din Sayed, S. S. & El-Kalioby, M. Efficacy of fractional carbon dioxide laser in the treatment of mature burn scars. J Clin Aesthet Dermatol 10, 36–43 (2017).
  19. Żądkowski, T. et al. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: an observational study. Medicine (Baltimore) 95, e5168 (2016).
  20. Lei, Y., Li, S. F., Yu, Y. L. & Tan, J. Clinical effects of different modes of ultra pulse carbon dioxide fractional laser used in combination on the treatment of hypertrophic scar on face and neck. Zhonghua Shao Shang Za Zhi 32, 474–478 (2016).
  21. Lee, S.-J., Suh, D.-H., Lee, J. M., Song, K.-Y. & Ryu, H. J. Dermal remodeling of burn scar by fractional CO2 laser. Aesthetic Plast Surg 40, 761–768 (2016).
  22. Blome-Eberwein, S., Gogal, C., Weiss, M. J., Boorse, D. & Pagella, P. Prospective evaluation of fractional CO2 laser treatment of mature burn scars. J Burn Care Res 37, 379–387 (2016).
  23. Azzam, O. A. et al. Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study. Lasers Med Sci 31, 9–18 (2016).
  24. El-Zawahry, B. M., Sobhi, R. M., Bassiouny, D. A. & Tabak, S. A. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol 14, 324–331 (2015).
  25. Makboul, M., Makboul, R., Abdelhafez, A. H., Hassan, S. S. & Youssif, S. M. Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar. J Cosmet Dermatol 13, 169–179 (2014).
  26. Khandelwal, A., Yelvington, M., Tang, X. & Brown, S. Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon’s experience. J Burn Care Res 35, 455–463 (2014).
  27. Choi, J. E. et al. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat 25, 299–303 (2014).
  28. Ozog, D. M. et al. Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA Dermatol 149, 50–57 (2013).
  29. Qu, L. et al. Clinical and molecular effects on mature burn scars after treatment with a fractional CO(2) laser. Lasers Surg Med 44, 517–524 (2012).

Side Effects

Medium
Medium side effects and adverse reactions

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