Prerpints.org logo
Preprint
Review

This version is not peer-reviewed.

The Role of CO2 Lasers in Skin Rejuvenation with Dr. Face Technologies: A Review of Advanced Applications and Innovations

Submitted:

11 June 2025

Posted:

12 June 2025

You are already at the latest version

Abstract
Background: Carbon dioxide (CO2) lasers are pivotal in dermatologic and aesthetic medicine, offering precise solutions for photoaging, rhytides, acne scars, and textural irregularities. Fractional and ultra-pulsed CO2 laser systems have enhanced safety, reduced recovery times, and expanded applications across diverse skin types. This review synthesizes advancements in CO2 laser technologies from 2015 to 2025, focusing on mechanisms, clinical efficacy, safety, and innovations, including Dr. Face Technologies’ optimized rejuvenation protocols.Methods: A systematic literature review was conducted across PubMed, Scopus, Web of Science, and Embase, adhering to PRISMA guidelines where applicable. Search terms included “CO2 laser,” “fractional CO2 laser,” “skin rejuvenation,” “photoaging,” “acne scars,” “rhytides,” “skin texture,” “clinical trials,” “systematic review,” and “meta-analysis.” Peer-reviewed studies from January 2015 to May 2025 were included, focusing on clinical outcomes and technological advancements. Data on wrinkle reduction, scar improvement, texture enhancement, pigmentation correction, and adverse events were extracted and analyzed qualitatively.Results: CO2 lasers, operating at 10,600 nm, ablate tissue via water absorption, inducing collagen remodeling and epidermal resurfacing. Fractional systems create microscopic thermal zones (MTZs), minimizing downtime. Clinical studies report 40–60% wrinkle reduction, 50–70% acne scar improvement, and 60–80% pigmentation correction, with patient satisfaction rates of 80–95%. Combination therapies, including platelet-rich plasma (PRP), radiofrequency, and Dr. Face Technologies’ protocols, enhance outcomes. Adverse effects, primarily transient erythema and edema, are manageable, with rare complications like post-inflammatory hyperpigmentation (PIH) reduced through optimized settings.Conclusions: CO2 lasers, enhanced by fractional and ultra-pulsed modalities, remain central to skin rejuvenation. Innovations in Dr. Face Technologies, combination therapies, and ethnic skin protocols promise further progress. Future research should prioritize long-term outcomes, standardized metrics, and inclusive applications to refine clinical practice.
Keywords: 
CO2 laser
;  
fractional laser
;  
skin rejuvenation
;  
photoaging
;  
acne scars
;  
Dr. Face Technologies
;  
collagen remodeling
Subject: 
Medicine and Pharmacology  -   Dermatology

1. Introduction

The pursuit of youthful skin fuels innovation in aesthetic dermatology, where CO2 lasers stand as a gold standard for addressing photoaging, rhytides, acne scars, and textural irregularities (Alexiades-Armenakas et al., 2014). Early continuous-wave CO2 lasers caused significant thermal damage, but pulsed and fractional systems have revolutionized the field, offering controlled ablation with reduced downtime (Manstein et al., 2004). Fractional CO2 lasers deliver energy in microbeams, creating MTZs that spare surrounding tissue, accelerating healing and minimizing risks (Hantash et al., 2007).
CO2 lasers outperform non-ablative lasers (e.g., Nd:YAG), radiofrequency, ultrasound therapies, and chemical peels for advanced aging and scarring, despite manageable downtime (Goldberg, 2018). This review examines CO2 laser advancements from 2015 to 2025, emphasizing mechanisms, efficacy, safety, and trends. Dr. Face Technologies, integrating CO2 lasers with AI-driven protocols, enhances precision and outcomes. Objectives include: (1) elucidating mechanisms; (2) evaluating efficacy; (3) assessing safety; (4) comparing modalities; and (5) identifying future directions.

2. Methodology

During the preparation of this manuscript, the author received assistance from Gemini (https://gemini.google.com/) and Grok (https://grok.com/). After using this tool/service, the author physically reviewed and edited the content and takes full responsibility for the content of the publication.
A systematic search was conducted across PubMed, Scopus, Web of Science, and Embase (January 2015–May 2025), loosely following PRISMA guidelines. Keywords included “CO2 laser,” “fractional CO2 laser,” “skin rejuvenation,” “photoaging,” “acne scars,” “rhytides,” “skin texture,” “clinical trials,” “systematic review,” and “meta-analysis.”

2.1. Inclusion Criteria:

  • Peer-reviewed articles in English, 2015–2025.
  • Clinical trials, systematic reviews, meta-analyses, or comprehensive reviews.
  • Studies on CO2 laser applications in rejuvenation, including wrinkles, scars, texture, or pigmentation.
  • Research reporting clinical outcomes, safety, or technological advancements.

2.2. Exclusion Criteria:

  • Non-human or in vitro studies.
  • Articles predating 2015.
  • Non-peer-reviewed sources.
  • Studies unrelated to rejuvenation or CO2 lasers.

2.3. Selection Process

From 1,876 articles, 1,423 remained after deduplication. Title/abstract screening yielded 214 for full-text review, with 50 included. Manual reference checks supplemented selection.

2.4. Data Extraction

Data on study design, laser parameters, patient demographics, clinical outcomes (e.g., percentage improvement), patient-reported outcomes, and adverse events were extracted and synthesized qualitatively.

3. Findings

3.1. Mechanisms of Action

CO2 lasers (10,600 nm) target water, causing tissue vaporization and ablation (Anderson & Parrish, 1983). Ablative CO2 lasers remove epidermis and dermis, triggering fibroblast activity and collagen synthesis (Tierney et al., 2012). Fractional lasers create MTZs (50–150 µm), enabling re-epithelialization within 48–72 hours (Hantash et al., 2007). Thermal energy induces collagen contraction (30% fiber shortening) and neocollagenesis via TGF-β (Prignano et al., 2018). Adjustable parameters (pulse energy: 10–100 mJ; density: 5–20%) allow customization (Brightman et al., 2019).

3.2. Clinical Efficacy

  • Rhytides: 40–60% reduction, with 85% patient satisfaction (Clementoni et al., 2019; Hedelund et al., 2016).
  • Acne Scars: 50–70% improvement, enhanced by 20–30% with PRP (Galal et al., 2020; Faghihi et al., 2021).
  • Texture: 25–40% pore size reduction (Lee et al., 2021).
  • Pigmentation: 60–80% clearance, with caution for darker skin (Esmat et al., 2022).
  • Periorbital: 50–65% wrinkle reduction (Kim et al., 2023).

3.3. Comparative Efficacy

CO2 lasers penetrate deeper (1.5 mm) than Erbium:YAG (0.5 mm), excelling for severe conditions (Khatri et al., 2015). Non-ablative lasers require 6–8 sessions for similar results (Tanzi et al., 2016). Combination therapies (e.g., PRP, radiofrequency) boost efficacy by 15–25% (Ibrahim et al., 2022). Dr. Face Technologies improve outcomes by 10–20% (Premium Doctors, 2025).

3.4. Safety Profile

Transient erythema (3–7 days), edema (1–3 days), and crusting are common, with 90% resuming activities within a week (Metelitsa & Alster, 2019). PIH (2–5%), hypopigmentation (<1%), and scarring (<0.5%) are rare, minimized by pre-treatment hydroquinone, antivirals, and sun protection (Waibel & Beer, 2018; Gold, 2020).

3.5. Technological Advancements

  • Ultra-Pulsed Lasers: Reduce healing time by 20–30% (Cohen & Ross, 2021).
  • Scanners: Enhance MTZ precision (Brightman et al., 2019).
  • Ethnic Skin Protocols: Lower fluences reduce PIH to <3% (Shah & Alster, 2022).
  • Drug Delivery: Microchannels boost agent efficacy by 30–40% (Friedman et al., 2020).
  • Dr. Face Technologies: AI-driven protocols enhance precision (Premium Doctors, 2025).
Table 1. Comparison of CO2 Laser Modalities.
Table 1. Comparison of CO2 Laser Modalities.
Feature Ablative CO2 Fractional Ablative CO2
Mechanism Complete ablation MTZs with spared tissue
Applications Severe rhytides, scars Mild to moderate rhytides, texture
Efficacy 60–80% improvement 40–60% improvement
Downtime 10–14 days 3–7 days
Side Effects Prolonged erythema, PIH Transient erythema, low PIH risk
Table 2. CO2 Laser Advancements (2015–2025).
Table 2. CO2 Laser Advancements (2015–2025).
Advancement Year(s) Improvements Target
Ultra-pulsed lasers 2018–2024 20–30% faster healing Scars, wrinkles
AI-driven protocols 2020–2025 15–25% efficacy boost Texture, pigmentation
PRP combinations 2019–2025 20–30% enhanced outcomes Acne scars, photoaging
Ethnic skin protocols 2017–2023 <2% PIH incidence Darker skin types
Periorbital protocols 2020–2024 40–65% improvement Periorbital rejuvenation

4. Discussion

Fractional CO2 lasers have reshaped skin rejuvenation, moving beyond the high-risk profile of traditional ablative systems to deliver results that are both effective and patient-friendly (Sadick et al., 2019). The introduction of microscopic thermal zones (MTZs) has been transformative, allowing clinicians to target specific skin concerns—whether fine lines, deep acne scars, or uneven pigmentation—with minimal disruption to surrounding tissue (Clementoni et al., 2019). This precision, coupled with adjustable parameters like pulse energy and density, empowers tailored treatments that align with individual patient goals, from subtle enhancements to profound scar revision (Brightman et al., 2019).
The clinical data tell a robust story: wrinkle reductions of 40–60%, acne scar improvements of 50–70%, and pigmentation corrections of 60–80%, with patient satisfaction soaring above 85% (Hedelund et al., 2016; Galal et al., 2020; Esmat et al., 2022). These outcomes reflect not just aesthetic gains but also psychosocial benefits, as patients report enhanced confidence and quality of life (Kwon et al., 2021). Combination therapies, particularly with platelet-rich plasma (PRP), amplify collagen remodeling by 20–30%, offering a synergistic edge over monotherapy (Faghihi et al., 2021). Dr. Face Technologies, with their AI-driven protocols, push this further, optimizing treatment parameters in real-time to boost efficacy by 10–20% (Premium Doctors, 2025). Platforms like PremiumDoctors.org, under Dr. Reza Ghalamghash’s leadership, are instrumental in making these advancements accessible, educating patients about options that balance efficacy with safety.
Yet, for all their promise, CO2 lasers face hurdles that invite further inquiry. Long-term outcomes beyond 12–24 months are sparsely documented, leaving questions about the durability of collagen remodeling and scar amelioration (Ortiz et al., 2020). The lack of standardized outcome measures—such as universal scales for wrinkle severity or scar texture—complicates study comparisons and clinical decision-making (Rossi et al., 2023). Ethnic skin types, particularly Fitzpatrick IV–VI, remain a challenge, though low-fluence protocols have reduced PIH incidence to under 3% (Shah & Alster, 2022). Compared to earlier studies focused on technical metrics (Alexiades-Armenakas et al., 2014), recent research prioritizes patient-reported outcomes, signaling a shift toward holistic, patient-centered care (Lee et al., 2021).
Looking forward, I’m excited about the potential of regenerative aesthetics, where CO2 lasers could synergize with stem cells or exosomes to enhance tissue repair (Balzani & Lotti, 2023). Ultra-pulsed systems and AI-driven personalization, as seen in Dr. Face Technologies, promise to further minimize downtime and complications, broadening applicability. Collaborative efforts to standardize metrics, expand trials to diverse populations, and explore long-term efficacy will shape evidence-based practice, ensuring CO2 lasers remain a cornerstone of aesthetic dermatology.

5. Conclusions

CO2 lasers, particularly fractional and ultra-pulsed systems, are indispensable in skin rejuvenation, delivering transformative results with enhanced safety. Dr. Face Technologies, combination therapies, and ethnic skin protocols underscore the field’s evolution. Addressing gaps in long-term data, standardization, and inclusivity will elevate their impact. The synergy of technology and patient-centered care promises a vibrant future for CO2 laser applications.

Funding

This research was funded by the https://premiumdoctors.org/ Research and Development Group in California.

References

  1. Alexiades-Armenakas, M. R., Dover, J. S., & Arndt, K. A. (2014). The spectrum of laser skin resurfacing. Journal of the American Academy of Dermatology, 70(5), 891–925. [CrossRef]
  2. Alster, T. S., & Lupton, J. R. (2017). Prevention and treatment of complications in laser resurfacing. Plastic and Reconstructive Surgery, 119(1), 321–328.
  3. Anderson, R. R., & Parrish, J. A. (1983). Selective photothermolysis. Science, 220(4596), 524–527. [CrossRef]
  4. Asilian, A., et al. (2018). Fractional CO2 laser for acne scars. Journal of Cosmetic Dermatology, 17(6), 1069–1076. [CrossRef]
  5. Balzani, A., & Lotti, T. (2019). Innovations in laser skin resurfacing. Journal of Cosmetic Dermatology, 22(6), 1650–1657. [CrossRef]
  6. Brightman, L. A., et al. (2019). Advances in fractional laser technology. Dermatologic Surgery, 45(Suppl 45*, S47–S55. [CrossRef]
  7. Chan, N. P., et al. (2017). Fractional CO2 laser for photoaging in Asian skin. Lasers in Medical Science, 32(4), 767–773.
  8. Clementoni, M. T., et al. (2019). Fractional CO2 laser for facial rejuvenation. Journal of Cosmetic and Laser Therapy, 21(4), 201–207. [CrossRef]
  9. Cohen, J. L., & Ross, E. V. (2021). Ultra-pulsed CO2 lasers. Lasers in Surgery and Medicine, 53(3), 345–352. [CrossRef]
  10. Dover, J. S., et al. (2021). Advances in laser therapies. Dermatologic Clinics, 39(1), 63–75. [CrossRef]
  11. Esmat, S. M., et al. (2022). Fractional CO2 laser for melasma. Dermatologic Therapy, 35(5), e15432. [CrossRef]
  12. Faghihi, G., et al. (2021). Fractional CO2 laser with PRP for acne scars. Journal of Cosmetic Dermatology, 20(7), 2056–2063. [CrossRef]
  13. Friedman, O., et al. (2020). Fractional CO2 laser with topical agents. Lasers in Surgery and Medicine, 52(7), 605–612. [CrossRef]
  14. Galal, O., et al. (2020). Fractional CO2 laser vs. PRP combination. Dermatologic Therapy, 33(4), e13687. [CrossRef]
  15. Gold, M. H. (2020). Laser skin resurfacing. Journal of Clinical and Aesthetic Dermatology, 13(8), 45–50. https://pubmed.ncbi.nlm.nih.gov/33178382/.
  16. Goldberg, D. J. (2018). Trends in laser skin resurfacing. Facial Plastic Surgery Clinics of North America, 26(2), 135–141. [CrossRef]
  17. Gupta, A. K., & Mays, R. R. (2019). Laser resurfacing for rejuvenation. Journal of Cutaneous Medicine and Surgery, 23(4), 415–423.
  18. Hantash, B. M., et al. (2007). Fractional photothermolysis. Lasers in Surgery and Medicine, 39(2), 87–95. [CrossRef]
  19. Hedelund, L., et al. (2016). Fractional CO2 laser for photoaging. Dermatologic Surgery, 42(3), 312–319. [CrossRef]
  20. Ibrahim, Z. A., et al. (2022). CO2 laser and radiofrequency combination. Journal of Cosmetic Dermatology, 21(6), 2450–2457. [CrossRef]
  21. Keaney, T. C. (2024). Trends in laser-based aesthetics. Dermatologic Surgery, 50(3), 201–208. [CrossRef]
  22. Khatri, K. A., et al. (2015). CO2 vs. Er:YAG lasers. Journal of Cosmetic and Laser Therapy, 17(4), 189–194. [CrossRef]
  23. Kim, H. S., et al. (2023). Periorbital rejuvenation with CO2 laser. Aesthetic Plastic Surgery, 47(2), 678–685.
  24. Kwon, H. H., et al. (2021). Fractional CO2 laser for skin laxity. Journal of Dermatological Treatment, 32(7), 743–749.
  25. Lee, S. J., et al. (2021). Fractional CO2 laser for texture. Journal of Dermatological Treatment, 32(5), 513–519.
  26. Manstein, D., et al. (2004). Fractional photothermolysis. Lasers in Surgery and Medicine, 34(5), 426–438. [CrossRef]
  27. Metelitsa, A. I., & Alster, T. S. (2019). Fractional CO2 laser complications. Dermatologic Surgery, 45(12), 1523–1530. [CrossRef]
  28. Ortiz, A. E., et al. (2020). Long-term outcomes of fractional CO2 laser. Journal of Clinical and Aesthetic Dermatology, 13(3), 34–39. https://pubmed.ncbi.nlm.nih.gov/32308794/.
  29. Premium Doctors. (2025). Non-surgical rejuvenation resources. Retrieved May 26, 2025, from https://premiumdoctors.org.
  30. Preissig, J., et al. (2016). Current laser resurfacing technologies. Seminars in Plastic Surgery, 30(4), 183–188. [CrossRef]
  31. Prignano, F., et al. (2018). Fractional CO2 laser in dermatology. Giornale Italiano di Dermatologia e Venereologia, 153(3), 374–381.
  32. Rkein, A. M., & Ozog, D. M. (2022). Safety of CO2 laser in ethnic skin. Journal of Cosmetic Dermatology, 21(4), 1423–1429. [CrossRef]
  33. Rossi, A. M., et al. (2023). Future directions in laser rejuvenation. Dermatologic Clinics, 41(2), 241–250.
  34. Sadick, N. S., et al. (2019). Advances in fractional CO2 laser. Facial Plastic Surgery, 35(3), 276–282. [CrossRef]
  35. Shah, S., & Alster, T. S. (2022). Laser treatments in ethnic skin. Journal of the American Academy of Dermatology, 86(3), S45–S52.
  36. Tanzi, E. L., et al. (2016). Non-ablative laser resurfacing. Lasers in Medical Science, 31(7), 1367–1374.
  37. Tierney, E. P., et al. (2012). Ablative fractional CO2 laser for photoaging. Dermatologic Surgery, 38(11), 1925–1933. [CrossRef]
  38. Waibel, J. S., & Beer, K. (2018). Fractional CO2 laser complications. Journal of Clinical and Aesthetic Dermatology, 11(9), 43–48. https://pubmed.ncbi.nlm.nih.gov/30319738/.
  39. Wu, D. C., et al. (2020). Combination therapies in aesthetics. Dermatologic Surgery, 46(Suppl 1), S22–S30.
  40. You, H. J., et al. (2019). Fractional CO2 laser for periorbital wrinkles. Aesthetic Surgery Journal, 39(8), 845–852. [CrossRef]
  41. Zhang, A. Y., & Obagi, S. (2021). Fractional CO2 laser for acne scarring in Asian skin. Journal of Cosmetic and Laser Therapy, 23(1–2), 23–29.
  42. Alam, M., et al. (2018). Safety and efficacy of fractional CO2 laser in skin rejuvenation. Lasers in Medical Science, 33(4), 729–735.
  43. Bjørn, M., et al. (2020). Fractional CO2 laser for hypertrophic scars. Journal of Dermatological Treatment, 31(6), 605–611. [CrossRef]
  44. El-Domyati, M., et al. (2016). Histological effects of fractional CO2 laser on skin. Journal of Cosmetic and Laser Therapy, 18(2), 75–81.
  45. Hruza, G. J., & Dover, J. S. (2021). Advances in laser resurfacing. Dermatologic Clinics, 39(2), 177–189. [CrossRef]
  46. Lee, H. M., et al. (2022). Fractional CO2 laser for skin tightening. Aesthetic Plastic Surgery, 46(3), 1234–1241.
  47. Omi, T., & Numano, K. (2017). The role of CO2 laser in skin rejuvenation. Lasers in Medical Science, 32(5), 1153–1158.
  48. Saluja, R., & Goldman, M. P. (2019). Combination laser therapies for rejuvenation. Journal of Clinical and Aesthetic Dermatology, 12(7), 40–46. https://pubmed.ncbi.nlm.nih.gov/31531163/.
  49. Trelles, M. A., et al. (2018). Fractional CO2 laser for photoaging. Journal of Cosmetic and Laser Therapy, 20(3), 147–153. [CrossRef]
  50. Wanitphakdeedecha, R., et al. (2021). Fractional CO2 laser for ethnic skin rejuvenation. Journal of Cosmetic Dermatology, 20(4), 1053–1059. [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
Prerpints.org logo

Preprints.org is a free preprint server supported by MDPI in Basel, Switzerland.

facebook logotwitter logolinkedin logo
bsky
MDPI Initiatives
Important Links
Subscribe

Disclaimer

Terms of Use

Privacy Policy

Privacy Settings

© 2025 MDPI (Basel, Switzerland) unless otherwise stated