What it is
The CO₂ laser emits light at 10,600 nanometers, a wavelength absorbed almost exclusively by water. Because water lives in every soft tissue, the CO₂ laser does not chase a specific pigment or vessel — it ablates whatever skin you point it at, in the precise pattern the device delivers.
Modern CO₂ work is almost always fractional. Instead of removing the entire surface in a single sheet — which was the way ablative resurfacing was done a generation ago — the fractional pattern removes microscopic columns of tissue and leaves the skin between them intact. Healing is faster, downtime is shorter, and the dermis underneath responds with months of new collagen production.
The CO₂ laser is the largest single-treatment lever in cosmetic dermatology for deep wrinkles, true photodamage, and atrophic scarring. It is also the modality with the most downtime. Both facts are real and both belong in the conversation.
For the full protocol, pre-care, and day-by-day timeline of fractional CO₂ resurfacing as performed at Esvie, see the CO₂ Skin Resurfacing page. This page covers the broader CO₂ category — what the laser does, why the wavelength matters, and how to think about it relative to other tools.
How Dr. Brown approaches it
CO₂ at Esvie is performed by Dr. Brown personally. Settings — depth, density, energy per microcolumn, pulse stacking — are the treatment. A passive “preset” is not a plan.
The decision tree:
- Broad photodamage, fine lines, dyschromia. Full-face fractional CO₂ at moderate density. One carefully-planned course rather than a long series of light passes.
- Atrophic acne scars or deep perioral lines. Higher-density, deeper passes targeted at the scar bed or rhytid; lighter settings on intervening skin.
- Periocular or perioral only. Limited treatment area, limited downtime, often combined with neuromodulator on the same visit.
- Skin types IV–VI. Conservative settings, aggressive pre-treatment with topical tretinoin and a pigment-blocking regimen for 4–6 weeks, antiviral prophylaxis, and a frank conversation about post-inflammatory hyperpigmentation risk. Sometimes the right answer is a non-ablative protocol or microneedling RF instead.
The depth of the laser pulse — not the number of sessions — drives the result. Most patients are better served by one well-executed aggressive course than by a year of underpowered touch-ups.
What to expect
Pre-treatment. A 4–6 week prep window with topical tretinoin and a skin-prep regimen is typical. Antiviral medication starts before the treatment day if you have any cold-sore history. Stop retinoids 48 hours before the procedure per Dr. Brown’s specific instructions.
Day of treatment. Topical anesthesia for approximately one hour. Treatment time runs 30–60 minutes depending on the area and aggressiveness. Local nerve blocks may be added for deeper passes. Most patients describe the procedure itself as warm and tolerable rather than painful.
Days 1–5. Oozing, crusting, and weeping as the treated columns heal. Frequent gentle cleansing and an occlusive ointment. No makeup, no sun, no scrubbing.
Days 5–10. Crusts release. Skin underneath is bright pink. Mineral makeup may be tolerated by day 7. Most patients return to social activity by day 7–10.
Weeks 2–8. Pinkness fades. Texture continues to refine. UV exposure during this window is the single largest cause of post-treatment pigment problems — sun protection is not optional.
Months 3–6. Final result. Collagen remodeling matures. Photodamage indications continue to improve through month six.
Candidacy
Good candidates have meaningful photodamage, deep wrinkles, or atrophic scarring; have skin types I–III (or types IV–VI with appropriate planning); are willing to commit to 5–10 days of social downtime; are diligent with sun protection; and do not have any active skin infection or recent isotretinoin therapy.
Not a candidate if you are pregnant or nursing, have active acne or herpes outbreak at the site, are within six to twelve months of isotretinoin, or have a history of keloid scarring.
If CO₂ is the wrong tool — too aggressive for your situation, or not aggressive enough to change what you are seeing — Dr. Brown will say so. Better answers in that conversation often include microneedling with radiofrequency, IPL combined with a 1064 nm Nd:YAG protocol, or a vascular laser if redness is the dominant concern.