What Is Laser Resurfacing? CO₂, Erbium, Fractional & Ablative Lasers Explained

Laser resurfacing is best understood as a family of procedures rather than a single treatment. The laser wavelength, depth, amount of thermal injury and whether the skin is treated fractionally or across the full surface determine what the procedure can improve and how much downtime it requires.

This distinction matters because an aggressive full-field CO₂ resurfacing procedure and a light fractional Erbium treatment should not be discussed as if they have the same recovery, risk or result.

If you are comparing actual treatment options, recovery and current pricing at Skin Works, see our skin resurfacing treatment options. This article stays focused on the educational question: what laser resurfacing is and how the major laser categories differ.

How Does Laser Skin Resurfacing Work?

Lasers deliver light at specific wavelengths. In ablative resurfacing, CO₂ and Er:YAG wavelengths are strongly absorbed by water in skin tissue. That energy creates controlled vaporization or ablation of damaged tissue and a surrounding healing response.

As the treated skin repairs itself, a new epidermal surface forms and collagen in the dermis remodels over the following weeks and months. That combination is why resurfacing can improve both surface irregularities and deeper texture.

Nonablative resurfacing works differently: it creates controlled thermal injury beneath an intact or largely intact epidermis. The tradeoff is usually less downtime in exchange for a more gradual or less aggressive result.

The Four Terms You Need to Understand

CO₂ vs. Erbium Laser Resurfacing

Skin Works offers both fractional CO₂ laser resurfacing and Erbium laser resurfacing. Which one fits better depends on the concern, skin type, treatment depth and how much downtime you can realistically manage.

What Can Laser Resurfacing Treat?

The strongest uses are problems related to surface damage, texture and photoaging. Depending on the laser and settings, resurfacing may improve:

• Fine lines and selected wrinkles
• Sun-damaged skin and uneven texture
• Selected age spots and uneven pigmentation
• Atrophic acne scars, including rolling and boxcar scars in appropriate patients
• Enlarged-looking pores and rough texture
• Some traumatic or surgical scars

A 2026 systematic review and meta-analysis comparing fractional CO₂ with erbium-based fractional lasers for atrophic acne scars found that both categories can improve scars, while the comparative strength and tolerability differed across studies. That is a good example of why the “best laser” depends on the outcome being prioritized.

What Laser Resurfacing Does Not Do Well

Resurfacing is not the right tool for every facial concern.

The older version of this article grouped redness, spider veins, fresh stretch marks and “sagging skin” together as routine resurfacing targets. That is too broad. Vascular redness often requires a vascular or IPL-based approach, and significant laxity requires a different treatment strategy.

Why Is Fractional Laser Resurfacing So Common?

Fractional technology creates microscopic treatment zones surrounded by untreated tissue. Those untreated areas act as reservoirs for faster healing, allowing clinicians to produce meaningful remodeling with less downtime than comparable full-field ablation.

Fractional does not automatically mean “light.” The depth, density, energy and number of passes can still make a fractional treatment quite aggressive. A high-density fractional CO₂ treatment can require significantly more recovery than a light fractional Erbium session.

How Many Laser Resurfacing Sessions Do You Need?

There is no universal five-treatment rule.

A deeper traditional ablative treatment may be designed as a single session. Fractional resurfacing is more often performed as a series, especially when the goal is acne-scar remodeling with less downtime per visit.

At Skin Works, traditional Erbium may be performed as a single stronger treatment, while fractional Erbium commonly uses a series. Fractional CO₂ planning depends on concern severity, treatment depth and recovery tolerance. The number of sessions should come from the treatment plan rather than from the generic category name.

When Do Results Appear?

Some improvement in tone or surface smoothness can become visible after the initial healing period. Collagen remodeling continues for months, so the final result is not judged the moment peeling stops.

The American Society of Plastic Surgeons notes that improvement can continue for up to a year after laser resurfacing. Normal aging continues afterward, so results are long-lasting rather than permanent.

How Much Downtime Does Laser Resurfacing Have?

Downtime varies dramatically by technology and treatment depth. Light fractional Erbium can involve only a few days of visible recovery. Fractional CO₂ often requires several days to more than a week, while deeper full-field CO₂ can require two or more weeks before patients are comfortable returning to normal social activity.

Because this is a major search topic on its own, we keep the detailed timelines in our laser resurfacing recovery guide.

Can Darker Skin Tones Have Laser Resurfacing?

Yes, but treatment must be selected more carefully. Darker Fitzpatrick skin types have a higher risk of post-inflammatory hyperpigmentation after aggressive thermal injury.

That does not mean darker skin is automatically excluded from laser resurfacing. It means wavelength, depth, density, pretreatment skin preparation, recent sun exposure and post-treatment sun protection matter more. A conservative fractional strategy or a different technology may be safer than aggressive full-field ablation.

What Are the Risks?

Expected short-term effects include redness, swelling, peeling, crusting and sensitivity. Potential complications include:

• Post-inflammatory hyperpigmentation or hypopigmentation
• Prolonged redness
• Bacterial, fungal or viral infection, including herpes simplex reactivation
• Acneiform eruptions or milia during healing
• Scarring, particularly after excessive thermal injury or abnormal healing

Risk is influenced by skin type, treatment depth, recent sun exposure, medications, history of cold sores, smoking, aftercare and operator experience.

Who Is a Good Candidate?

1. You have a resurfacing problem such as texture, photodamage, fine lines or selected acne scars.
2. Your skin type and medical history are compatible with the planned wavelength and treatment depth.
3. You can avoid significant sun exposure before and after treatment.
4. You can accommodate the expected recovery period for the specific laser settings.
5. You understand that deeper treatment can produce greater correction but also increases downtime and risk.
6. You have realistic expectations about what resurfacing can and cannot correct.

How Much Does Laser Resurfacing Cost?

Cost depends on the device, treatment area, depth, number of sessions and whether the procedure is fractional or full-field. Because price intent is different from “what is laser resurfacing,” we keep the detailed discussion on our separate laser resurfacing cost guide.

How Do You Choose Between Erbium and CO₂?

Start with the problem and the downtime you are willing to accept.

Erbium is often a strong fit when the concern is fine lines, sun damage, shallow acne scarring or texture and the patient values a more contained thermal effect and faster recovery. CO₂ can be a better fit when stronger remodeling is needed for deeper wrinkles, more significant acne scarring or heavier photodamage and the patient accepts more downtime.

The decision should be based on skin type, scar type, treatment area, severity and recovery tolerance, not simply which laser sounds more powerful.

Frequently Asked Questions