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Fractional Carbon DioxideLaser Skin Resurfacing

We, at LL Cheong Skin & Laser Clinic, have just incorporated the Mixto SXTM system (Lasering, Modena, Italy), a fractional CO2 laser device, into our clinical services. We are very excited over the capabilities of this new laser device and believe the information below will aid you in making an informed decision on laser resurfacing of the skin.

New Sheen
on an
Old Laser

Laser Skin Resurfacing – Past to Present

Fractional carbon dioxide laser skin resurfacing (LSR) is a technology borne of the need for a "middle ground" between aggressive conventional carbon dioxide LSR and the patient- friendly non-ablative forms of LSR. In conventional CO2 LSR, the entire thickness of the epidermis and selected depths of the dermis are ablated in a clean and precise manner. The procedure is technique-dependent but, in good hands, the results can be very good. However, the prolonged downtime and myriad side-effects limit its acceptance by many patients.

The pendulum of laser options then swung to the non-ablative laser systems which aim to stimulate collagen production in the superficial dermis without epidermal disruption. There is little or no downtime involved but repeated laser sessions are needed to achieve clinical results which are more subtle. Many patients prefer procedures that require fewer treatments and produce better results. This is where the true value of fractional LSR lies.

New Technology in Laser Skin Resurfacing

Fractional CO2 laser skin resurfacing is a new treatment for dyschromias(pigmentary disturbances), wrinkles, scars and sagging skin using fractional technology to reduce downtime while impacting the skin sufficiently to produce noticeable results after 1 or 2 treatments. This is unlike the older form of non-ablative fractional LSR.

A computer-controlled scanner produces precise zones of laser coagulation in the skin. The CO2 laser generates heat in the deeper dermis and this heat is needed to stimulate new collagen production. The nature of the laser beam minimizes the damage to the surrounding tissue so that the patient heals sooner.

At the same time, fractional technology leaves bridges of healthy tissue intact between the laser beams to accelerate tissue healing.

The fractional CO2 laser device can be tuned to target the superficial layers of the skin with lower energy settings resulting in the improvement of dyschromias, fine lines, mild scarring and skin texture. Laser energy levels can be adjusted to target deep collagen remodeling to impact deeper wrinkles and scars and to achieve skin tightening. Patient discomfort is kept to a minimum and topical anaesthesia is usually all that is needed.

What to Expect

The procedure is highly tolerable with most patients describing the sensation during and after treatment as “hot”. The heat and soreness last for between 1 to 3 hours after the procedure during which the skin appears bright pink. The patient may appear “sunburnt” for about 2 days after which tiny brown crusts are seen on the treated areas. These crusts eventually detach and the skin is crust-free after about 5-7 days. Post-operative care is simple. The use of an emollient is encouraged and avoidance of sun-exposure during the healing phase is essential.

The Downside

The potential adverse effects are uncommon and include post-inflammatory hyperpigmentation (often mild and transient), redness of the skin, reactivation of the herpes simplex virus, secondary bacterial infection and scarring.


Effect of laser pulses on a wooden spatula in descending order of energy intensity from left to right.

The picture shows how the level of laser energy can be finely tuned to vary the degree of impact. This flexibility allows the doctor and patient to determine the degree of results and duration of downtime from the procedure.

The almost immediate results that are often seen after the skin heals include brighter and more radiant skin, a more even skin tone and improved skin texture. One can expect continued collagen remodeling over the next few months producing improvement in deep wrinkles and scars. Skin tightening is another delightful “late” result of the treatment.

The Reality Check

Effective as it is, fractional CO2 LSR does not give you the same degree of results as plastic surgical procedures like a face-lift and blepharoplasty(double eyelid surgery and eyebag surgery). If you are looking for dramatic results and are comfortable with the risk-benefit profile of such procedures, you should consult a good plastic surgeon. However, if you are after readily discernible results with a minimum of risk and downtime, fractional CO2 LSR may just be the procedure for you.


Fractional CO2 LSR fills an important niche in the dermatologist's armamentarium for skin resurfacing, affording the rapid onset of clinical results while minimizing the severity of post-operative downtime and potential adverse effects.