The Return of the CO2: Why These Next-Level Lasers are a Perfect Procedure for Fall
by Jolene Edgar
Posted October 7, 2019 on RealSelf.com/news
The reboot of a classic can often feel like a last gasp—one final attempt to get with the times (we see you, Abercrombie & Fitch). So recently, when we learned of a carbon dioxide (CO2) laser aiming to woo millennials with promises of born-again skin and minimal downtime, we felt compelled to do a proverbial pulse check on the veteran resurfacing technology.
If you’re even a little familiar with lasers, you likely know that the CO2 is hardly a “lunchtime procedure.” A true-to-form CO2 emits a powerful, ablative beam of infrared light that targets water molecules in the skin, vaporizing the tissue to spark healing and collagen renewal. “Very few lasers have stood the test of time like the CO2—it can tighten tissue and improve damaged skin, addressing wrinkles, sun spots and scars,” says Dr. Sameer Bashey, a dermatologist in New York City and Los Angeles. But all that goodness comes at a cost: A typical CO2 recovery “is one where someone looks swollen, bloody and scabby for a week or two and then their skin is pink for about a month,” says Dr. Robert Anolik, a dermatologist in New York City.
What’s behind the CO2 laser comeback, and who’s getting the treatment?
It was, in fact, the advent of fractional technology, back in 2004, that ushered in the modern age of such low-downtime devices as the non-ablative (or surface-sparing) Fraxel and Clear + Brilliant, relegating the heavy hitters to relative obscurity—for a time, anyway. Today, experts say, there’s a definite role for both, especially as aging Gen-Xers—many of whom grew up on “baby” lasers—are aiming to take their resurfacing game to the next level.
“The pendulum swung one way, and now it’s starting to swing back because people are getting frustrated with less invasive procedures that don’t give much of an improvement and yet are still pretty expensive,” says Dr. Sunder.
Dermatologist Dr. Sejal Shah is noticing a similar trend in her New York City practice: “We’re seeing people in their 40s and 50s who’ve been getting light laser treatments for 10 or 15 years and now want something more intense.” (To quantify the difference, Dr. Shah typically tells patients that a single fractional ablative CO2 is equivalent to four rounds of non-ablative Fraxel.) Dr. Anolik can also confirm the CO2 resurgence: “Instead of using it only a few times a year, I’m now reaching for it a few times a month,” he says, mainly to treat light-skinned patients with more significant signs of aging. “We’re taking advantage of the CO2’s ability to create a far stronger collagen change to treat deep lines and creases, acne scarring and even some laxity.”
But fear not: glow-boosting, no-downtime devices aren’t going anywhere. “They’re still popular and always will be, because more and more young people are coming in for cosmetic treatments for maintenance and skin brightening,” explains Dr. Shah.
Not just for olds: ablative lasers are more versatile than you might think
But what of the aforementioned attempt to spin the CO2 as NBD? Can a laser be ablative and gentle at once? Yep, at least, according to the engineers of the CoolPeel—the “more inclusive” fractional ablative CO2 currently disrupting the laser landscape. (The CoolPeel is just one treatment program on a larger and more aggressive CO2 platform.) Dr. Shah describes it as “a very superficial ablation, at lighter energies—like a souped-up version of the Clear + Brilliant [a baby fractional device].” It’s ideal for those battling dullness, mottling and fine lines. Since the CoolPeel’s heat doesn’t go as deep as a traditional CO2, it’s not effective for pronounced wrinkles, significant dark spots or acne scars, she adds; but on the upside, the downtime is next to nothing—figure two days of redness, followed by a few days of sandpapery skin.
Another early adopter of the CoolPeel, New York City dermatologist Dr. Paul Jarrod Frank, recently shared with RealSelf his affection for the treatment: “It achieves what CO2 was meant to do, which is tightening fine lines, [fixing] overall sun damage [and improving] skin tone—and it does it while minimizing heat trauma.” He recommends a series of three for best results.
While Dr. Frank agrees that all CO2s can be adjusted to superficial effect, he argues that the CoolPeel isn’t merely a muted modification of the OG treatment: “What’s unique to CoolPeel is the pulse duration and delivery wave of the pulses. This maximizes ablation and minimizes heat distribution—[which is what] ultimately prolongs downtime and risk.” The entire system is “customized and optimized for easy use and predictability, with low, medium and high settings.”
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