Review Article| Volume 28, ISSUE 1, P17-28, February 2020

New Developments for Fractional CO2 Resurfacing for Skin Rejuvenation and Scar Reduction


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Facial Plastic Surgery Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Walsh Jr., J.T.
        • Thomas J.
        • Flotte T.J.
        • et al.
        Pulsed CO2 laser tissue ablation: effect of tissue type and pulse duration on thermal damage.
        Lasers Surg Med. 1988; 8: 108-118
        • Ross V.E.
        • Domankevitz Y.
        • Skrobal M.
        • et al.
        Effects of CO2 laser pulse duration in ablation and residual thermal damage: implications for skin resurfacing.
        Lasers Surg Med. 1996; 19: 123-129
        • Farkas J.P.
        • Richardson J.A.
        • Brown S.A.
        • et al.
        TUNEL assay to characterize acute histopathological injury following treatment with the active and deep FX fractional short-pulse CO2 devices.
        Aesthet Surg J. 2010; 30: 603-613
        • Dover J.S.
        • Bhatia A.C.
        • Stewart B.
        • et al.
        Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging.
        Arch Dermatol. 2005; 141: 1247-1252
        • Clementoni M.T.
        • Gilardino P.
        • Muti G.F.
        • et al.
        Non-sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: preliminary clinical report.
        J Cosmet Laser Ther. 2007; 9: 218-225
        • Tretti Clementoni M.
        • Galimberti M.
        • Tourlaki A.
        • et al.
        Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation.
        Lasers Med Sci. 2013; 28: 643-650
        • Qu L.
        • Liu A.
        • Zhou L.
        • et al.
        Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser.
        Lasers Surg Med. 2012; 44: 517-524
        • Hu Y.
        • Chen Y.
        • Lin M.
        • et al.
        Pathogenic role of the Wnt signaling pathway activation in laser-induced choroidal neovascularization.
        Invest Ophthalmol Vis Sci. 2013; 54: 141-154
        • Connolly K.L.
        • Chaffins M.
        • Ozog D.
        Vascular patterns in mature hypertrophic burn scars treated with fractional CO2 laser.
        Lasers Surg Med. 2014; 46: 597-600
        • Karmisholt K.E.
        • Banzhaf C.A.
        • Glud M.
        • et al.
        Laser treatments in early wound healing improve scar appearance: a randomized split-wound trial with nonablative fractional laser exposures vs. untreated controls.
        Br J Dermatol. 2018; 179: 1307-1314
        • Karmisholt K.E.
        • Haerskjold A.
        • Karlsmark T.
        • et al.
        Early laser intervention to reduce scar formation–a systematic review.
        J Eur Acad Dermatol Venereol. 2018; 32: 1099-1110
        • Yang Z.
        • Lv Y.
        • Yue F.
        • et al.
        Early intervention of fractional carbon dioxide laser on fresh traumatic scar.
        Lasers Med Sci. 2019; 34: 1317-1324
        • Hultman C.S.
        • Friedstat J.S.
        • Edkins R.E.
        • et al.
        Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up.
        Ann Surg. 2014; 260 ([discussion: 529–32]): 519-529
        • Cervelli V.
        • Gentile P.
        • Spallone D.
        • et al.
        Ultrapulsed fractional CO2 laser for the treatment of post-traumatic and pathological scars.
        J Drugs Dermatol. 2010; 9: 1328-1331
        • Uebelhoer N.S.
        • Ross E.V.
        • Shumaker P.R.
        Ablative fractional resurfacing for the treatment of traumatic scars and contractures.
        Semin Cutan Med Surg. 2012; 31: 110-120
        • Waibel J.
        • Beer K.
        Ablative fractional laser resurfacing for the treatment of a third-degree burn.
        J Drugs Dermatol. 2009; 8: 294-297
        • Hultman C.S.
        • Edkins R.E.
        • Lee C.N.
        • et al.
        Shine on: review of laser- and light-based therapies for the treatment of burn scars.
        Dermatol Res Pract. 2012; 2012: 243651
        • Gold M.H.
        • Berman B.
        • Clementoni M.T.
        • et al.
        International advisory panel on scar management. Updated international clinical recommendations on scar management: part 1—evaluating the evidence.
        Dermatol Surg. 2014; 40: 817-824
        • Gold M.H.
        • McGuire M.
        • Mustoe T.A.
        • et al.
        International advisory panel on scar management updated international clinical recommendations on scar management: part 2—algorithms for scar prevention and treatment.
        Dermatol Surg. 2014; 40: 825-831
        • Anzarut A.
        • Olson J.
        • Singh P.
        • et al.
        The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis.
        J Plast Reconstr Aesthet Surg. 2009; 62: 77-84
        • Levi B.
        • Ibrahim A.
        • Mathews K.
        • et al.
        The use of CO2 fractional photothermolysis for the treatment of burn scars.
        J Burn Care Res. 2016; 37: 106-114
        • Issler-Fisher A.C.
        • Fisher O.M.
        • Smialkowski A.O.
        • et al.
        Ablative fractional CO2 laser for burn scar reconstruction: an extensive subjective and objective short-term outcome analysis of a prospective treatment cohort.
        Burns. 2017; 43: 573-582
        • Anderson R.R.
        • Donelan M.B.
        • Hivnor C.
        • et al.
        Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report.
        JAMA Dermatol. 2014; 150: 187-193
        • Waibel J.
        • Beer K.
        Fractional laser resurfacing for thermal burns.
        J Drugs Dermatol. 2008; 7: 59-61
        • Willows B.M.
        • Ilyas M.
        • Sharma A.
        Laser in the management of burn scars.
        Burns. 2017; ([pii:S0305-4179(17)30376-5])
        • El-Zawahry B.M.
        • Sobhi R.M.
        • Bassiouny D.A.
        • et al.
        Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study.
        J Cosmet Dermatol. 2015; 14: 324-331
        • Khandelwal A.
        • Yelvington M.
        • Tang X.
        • et al.
        Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon’s experience.
        J Burn Care Res. 2014; 35: 455-463
        • Haedersdal M.
        Fractional ablative CO2 laser resurfacing improves a thermal burn scar.
        J Eur Acad Dermatol Venereol. 2009; 23: 1327-1349
        • Lee S.J.
        • Kim J.H.
        • Lee S.E.
        • et al.
        Hypertrophic scarring after burn scar treatment with a 10,600-nm carbon dioxide fractional laser.
        Dermatol Surg. 2011; 37: 1168-1172
        • Krakowski A.C.
        • Admani S.
        • Shumaker P.R.
        • et al.
        Fractionated carbon dioxide laser as a novel, noninvasive treatment approach to burn scar-related nail dystrophy.
        Dermatol Surg. 2014; 40: 351-354
        • Shumaker P.R.
        • Kwan J.M.
        • Landers J.T.
        • et al.
        Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol.
        J Trauma Acute Care Surg. 2012; 73: S116-S121
        • Krakowski A.C.
        • Goldenber A.
        • Eichenfield L.F.
        • et al.
        Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures.
        Pediatrics. 2014; 134: 1700-1705
        • Poetschke J.
        • Dornseifer U.
        • Clementoni M.T.
        • et al.
        Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach.
        Lasers Med Sci. 2017; 32: 1031-1040
        • Clayton J.L.
        • Edkins R.
        • Cairns B.A.
        • et al.
        Incidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars.
        Ann Plast Surg. 2013; 70: 500-505
        • Haedersdal M.
        • Sakamoto F.H.
        • Farinelli W.A.
        • et al.
        Fractional CO(2) laser-assisted drug delivery.
        Lasers Surg Med. 2010; 42: 113-122
        • Forster B.
        • Klein A.
        • Szeimies R.M.
        • et al.
        Penetration enhancement of two topical 5-aminolaevulinic acid formulations for photodynamic therapy by erbium:YAG laser ablation of the stratum corneum: continuous versus fractional ablation.
        Exp Dermatol. 2010; 19: 806-812
        • Lee W.R.
        • Shen S.C.
        • Pai M.H.
        • et al.
        Fractional laser as a tool to enhance the skin permeation of 5-aminolevulinic acid with minimal skin disruption: a comparison with conventional erbium:YAG laser.
        J Control Release. 2010; 145: 124-133
        • Waibel J.S.
        • Wulkan A.J.
        • Shumaker P.R.
        Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery.
        Lasers Surg Med. 2013; 45: 135-140
        • Cavalie M.S.L.
        • Montaudie H.
        • Bahadoran P.
        • et al.
        Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases.
        Dermatol Ther. 2015; 28: 74-78
        • Austin E.
        • Koo E.
        • Jagdeo J.
        The cellular response of keloids and hypertrophic scars to botulinum toxin A: a comprehensive literature review.
        Dermatol Surg. 2018; 44: 149-157
        • Chen H.C.
        • Yen C.I.
        • Yang S.Y.
        • et al.
        Comparison of steroid and botulinum toxin type A monotherapy with combination therapy for treating human hypertrophic scars in an animal model.
        Plast Reconstr Surg. 2017; 140: 43e-49e