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While there is no magic bullet procedure to instantly undo the decade of acne I've experienced as a 29-year-old, my dermatologist recently offered one way to fade my old scars. He thought I should try resurfacing laser treatment — specifically Fractional CO2 laser. After I learned Kim Kardashian once told Oprah that she tells her sisters, "Girls, you should get fraxel laser on your face," I was sold. 3d mirror pad
My acne has left me with some rolling scars (scar tissue that forms under the skin) and pigmentation from old breakouts around my mouth and chin. So — and I fully realize this sounds a little extreme — by burning off the thin top layer of skin, resurfacing treatments can help to reveal new, smooth, and glowing skin underneath.
It sounds painful — and it is, more on that in a second — but when administered for the right patient (more on that soon, too) it is safe and effective, according to studies dating back to 1997. Still, the details of what's happening on your face aren't so pretty. Lasers work by wounding the top layer of skin (a.k.a. the epidermis) with a laser and heating the deeper layers of the skin (dermis), cosmetic chemist Shuting Hu tells Allure. But this process actually triggers the body's wound-healing response, which, in turn, increases collagen and elastin production in the dermis to heal and strengthen cells. Give it some downtime, and your skin will emerge looking bright and clear.
Because of my history with acne, I was a great candidate for fractional CO2. There are non-ablative treatments, meaning ones that do not remove layers of skin, I could try but those can be less effective. And I'm not alone in wanting to use a laser to buzz away the skin that doesn't suit my complexion anymore. "Undergoing this laser treatment at 29 is not uncommon," explains Marie Hayag, MD, a board-certified dermatologist and the founder of 5th Avenue Aesthetics in New York City.
The author before her treatment.
My dermatologist advised me to stop using retinoids 10 days prior to the treatment to minimize sensitivity. I also had to avoid blood-thinning painkillers (like ibuprofen) and take tablets to prevent cold sores prior to the treatment.
At the clinic, the doctor applied a thick layer of numbing cream and let it sit for 45 minutes. When she started with the laser on one side of my face, I could feel a mild zapping similar to that of laser hair removal.
Throughout the treatment, there was a burning scent – it was my dermis being burnt off. The sensation felt like a rubber band lightly hitting my skin, which was uncomfortable but not painful. At least not at first… halfway through the one-hour treatment, I started to feel like my face was burning. It was about a six out of 10 in terms of pain, and I couldn't wait to be done.
Fani immediately after her treatment.
After the laser, doctors placed ice packs on my face for 10 minutes to relieve the burning and then applied a thick layer of antibiotic cream. I was in the clinic for about two hours, though the laser itself took one hour. After I left the clinic, the burning got worse: it felt hot and sweaty, like a bad sunburn. By the time I got home, I was in need of something soothing, so I applied cold compresses as advised. Thankfully, the burning sensation went away overnight.
The night after the laser, I didn't sleep well as it felt like my skin was burning. I took a pain killer and applied a thick layer of antibiotic cream. The next day my face was puffy, but there was no pain. My skin started to itch (which is normal while the skin is healing), and I noticed there was scabbing all over that looked like little red dots. On top of everything, I'd have to wait two more weeks to see the final result, and to know if all that pain was "worth it."
The downtime required for full recovery is one to two weeks, depending on how quickly your skin heals. For me, full recovery took 14 days, meaning all the scabbing had come off and my skin had healed. The first day was the worst, as I felt like I had a terrible sunburn. Overall, the pain went away after the first day. After that, the itching was the most uncomfortable thing.
For the first four days, I applied a thick antibiotic cream my doctor prescribed twice a day. I set up my appointment in the middle of a cold winter, which most people recommend since I was told to minimize sun exposure. I didn't cleanse, apply makeup, or rub my skin at all — when the itching felt uncomfortable, I used lukewarm compresses to clean my face in tapping motions.
Around the fourth day post-treatment, the red dots on my face turned into tiny brown scabs. By then, I replaced the antibiotic cream with a fragrance-free moisturizer filled with hydrating ingredients like glycerin and hyaluronic acid. My doctors gave me A-Derma Epitheliale A.H Repairing Cream, which I used to keep my skin feeling moisturized at all times. (Allure also recommends the fragrance-free Olay Regenerist Max Hydration Moisturizer.) I was told not to exercise for one week, so I ditched the gym, and I used much more sunscreen than felt normal since my skin was extra sensitive.
But before you use any product post-fraxel, follow some simple advice from board-certified dermatologist and associate clinical professor of dermatology at Yale School of Medicine Mona Gohara, MD. "Your inner forearm is a good spot for what we call a 'use test,'" she explains, saying to try out any product there before it goes on your healing face. "You can place the products there and see if you react."
A-Derma Epitheliale A.H Repairing Cream
Regenerist Max Hydration Face Serum
Within a week, my skin had improved, but it was still itchy. By day 10, all the little skin flakes had fallen off. The final four days, I noticed I had rosy cheeks and had glass-like skin with (almost) minimal effort.
It was an uncomfortable process, but it was worth it and I'm really impressed with the results. I had a sunken chickenpox scar at the tip of my nose, which is almost gone. I followed the doctor’s instructions for the full two weeks and then went back to a normal routine, focusing on keeping my skin moisturized. My dermatologist suggested that I avoid retinoids and acids for a few weeks as the new skin may be more sensitive.
"After a procedure, the skin is still fragile and we only recommend hydrating products with low potential for irritation — think Aquaphor, CeraVe, or Cetaphil," says New York board-certified dermatologist Dhaval G. Bhanusali, MD. "Using retinoids or acids can delay healing and potentially contribute to hyperpigmentation."
Though I tried fractional CO2 specifically for acne scars, board-certified dermatologist and founder of Skin Science Dermatology Geeta Yadav, MD says it's recommended for age spots, wrinkles, dark spots, sun damage, and overall rejuvenation. So a lot of people can get something from this laser.
I was told to block off an hour for the procedure, though it can take much less time than that, depending on the number of areas treated. The laser most often targets the face, though in some cases, it can be used on the eyes, neck, and chest, too.
"The laser penetrates the skin in thousands of tiny columns, destroying old skin cells only in the area the laser targets. The laser can go down to the dermis. The depth and intensity changes depending on the patient," says Dr. Hayag.
That said, darker skin tones are more susceptible to post-inflammatory hyperpigmentation (PIH) and have to be treated carefully when it comes to resurfacing treatments. "The main concern about using fractional CO2 on darker skin is that there is a chance it will cause permanent post-inflammatory hyperpigmentation," Dr. Hu explains. "The heat from the laser can trigger the production of melanocytes, which will create more melanin pigment, leading to hyperpigmentation and dark spots forming." That's why caution should be taken for melasma-prone skin as well, as melasma can be aggravated by thermal heat.
There are alternatives for darker and/or melasma-prone skin, like the picosecond resurfacing laser, says Loretta Ciraldo, MD, a board-certified dermatologist and the founder of Dr. Loretta Skin Care in New York City. This is a non-ablative, non-thermal laser that targets pigmentation. It's less invasive in comparison to fractional CO2 and has a 12-hour recovery period, but it isn't as effective, and you may need multiple treatments for the desired results.
Jamie Sherril (a.k.a. Nurse Jamie), a certified nurse and aesthetician, agrees. "PiQ04 [a type of picosecond laser] is our most popular technology for laser skin resurfacing and rejuvenation," she explains. "These treatments don't have any restrictions with regard to age, skin color, or skin type."
Fractional CO2 typically costs between $1,000 and $3,000 per session in New York City-based clinics. Offices may offer discounts after the first treatment and prices vary depending on location.
Though one session does a lot, multiple treatments are needed for the best result — but the frequency really depends on your age, skin type, and concerns. Dr. Hayag explains that deeper wrinkles and severe acne scarring require more treatments in comparison to mild damage. For maintenance, she recommends one treatment per year, which is what I am planning on doing, too.
Fani 17 days after her treatment, wearing makeup but no foundation.
That said, experts agree that even a single treatment can significantly improve one's skin texture, scarring, and wrinkles. That's what happened in my case; I saw great results straight away. Despite not having many acne scars, the overall appearance of my skin has improved; it's glowing and smoother. If you believe beauty is pain, then fractional CO2 is well worth the itching, pain, and downtime.
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