CO₂ laser for wrinkles and photoageing: which type of wrinkle improves and which needs something else

“Does the laser get rid of wrinkles?” is a question that cannot be answered yes or no, because the word wrinkle covers at least four different problems that are not treated with the same thing. There are wrinkles that depend on the muscle, others already etched in at rest, accumulated surface damage that is not exactly a wrinkle, and a sagging that is not a skin problem but tissue that is surplus.

The CO₂ laser works well in one part of that map and does nothing in another. This page explains which is which, so that the conversation at the appointment starts with the diagnosis and not with the machine.

This page expands on the rejuvenation indication for the fractional CO₂ laser. How long recovery takes according to the intensity used is in recovery day by day.

Four things we call “wrinkles”

• Dynamic wrinkle. It is produced by repeated contraction of the muscle: it appears when you make an expression and fades or disappears with the face at rest. The glabella, the forehead and crow’s feet are its classic sites.
• Static wrinkle. It is the next step. Over the years, that repeated fold leaves a permanent mark that is visible at rest too. It no longer depends on the muscle alone: there is a structural change in the skin.
• Texture and photoageing. Not one particular wrinkle but the general state of the surface: fine lines, enlarged pores, uneven relief, a dull and patchy tone from accumulated sun damage.
• Laxity and loss of volume. Here the problem is not on the surface: there is tissue that has descended or is surplus, and there are fat compartments that have lost volume. It shows in the jawline, the neck and the eyelid.

The distinction between the first two is well described in the literature: muscle tone at rest increases over a lifetime and gradually marks the skin, and if those wrinkles go untreated, the skin ends up showing a permanent mark. That is why treating the muscular component is indicated mainly for the dynamic wrinkle, while the static one, which reflects a structural change, does not improve in the same way from relaxing the muscle alone.

Where the CO₂ laser comes in

CO₂ is an ablative laser: it vaporises microcolumns of tissue and prompts a repair that remodels the surrounding skin. That places it squarely in the third group — texture, fine lines, photoageing — and gives it a partial role in the second.

• Texture and photoageing: this is its territory. An uneven surface, pores, fine lines and sun-damaged skin.
• Static wrinkle: improves, depending which. The more superficial it is and the more tied to skin quality, the better it responds. A deep, structural furrow responds less.
• Dynamic wrinkle: not its indication. The laser does not act on the muscle contraction that produces it.
• Laxity: no. And this is not a quibble, it is the hard limit of the treatment: however deeply it is worked, the laser does not lift tissue.

That last point is the source of most disappointments. Skin can be visibly better on the surface and still have exactly the same slackened jawline, because they are two different problems.

What the evidence says

A randomised, double-blind, split-face trial compared fractional CO₂ against fractional Er:YAG in 40 patients with facial wrinkles, with three monthly sessions and assessment by two independent dermatologists, plus an instrumental measure of skin biomechanics. Results:

• Both significantly reduced facial wrinkles, and the improvement was confirmed by the instrumental measure too.
• There was no appreciable difference between the two technologies in clinical outcome.
• No serious, lasting adverse effects appeared with either.
• Discomfort afterwards was greater with CO₂.

It is an honest result and it is worth reading in full: CO₂ works on facial wrinkles, and it is not the only technology able to do so. Er:YAG appears here because it is the comparator in that trial, not as an alternative offered at the clinic: at ICPM we work with the CO₂ laser. What is adjusted to the case is the intensity, the number of sessions and the area.

In the general picture, reviews in the field place ablative lasers in the role of precise tissue vaporisation and non-ablative ones in that of stimulating collagen by coagulation with less recovery, and describe the fractional format as the one that allows rejuvenation with less downtime. The practical reading is that the same device covers a wide range: the intensity used moves both the result and the days of recovery, and that decision is explained in recovery day by day.

When the answer is something else

This is the part that rarely appears on a page selling laser, and it is exactly the part that prevents the wrong treatment.

• If the wrinkle is dynamic, what is called for is acting on the muscle that produces it, and there the treatment is botulinum toxin. It is a prescription medicine: it is assessed and prescribed at an appointment, with its own contraindications, and it is not interchangeable with a surface treatment. It is described in botulinum toxin.
• If what there is is loss of volume — furrows that show because the support has dropped — the approach is to replace volume, not to treat the surface.
• If what is surplus is skin, the answer is surgical: a facelift for the mid and lower face and the neck, or blepharoplasty when the problem is in the eyelid.
• If the aim is tightening with less recovery, microneedling radiofrequency occupies a middle ground: it is described in microneedling radiofrequency.
• If what predominates is colour — patches, redness — and not relief, the technology is a different one: the comparison is in the comparison between CO₂ and intense pulsed light.

And often the right answer is more than one thing, in a particular order. What does not work is asking a single tool to solve all four problems.

The sun is both the cause and the limit

Photoageing is, by definition, damage accumulated through sun exposure. That has two consequences worth accepting before being treated:

• Sun protection afterwards is not cosmetic advice, it is what holds the result and what stops the treatment’s own inflammation leaving a patch where there was none before.
• The time of year matters. Tanned skin at the start and foreseeable exposure afterwards are the two factors that most raise the pigmentary risk. It is set out in the risks of the CO₂ laser.

If you go on sunbathing exactly as before, the damage accumulates again. The treatment improves the starting point; it does not change habits.

When we do not offer it

• Tanned skin, recent sun exposure or exposure expected in the near future.
• Active infection in the area, including a herpes outbreak.
• A history of keloid or hypertrophic scarring, which calls for a specific assessment.
• Undiagnosed pigmented lesions in the area to be treated.
• The expectation that a laser will replace surgery for laxity.
• Being unable to take on the recovery time at this point in your life.

A higher skin phototype does not contraindicate the treatment, but it changes the settings, the preparation and the conversation about risks beforehand.

Frequently asked questions

Does the CO₂ laser get rid of wrinkles?

It improves the ones that depend on skin quality: fine lines, texture and photoageing, and partly the static wrinkle. It does not act on the dynamic wrinkle, which depends on the muscle, nor on laxity.

What is the difference between a dynamic and a static wrinkle?

The dynamic one appears when you make an expression and fades with the face at rest. The static one stays visible at rest, because the repeated fold has left a permanent mark in the skin.

Will it lift my jawline or my eyelid?

No. The laser treats the skin, not laxity. If what is surplus is tissue, the answer is surgical, and promising otherwise is the commonest way of disappointing a patient.

Which is better, CO₂ or Er:YAG?

In the comparative trial available, with 40 patients and three sessions, both significantly reduced wrinkles with no appreciable difference between them; CO₂ proved more uncomfortable during the session. That is information from the literature: at ICPM the device we work with is the CO₂ laser.

How many sessions do you need?

It depends on the intensity used: a gentle approach is spread over several sessions and an intense one is concentrated into a single treatment with more recovery. It is decided at the appointment, not from a catalogue.

When is the result visible?

The skin improves once the redness settles, but collagen goes on remodelling for months. The result is not judged at one month.

Can it be done in summer?

It is the worst time of year, and not because of the heat: because of the tan beforehand and the exposure afterwards, which are the factors that most raise the risk of a pigmented patch.

Can I combine it with other treatments?

It is common, because the problems usually coexist. What changes is the order and the intervals, and that is part of the individual plan.

Sources

• Robati RM, Asadi E. Efficacy and safety of fractional CO₂ laser versus fractional Er:YAG laser in the treatment of facial skin wrinkles. Lasers Med Sci. 2017. Randomised, double-blind, split-face trial with 40 patients and three monthly sessions: both lasers significantly reduced facial wrinkles, with no appreciable difference between them and no serious lasting adverse effects, with greater discomfort after CO₂. https://pubmed.ncbi.nlm.nih.gov/27885522/
• Camargo CP, Xia J, Costa CS, et al. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev. 2021;7:CD011301. Describes how muscle tone at rest gradually marks the skin and how, without treatment, those wrinkles leave a permanent mark (the static wrinkle); addressing the muscular component is indicated mainly for the dynamic wrinkle. https://pubmed.ncbi.nlm.nih.gov/34224576/
• Haykal D, Cartier H, Goldberg D, Gold M. Advancements in laser technologies for skin rejuvenation: A comprehensive review of efficacy and safety. J Cosmet Dermatol. 2024. Ablative lasers vaporise tissue precisely and non-ablative ones act by coagulation, stimulating collagen with less recovery; the fractional format allows rejuvenation with less downtime. https://pubmed.ncbi.nlm.nih.gov/39158413/
• Alexiades-Armenakas M, Sarnoff D, Gotkin R, Sadick N. Multi-center clinical study and review of fractional ablative CO2 laser resurfacing for the treatment of rhytides, photoaging, scars and striae. J Drugs Dermatol. 2011;10(4):352-362. Fractional ablative lasers offer a better balance between safety and efficacy than standard ablative resurfacing. https://pubmed.ncbi.nlm.nih.gov/21455544/
• Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: a review. Dermatol Surg. 2010;36(3):299-306. A greater likelihood of complications in sensitive skin areas, darker phototypes and predisposing medical risk factors. https://pubmed.ncbi.nlm.nih.gov/20100273/

Book your consultation

If you can see wrinkles and do not know what type they are, that is exactly the conversation of a first appointment: the skin is examined at rest and in movement, which type predominates is identified, and we explain what is called for — including the possibility that the laser is not the tool, or is not the first one.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 23 August 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.