CO₂ laser recovery: how many days it really takes, and what changes if the treatment is aggressive

There is no such thing as “the recovery from the CO₂ laser”. There are two, and confusing them is the most common reason for someone being disappointed: the same commercial name covers a gentle fractional treatment, after which you lead an almost normal life within a few days, and an intense treatment, which means stopping and after which the skin takes weeks to look well. The machine is the same and so is the format — both are fractional; what changes is the density of points and the power used.

This page describes what happens in the skin in each case, which aftercare really influences the result and which signs mean you should seek advice before the scheduled check-up.

This page develops the aftercare for the fractional CO₂ laser. The adverse effects and changes in pigment have a page of their own at risks of the CO₂ laser.

Both are fractional: what changes is the density

CO₂ is an ablative laser: its energy is absorbed by the water in the tissue and vaporises the layer treated. Historically it was used in full field, vaporising the whole surface at once. It was effective, but the recovery was long and the risk high.

The fractional format divides the shot into hundreds of microcolumns and leaves intact skin between them. Those healthy islands act as a reservoir of cells: the repair advances from the sides of each column, not only from the outer edge of the treated area. That is the physical reason recovery is quicker.

Here is the key point that almost nobody explains properly: at ICPM the intense treatment is fractional too. There is no switch to full field. What is done is to raise the density of points and the power, so that it reaches deeper and treats more surface per session, but islands of intact skin still remain between the columns.

The consequence follows directly: the islands are narrower, so closure takes longer than with a gentle fractional treatment, but the skin still repairs from many fronts at once instead of having to close in from the edges of a flattened surface. Depth is gained without paying the price of full field.

The fractional treatment, day by day

This is the timeline explained in consultation for a fractional treatment. It is a guide: the area treated, the density and the settings shift it.

• The first 48-72 hours. Intense redness, the feeling of bad sunburn and swelling, which on the face tends to be more noticeable on waking. Gentle cleansing and an occlusive or healing cream, according to what has been prescribed.
• Days 3 to 7. The skin dries and flakes off in small dark crusts that trace the pattern of the treatment. They are not touched or picked off: picking them off is one of the few ways of turning a correct treatment into a mark.
• Second week. The flaking ends and a pinkness remains that gradually fades. Many patients can already wear make-up.
• The following weeks and months. The pinkness fades progressively and the new collagen goes on remodelling for months. The result is not judged at one month.

The intense treatment: what changes and what you gain

When the aim is not maintenance but a real change in the quality of the skin — fine lines around the eyes and the lip, sun-damaged skin, a dull surface with uneven texture — the density of points and the power are raised and it is resolved in one go, rather than stringing together several gentle sessions.

This is the timeline explained in consultation:

• Wounds and inflammation: about 9 to 14 days. This is the stretch in which the skin is repairing and has to be cared for as a wound, not as treated skin.
• Flaking: about two weeks more. The skin renews itself and sheds the treated tissue. It is the part that most surprises anyone expecting “a week and that’s it”.
• Redness: it can last months. It fades progressively, but it is the long phase and the one to accept before deciding.

What you gain in exchange, and why it is worth it:

• A single procedure instead of a calendar. The result is not spread over sessions months apart across half a year: it is concentrated in one procedure and from then on all that remains is to recover.
• It reaches a depth the gentle fractional treatment does not. Maintenance fractional treatment is comfortable, but it has a ceiling; when what you want is genuinely to change the quality of the surface, that ceiling shows.
• It is not full field, and that shortens the recovery. Because islands of intact skin are preserved between the columns, the repair has many more fronts to advance from than in a total ablative resurfacing, where the whole surface has been vaporised.
• The risk profile is better than that of the classic ablative laser too. The reference review on complications says so explicitly: the overall complication rate of fractional resurfacing is much lower than that of traditional ablative techniques. It is not that there are no risks — there are, and they are described separately — but the starting point is more favourable.
• The intensity can be graded. Density and power are adjusted to the skin type, the area and the days you have available, so it is not an all-or-nothing decision between “gentle” and “intense”.

Two points so as not to oversell:

• “Closed skin” and “presentable skin” are not the same thing. Closure marks when there is no longer a surface that has to be dressed; the residual redness is what determines when social life fully returns, and that runs to months.
• The timings are a guide. They depend on the density and power decided in your case, on the area and on your skin. They are settled in consultation, not before.

The first 48-72 hours: why the dressing matters

This is the stretch in which the skin is an open surface and in which care decisions have the most consequence.

Occlusive dressing regimes — keeping the area covered with a dressing or an occlusive layer for the first 48 to 72 hours — can speed up re-epithelialisation and reduce crusting, discomfort, redness and swelling, compared with leaving the wound open to the air. The particular regime, product and frequency are set by the team that carried out the treatment, because they depend on the depth applied and on the area.

What does not change in any case: the crusts are not picked off and no products are applied on one’s own initiative to skin that has not yet closed, including those that at another time would be suitable for that skin.

Sun protection is part of the treatment

This is where most of the result is decided and the point most underestimated.

The published recommendation is explicit: sun protection and sun avoidance must be kept up throughout the period of redness after the treatment, and their purpose is to keep post-inflammatory hyperpigmentation to a minimum. This is not cosmetic advice: it is what prevents a mark appearing where there was none before.

Two practical consequences:

• The calendar overrules impatience. If the redness lasts weeks, the sun protection lasts weeks.
• Summer is not a good time, and not because of the heat but because tanned skin before the treatment and foreseeable exposure afterwards are two of the factors that most raise the risk to the pigment.

Cold sores and infection: what is prevented and how

Reactivation of herpes simplex is one of the described complications of fractional resurfacing. In a series of 961 treatments with a non-ablative fractional laser, herpes simplex outbreaks appeared in 1.77% of treatments and acneiform eruptions in 1.87%, with an overall complication rate of 7.6% and no long-term sequelae.

In patients with a history of cold sores, antiviral prophylaxis is prescribed. The regimes described in the ablative resurfacing literature start the antiviral 24 hours before the treatment and keep it up until epithelialisation is complete, at around ten days. The particular regime — drug, dose and duration — is set by the doctor treating you; what is explained here is the reasoning, not a prescription.

What you can do and when

These are the questions that come up most often, and they deserve a frank answer: they depend on how your skin is doing, not on a table. The general rule is that each thing is resumed once the skin has closed and the redness allows it.

• Make-up. Not on open skin. Many patients go back to it in the second week after a fractional treatment; after an intense treatment, later.
• Sport. Sweat and heat on skin that has not yet closed do not help. It is resumed gradually.
• Swimming pool and sea. Avoided while the skin is not closed.
• Work. It depends above all on how much the appearance of your face matters to you during those days. With a gentle fractional treatment most people arrange it so as to have a few days with less social exposure; with an intense treatment you have to reckon on stopping.

The team will give you a timetable suited to what has been done to you. If anyone gives you one before the depth of the treatment has been decided, they are giving you a figure they cannot yet know.

Warning signs

Seek advice without waiting for the check-up if any of the following appears:

• pain that increases rather than decreases;
• discharge or a bad smell;
• fever;
• clusters of blisters, which may indicate herpes reactivation;
• an area that is clearly developing differently from the rest;
• redness that, instead of fading, intensifies after the first few weeks.

The review of complications of fractional resurfacing insists on a point that justifies this list: although the overall rate is lower than that of the traditional ablative laser, serious complications can develop, and many of them are potentially preventable if they are picked up early.

Frequently asked questions

How many days of recovery does the CO₂ laser need?

It depends on whether the treatment is gentle fractional or intense. With the gentle one, the crusting usually resolves within the first week and leaves a pinkness that fades in the second. With the intense one, the wounds and the inflammation heal in about 9 to 14 days, the flaking goes on for about two weeks more and the redness can last months.

When can I wear make-up?

Never on open skin. After a fractional treatment, many patients go back to it in the second week; after an aggressive resurfacing, considerably later. It is decided by the state of the skin at the check-up, not by the calendar.

How long does the redness last?

It is the most variable part and the one it is best to accept in advance. With the gentle fractional treatment it fades over the second week and the weeks after. With the intense one it can last months, fading progressively.

Can I pick the crusts off if they bother me?

No. It is one of the few ways of turning a correct treatment into a permanent mark.

Do I have to use sun protection even if I do not go outside?

The published recommendation is to keep up sun protection and sun avoidance throughout the period of redness, in order to keep later hyperpigmentation to a minimum. It is the measure that most protects the result.

Will I be given antivirals?

If you have a history of cold sores, antiviral prophylaxis is considered. The regimes described start the day before and are kept up until the skin has closed. The drug and dose are set by the doctor.

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 two factors that most raise the risk of a mark.

When is the result visible?

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

Sources

• Batra RS. Ablative laser resurfacing — postoperative care. Skin Therapy Lett. 2004;9(7):6-9. Occlusive dressing for 48-72 hours; antiviral prophylaxis from 24 hours beforehand until epithelialisation is complete; sun protection throughout the period of redness to keep post-inflammatory hyperpigmentation to a minimum. https://pubmed.ncbi.nlm.nih.gov/15334277/
• Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg. 2008;34(3):301-305. Complications in 7.6% of treatments; acneiform eruptions 1.87%; herpes simplex 1.77%. https://pubmed.ncbi.nlm.nih.gov/18190541/
• Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: a review. Dermatol Surg. 2010;36(3):299-306. https://pubmed.ncbi.nlm.nih.gov/20100273/
• Xu Y, Deng Y. Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars. Facial Plast Surg. 2018;34(2):205-219. Sessions, intervals and settings individualised for each patient. https://pubmed.ncbi.nlm.nih.gov/29304516/

Book your consultation

If you are considering a CO₂ laser and what is holding you back is the recovery time, that is exactly the conversation worth having in consultation: depending on the result you are looking for and the days you have available, the approach changes, and sometimes the answer is to have a gentler treatment or to wait for another time of year.

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.