CO2 Laser in Valencia: What It Treats and Recovery

In short

CO₂ is an ablative laser: it vaporises microcolumns of skin and leaves the skin around them intact. That healthy skin is what shortens recovery to 3–7 days, at the cost of needing several sessions.
The indication with most literature behind it is atrophic acne scarring: a systematic review of 30 studies supports it, with parameters and number of sessions individualised for each patient.
On a surgical scar, timing counts as much as the settings: starting within the first month reduces the scar significantly, while starting more than three months later showed no significant improvement.
In burn and traumatic scarring, a review of 23 studies found significant or clinically relevant improvement in 22 of them, with adverse effects that were infrequent and mild.
It does not correct laxity: the laser treats the skin; excess skin is removed. And in darker skin types it calls for conservative settings because of the risk of hyperpigmentation.

Fractional CO₂ laser does not “erase” anything: it creates microcolumns of controlled damage in the skin so that the body responds by making new collagen and reorganising the tissue. That is the whole idea, and both its results and its limits follow from it.

This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, explains what there is evidence it works for, what it does not, what recovery is really like — the part most often underestimated — and the situations in which it should not be done. It also explains how to check that the equipment you will be treated with is legal, something that in Spain has stopped being a theoretical question.

What is fractional CO₂ laser and how does it differ from the classic ablative laser?

CO₂ is an ablative laser: its energy is absorbed by the water in the tissues and vaporises the layer treated. In its classic form, fully ablative, it treated the entire surface of the skin at once. It was effective, but recovery was long and the risk of complications high.

The fractional format divides the pulse into hundreds of microcolumns and leaves skin intact between them. Those healthy islands act as a reservoir of cells and speed up repair. You gain safety and recovery time in exchange for generally needing more than one session.

The fractional format also allows two very different intensities, and both are carried out at the centre: light fractional, for more repeatable treatments with a short recovery, and intensive fractional, with a far higher density of points and more power, when the aim is a genuine change in the quality of the skin. Neither works in full field: there is always intact skin between the microcolumns, and that is what shortens recovery compared with classic ablative resurfacing. Both are explained below.

The two ways of using the same laser. With the classic ablative laser the whole surface is removed, so the skin can only repair itself from the edges of the treated area and recovery is long. With the fractional laser, separate microcolumns are vaporised: the intact skin left between them repopulates the area from within, which cuts social recovery to a few days at the cost of needing several sessions. Diagram by the Instituto de Cirugía Plástica del Mediterráneo.

What CO₂ laser treats and what it does not

It is worth separating what is supported by evidence from what is claimed in advertising.

Atrophic acne scarring

This is the indication with most literature behind it. A systematic review bringing together 30 studies published between 1987 and 2016 concludes that ablative fractional CO₂ is an effective treatment for acne scarring, and adds two important caveats: the parameters and number of sessions must be adjusted to each patient, and for ice pick scars — the narrowest and deepest — combined treatment should be considered rather than laser alone.

Surgical, traumatic and burn scars

A systematic review of 23 studies of ablative fractional laser in hypertrophic burn and traumatic scars found statistically significant or clinically relevant improvement in almost every variable measured in 22 of the 23 papers, with adverse effects that were infrequent and mild. The authors themselves warn that heterogeneity between studies made it impossible to pool the data, so the exact size of the improvement cannot be given as a single figure.

Texture, pores and photoageing

CO₂ acts on the quality of the skin surface and on fine lines. It is not a substitute for surgery: the laser treats the skin, not the laxity. If what you have too much of is tissue — a drooping eyelid, a sagging neck, a double chin — no laser is going to lift it, and promising otherwise is the most common way of disappointing a patient.

What it does not treat

It is not a treatment for melasma — there the approach is different and there is a real risk of making it worse —, it does not remove scars, it improves them, and it is not indicated over a pigmented lesion that has not been diagnosed first. A mark that changes, bleeds or itches is investigated; it is not treated with a laser.

The point almost nobody makes: with surgical scars, timing matters

If you have just had surgery, this matters to you more than anything else on this page.

A systematic review with meta-analysis published in 2025, focused specifically on when to start fractional CO₂ laser on surgical scars, concludes that starting within the first month after surgery significantly reduces the resulting scar, with better results than starting after twelve weeks. And it adds the other side: treatment applied more than three months after the operation showed no significant improvement in the scar.

On the number of sessions, the authors note that a single session within the first month already produces significant results, although most trials support two or three sessions or more.

The practical reading is simple: if you are going to have surgery and you are worried about the scar, the conversation about laser needs to happen before or just after the operation, not a year later when it is no longer in time to contribute as much.

The window almost nobody mentions. The 2025 meta-analysis on timing found that starting fractional CO₂ laser within the first month after surgery significantly reduces the scar, while starting it more than three months later showed no significant improvement. Between one and three months the decision is taken case by case. Diagram by the Instituto de Cirugía Plástica del Mediterráneo.

How we approach it: CO₂ and pulsed light together, not one or the other

In the early treatment of a scar, at ICPM we do not choose between CO₂ laser and pulsed light: we combine them, because they tackle different problems in the same scar.

Intense pulsed light targets the redness and the active scar, that is, the vascular and inflammatory component that dominates the first few months and that is what makes a scar show.
The CO₂ laser deals with the rest: the raised profile, the texture and the weave of the tissue.

Presenting them as alternatives is a common mistake in the information in circulation. On a recent scar they are complementary, and the sequence and the intervals between the two are part of the individual plan.

This is not a house preference: the strategy of adding an ablative fractional laser to a device aimed at the vascular component has been studied. A meta-analysis of nine studies and 247 patients concludes that combining fractional CO₂ laser with a vascular laser improves scar remodelling compared with using either one alone, with significant differences on the three usual assessment scales — POSAS, OSAS and Vancouver — and a favourable safety profile.

Two points worth making, because not making them would be selling more than there is:

The trials included in that meta-analysis use a pulsed dye laser as the vascular device, not intense pulsed light. Both act on haemoglobin and the principle is the same, but the direct evidence with IPL in this particular combination is thinner.
Not all the literature agrees. A 2025 systematic review focused on burn scars found better scores with the vascular device alone than with the combination. It is a reminder that the size of the benefit is still being defined.

What is well established is the clinical rationale: a recent scar has two distinct components, one vascular and inflammatory and the other structural, and each responds to a different technology. Treating only one leaves half the problem unaddressed.

On a surgical scar, fractional CO₂ does not work in the same way as it does on ageing skin: it is not trying to renew a surface but to reorganise the collagen of a tissue that is still forming. Which is why here timing matters as much as technique. If the surgery is recent, that idea is developed in the scar protocol after surgery, with the schedule and the data on the treatment window. Image from the Instituto de Cirugía Plástica del Mediterráneo.

Aggressive CO₂ resurfacing: when the aim is rejuvenation

Light fractional treatment is convenient, but it has a ceiling. When what you are after is not maintenance but a genuine change in the quality of the skin — fine lines around the eyes and the lip, sun-damaged skin, a dull surface with an uneven profile — the approach is aggressive CO₂ resurfacing: greater depth and density of treatment, in a single session, rather than several light ones.

The trade-off is an honest one and worth understanding before deciding:

You gain in the scale of the result, and it is resolved in one procedure rather than over a calendar of sessions.
You pay with a considerably longer recovery than light fractional treatment: more days of raw skin and dressings, and a residual redness that can last for weeks after the skin has closed.
The risk goes up: post-inflammatory hyperpigmentation, late hypopigmentation and, with badly adjusted settings, scarring, all become more likely the deeper you work.

This is therefore not an off-the-shelf treatment. It is a medical decision that depends on skin type, on the state of the skin, on your history and — very specifically — on whether the point you are at in life allows you to take on the social isolation it demands. Anyone who cannot stop is offered the fractional option, with the explanation that the result will be more gradual.

And the usual limit still applies: however deeply you work, a laser does not lift tissue. Resurfacing improves the surface; laxity has a different answer.

What a session is like

The session is planned around the particular skin: type, thickness, area, history of cold sores and what is to be corrected. There is no standard “CO₂ programme”.

Topical anaesthetic is applied and, depending on the intensity and the area, local infiltration may be added. The sensation during the pulse is one of heat and stinging. How long it takes depends on the surface area: a localised area is done in minutes; a whole face takes longer.

On the eyelid, CO₂ also has a surgical use: it can be used as a cutting tool in blepharoplasty, which is a different matter from treating the skin with a fractional laser. This is explained on the laser blepharoplasty in Valencia page.

Recovery, day by day

This is the part worth reading twice, because it is where expectations come unstuck.

First 48–72 hours. Intense redness, the sensation of bad sunburn and swelling, which on the face is usually more noticeable in the morning. Gentle cleansing and an occlusive or healing cream are prescribed.
Days 3 to 7. The skin dries out and flakes off in small dark crusts that trace the pattern of the treatment. They are not to be touched or picked off.
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 maturing for months. The result is not judged at one month.

Two non-negotiable rules: strict sun protection from day one and for months afterwards, because treated skin pigments easily, and no scratching. Lack of sun protection is the most common reason a mark appears where there was none before.

Risks, adverse effects and warning signs

This is a medical procedure, not a facial.

Post-inflammatory hyperpigmentation, more likely in darker skin types, with sun exposure or without adequate protection. It is usually temporary, but it can last months.
Hypopigmentation, less common and harder to correct.
Infection, including reactivation of herpes simplex. In patients with a history of cold sores, antiviral prophylaxis is prescribed.
Scarring, uncommon but possible, particularly with aggressive settings or in areas of thin skin.
Prolonged redness beyond what would be expected.

Come in to be seen if you develop increasing pain, discharge, a bad smell, fever, clustered blisters or an area that is behaving differently from the rest.

Who is not a good candidate

Tanned skin, or recent or imminent sun exposure.
Active infection in the area, including a herpes outbreak.
A history of keloids or hypertrophic scarring, which calls for a specific assessment.
Undiagnosed pigmented lesions.
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 darker skin type is not an absolute contraindication, but it does mean adjusting the settings and being especially careful with preparation and sun protection.

How to check that the equipment is legal

In September 2025 the Spanish Agency for Medicines and Medical Devices (AEMPS) reported the detection of a forged CE marking certificate attributed to the manufacturer Beijing Globalipl Development Co., Ltd., which produces intense pulsed light devices combined with diode laser and fractional CO₂ laser systems. The certificate manipulated the issue and expiry dates and falsely attributed approval to a German notified body.

The AEMPS asks practitioners to check whether they have these devices and to review their date of manufacture: the genuine certificate expired on 27 October 2023, so a device manufactured after that date falls outside it and its conformity must be verified with the distributor before it is used any further. Distributors are asked not to market the affected devices.

As a patient, you have every right to ask what equipment you will be treated with, who makes it and who operates it. A serious centre answers without discomfort.

Prices

The name “CO₂ laser” covers treatments that bear little resemblance to one another, and the price reflects that:

Type of treatment	Price
CoolPeel and superficial treatments	from €220
Full facial resurfacing under sedation	up to €4,900

Between one end and the other there is a wide range, and the difference is not the “quality of the laser”: it is the same machine. What changes is how much work is done and how — depth, area treated, number of passes, whether sedation is needed and the theatre time that implies. That is why, as a general rule, the more power and the larger the area, the higher the cost and the greater the results, and also the longer the recovery. A CoolPeel on a localised area and an aggressive full-face resurfacing are two different clinical decisions, as explained above.

That is why the price is not settled over the phone: it follows from the indication, and the indication follows from seeing the skin. The quotation is given in writing after the assessment and is not conditional on booking on the spot.

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Frequently asked questions

How many sessions do you need?

It depends on the indication and on how intensively the treatment is carried out. In acne scarring, the literature does not set a number: the parameters and the sessions are individualised. In recent surgical scars, a single session within the first month already shows significant results, although most trials support two or three. At the consultation an estimated number is proposed and reviewed according to how you respond.

Does it hurt?

During the session you feel heat and stinging, controlled with topical and, if needed, local anaesthetic. Afterwards the dominant sensation is not pain but burning, similar to bad sunburn, which eases over a few days with the prescribed regimen.

How many days of social life will I lose?

The awkward stretch is the first three to seven days, because of the redness and the flaking. Many patients wear make-up from the second week. If you have a date in the diary, plan with room to spare: this is not a treatment to have the week before an event.

Can it be done in summer?

It is not advised. The most important risk factor for pigmentation is the sun, and in summer exposure is hard to avoid. If the treatment cannot wait, sun protection has to be strict and sustained.

Does it work for laxity or a drooping eyelid?

No. The laser treats the quality of the skin; excess skin is dealt with by removing it. If the problem is laxity, the answer lies in surgery or, depending on the case, in other technologies. You can see the approach in FaceTite in Valencia and Morpheus8 in Valencia.

What if I have darker skin?

A darker skin type does not rule out treatment, but it changes the equation: there is more risk of post-inflammatory hyperpigmentation and the settings must be more conservative. It is assessed individually and the skin is prepared beforehand.

Can I have CO₂ laser if I am taking isotretinoin?

It depends on the format. A multidisciplinary consensus from 2017, covering 32 publications and 1,485 procedures, found insufficient evidence to delay fractional lasers in patients taking isotretinoin or who have recently taken it. That same consensus does advise against fully ablative laser while on the drug, but here CO₂ is always used in fractional format, so that warning does not affect the treatments offered. Even so, it is a conversation to have at the consultation, case by case.

Does it remove scars?

It improves them; it does not remove them. A treated scar is still a scar: it gains in texture, in colour and in how it blends with the skin around it. Anyone promising to make it disappear is not describing what a laser does.

Is it the same as pulsed light?

No, and the two are confused daily. CO₂ is an ablative laser that works on texture and scarring; pulsed light is not a laser and is aimed above all at colour: pigmentation and redness. They are compared in CO₂ laser or IPL: the differences.

So do I have to choose between CO₂ and pulsed light?

For a recent scar, no: they are combined. Pulsed light treats the redness and the active scar; CO₂ treats the raised profile and the texture. They are two different problems in the same tissue and are tackled at the same time, in a planned sequence.

What is aggressive resurfacing and how does it differ from light fractional treatment?

In the depth and density of the treatment, and therefore in the result and in the recovery. Light fractional treatment is done over several sessions with little disruption to normal life; aggressive resurfacing aims for a genuine change in the quality of the skin in a single procedure, at the cost of a considerably longer recovery and a residual redness that can last weeks. Which one is appropriate depends on your skin and on whether you can afford to stop.

How much does CO₂ laser cost in Valencia?

It depends on how much work is done: from €220 for a CoolPeel or a superficial treatment, up to €4,900 for a full facial resurfacing under sedation. The machine is the same; what changes is the depth, the area treated, the number of passes and whether sedation is needed, and the more power and the larger the area, the higher the cost and the greater the results, in exchange for a longer recovery. The quotation is given in writing after the assessment and is not conditional on booking on the spot.

And what if a complication arises?

Every case is assessed individually. If a complication arises from the treatment, it is managed at the centre without charging for the procedure again; minor refinements are usually included, at minimal cost. This is not a guarantee of result — medicine is an obligation of means, not of outcome — but a commitment to making it as easy as possible to deal with anything that comes up.

Sources

Xu Y, Deng Y. Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars. Facial Plast Surg. 2018;34(2):205-219. Systematic review of 30 studies. https://pubmed.ncbi.nlm.nih.gov/29304516/
Buhalog B, Moustafa F, Arkin L, et al. Ablative fractional laser treatment of hypertrophic burn and traumatic scars: a systematic review of the literature. Arch Dermatol Res. 2021. https://pubmed.ncbi.nlm.nih.gov/32926192/
Ji Q, Luo L, Ni J, et al. Fractional CO2 Laser to Treat Surgical Scars: A Systematic Review and Meta-Analysis on Optimal Timing. J Cosmet Dermatol. 2025. https://pubmed.ncbi.nlm.nih.gov/39780524/
Alghamdi MA, Alkhunein JS, Alali FK, et al. Combined Fractional CO2 and Pulsed Dye Laser Therapy for Scar Treatment: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2026. Nine studies, 247 patients; the combination outperforms monotherapy on POSAS, OSAS and Vancouver. https://pubmed.ncbi.nlm.nih.gov/41684553/
Li P, Zhang Q, Tao C, Liang H, Li D. Pulsed dye laser, fractional CO2 laser, or combination for burn scar treatment: a systematic review. Lasers Med Sci. 2025. A review which, in burn scars, finds no advantage of the combination over the vascular laser alone. https://pubmed.ncbi.nlm.nih.gov/41003790/
AEMPS. The AEMPS reports the detection of a forged CE marking certificate from the company Beijing Globalipl Development Co., Ltd. (in Spanish) https://www.aemps.gob.es/informa/la-aemps-informa-sobre-la-deteccion-de-un-certificado-de-marcado-ce-falsificado-de-la-empresa-beijing-globalipl-development-co-ltd/

Book your consultation

If you have acne scarring, a recent scar you want to treat in time, or you are unsure which technology fits your case, an in-person assessment is what makes it possible to decide. At that appointment the skin is examined, your history is reviewed and an estimated number of sessions and a realistic recovery are set out.

Clinical confirmation by the surgeon

Clinical review: Dr Elena García Vilariño and Dr Enrique Salmerón González, specialists in Plastic, Aesthetic and Reconstructive Surgery, registered with the Ilustre Colegio Oficial de Médicos de Valencia under numbers 46/4624503 and 46/4624077 respectively. Last medical review: 2 August 2026. This information is for guidance and does not replace an individual medical assessment in consultation.