In short
- They are not in competition. The CO₂ laser works on texture and scars; intense pulsed light works on colour. Choosing well means first identifying what it is that bothers you.
- If the problem is slackness or excess skin it is neither of the two, and that is the most expensive mistake of indication: however much energy is applied, a laser does not lift tissue.
- With a recent scar the question is not which: it has two problems at once — the redness of the active phase and the raised texture — and they are treated by combining the two technologies, not by choosing.
- A meta-analysis of 9 studies and 247 patients found that adding a device aimed at the vascular component to the CO₂ improves the remodelling compared with using one alone. The trials used pulsed dye laser, not intense pulsed light.
- Comparing the prices of one and the other does not help you decide, because they do not solve the same problem: the useful comparison is made within each technology and once the indication has been settled.
The question is usually put the wrong way round. They are not two versions of the same thing from which the better has to be chosen: they treat different problems. The CO₂ laser works on texture and scars; intense pulsed light works on colour. Choosing well means first identifying what bothers you.
This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, sets out how they differ, what to expect from each according to the available evidence and the cases in which the right answer is neither of the two.
The underlying difference, in one sentence
CO₂ is an ablative laser: it vaporises microcolumns of skin to force a repair with new collagen. IPL is not a laser: it is filtered broad-spectrum light, selectively absorbed by pigment and haemoglobin, and it vaporises nothing.
Everything else follows from that: CO₂ leaves a microscopic wound, requires days of recovery and remodels the surface of the skin; IPL does not break the skin, allows normal life almost immediately and acts on what you see, not on what you feel.
Comparison table
| Fractional CO₂ laser | Intense pulsed light (IPL) | |
|---|---|---|
| What it is | An ablative laser of a single wavelength | Filtered polychromatic light; not a laser |
| What it acts on | Texture, raised tissue, scars, wrinkles | Colour: marks, redness, superficial vessels |
| Best-supported indications | Atrophic acne scars; surgical, traumatic and burn scars | Lentigines and sun spots; telangiectasia and redness; photoageing |
| Does it break the skin? | Yes, microscopically | No |
| Social downtime | 3 to 7 days of redness and flaking | Hours of redness; the marks flake off over a few days |
| Usual number of sessions | Individually decided; in a recent surgical scar, 2-3 according to most trials | An average of 4.29 in the literature, ranging from 3 to 7 |
| Main risk | Post-inflammatory hyperpigmentation, infection, scarring | Burns, changes in pigment, eye injury without protection |
| In darker skin types | Requires conservative settings and preparation | Among the technologies with the lowest risk of hyperpigmentation in skin types IV-VI |
| What it does not do | Does not correct slackness or excess skin | Does not flatten a raised scar or correct slackness (it does treat the redness of an active scar) |
| With a recent scar | Treats the raised tissue and the texture | Treats the redness and the active phase |
| Price at ICPM | From €220 (CoolPeel) to €4,900 (facial resurfacing with sedation) | From €190 a session, with course discounts |
If your problem is colour
Sun spots, lentigines, diffuse redness, dilated vessels on the sides of the nose or the cheeks: that is IPL.
A systematic review of 16 studies with 637 participants concludes that intense pulsed light is effective in skin rejuvenation, with results on telangiectasia, redness, lentigines and hyperpigmentation, among others. The authors point out that there is no consensus on the settings and that nine of the sixteen studies were of low methodological quality: it works, but the literature does not allow a specific degree of improvement to be promised.
With melasma the approach changes: the evidence supports IPL within a combined treatment — a meta-analysis of 8 studies and 215 patients shows a significant reduction in the MASI index — never as a treatment on its own and always with strict sun protection.
If your problem is texture or a scar
Acne scars, a surgical scar, a burn scar, enlarged pores, uneven texture: that is CO₂.
A systematic review of 30 studies supports fractional CO₂ in atrophic acne scars, with settings and numbers of sessions decided individually and combined treatment for the narrowest, deepest scars. In hypertrophic burn scars and traumatic scars, another review of 23 studies found significant or clinically relevant improvement in 22 of them, with adverse effects uncommon and mild.
And there is a window of time that it is best not to miss. A 2025 meta-analysis focusing on optimal timing concludes that starting the CO₂ laser within the first month after surgery significantly reduces the scar, whereas starting it more than three months later showed no significant improvement. If you have just had an operation, the conversation is one to have now.
If your problem is slackness, it is neither of the two
This is the most expensive mistake of indication.
Neither the CO₂ laser nor intense pulsed light lifts tissue. A laser treats the skin; excess skin is removed. A drooping eyelid, a sagging neck or a double chin are not resolved with energy however much it is insisted upon: they are resolved with surgery or, in intermediate cases, with technologies aimed at slackness such as microneedling radiofrequency — see Morpheus8 treatment in Valencia — or subdermal radiofrequency — FaceTite treatment in Valencia.
When a clinic proposes a laser for a problem of slackness, either it has not examined properly or it is selling what it happens to have.
With a recent scar the question is not “which”: it is both
This is the most important point on the whole page, and the one almost nobody explains.
A recent scar has two problems at once, not one. It is red and active — a vascular and inflammatory component that dominates the first months and is what makes it most noticeable — and it has raised tissue and texture that set it apart from the surrounding skin. These are different targets and they respond to different technologies.
That is why at ICPM a recent scar is not treated by choosing, it is treated by combining:
- intense pulsed light is aimed at the redness and the active scar;
- the CO₂ laser deals with the raised tissue, the texture and the rest.
Presenting them as alternatives — “should I have laser or IPL for the scar?” — is to frame the problem wrongly. And there is some urgency: the meta-analysis quoted above places the useful window within the first month after surgery.
The evidence backs the approach. A meta-analysis of nine studies and 247 patients concludes that adding a device aimed at the vascular component to the fractional CO₂ laser improves the remodelling of the scar compared with using one alone, with significant differences on the POSAS, OSAS and Vancouver scales and a good safety profile.
With two qualifications we would rather state: the trials used pulsed dye laser as the vascular device, not intense pulsed light — they share a target, haemoglobin, but they are not the same machine — and a 2025 systematic review on burn scars found no advantage of the combination over the vascular device alone. The rationale for treating both components is sound; the exact size of the benefit is still being defined.
Outside scars the combination is also common, because problems rarely come alone: anyone with acne scars usually also has residual marks from the flare-ups. In that case they are not done on the same day or without a plan: the sequence, the intervals and the preparation of the skin are all part of the planning, and that planning is what distinguishes a medical treatment from a sale of sessions.
What they have in common: when neither is done
- Tanned skin, recent sun exposure or exposure expected in the near future.
- Undiagnosed pigmented lesions. A mark that has changed, bleeds or itches is investigated before it is treated, and that is the reason these treatments should be indicated from a medical consultation.
- Active infection in the area.
- An expectation of an immediate, definitive result in a single session.
How to check that the equipment is legal
This applies to both technologies. The Spanish Agency for Medicines and Medical Devices (AEMPS) reported the detection of a forged CE marking certificate attributed to Beijing Globalipl Development Co., Ltd., a manufacturer of intense pulsed light devices combined with diode laser and of fractional CO₂ laser systems. The certificate manipulated dates and falsely attributed approval to a German notified body. The AEMPS asked professionals to check their equipment and its dates of manufacture.
Asking what you are going to be treated with, who makes it and who operates it is reasonable. No serious clinic takes offence.
What each costs, and why comparing the prices does not help you choose
At ICPM, intense pulsed light starts at €190 a session, with courses that bring the price per session down. CO₂ ranges from €220 for a CoolPeel to €4,900 for a full facial resurfacing with sedation.
It is tempting to read those figures as a scale from less to more and conclude that the expensive one is the good one. It is not. They are treatments for different problems: paying €4,900 for a resurfacing does not fix a sun spot that intense pulsed light resolves, and no course of IPL, however long, flattens the raised tissue of an acne scar. Choosing on price is choosing on the wrong variable.
The comparison that does make sense is within each technology — a single session against a course, a CoolPeel against an aggressive resurfacing — and that comparison can only be made once the indication has been decided. Within CO₂, the more power and the larger the area, the higher the cost and the greater the results, in exchange for a longer recovery.
When the plan combines the two, as with a recent scar, the quotation is given together and in writing after the assessment.
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Frequently asked questions
Which is better, CO₂ or intense pulsed light?
Neither: they treat different things. If the problem is colour, IPL. If it is texture or a scar, CO₂. If it is slackness, neither of the two.
Does intense pulsed light remove acne scars?
Not on its own. It improves the redness and the marks left by flare-ups — which is a real part of the problem — but it does not act on the raised tissue, which is the province of CO₂. What works is combining the two, not choosing.
For a recent scar, CO₂ or intense pulsed light?
Both, and as soon as possible. Intense pulsed light treats the redness and the active phase; CO₂ treats the raised tissue. And timing matters: the evidence places the greatest benefit within the first month after surgery.
Does the CO₂ laser remove marks?
It can improve superficial pigmentation by renewing the skin, but that is neither its main indication nor the most efficient or safest route for an isolated mark. IPL is what that is for.
Which has the longer recovery?
CO₂, by some way: between three and seven days of redness and flaking. IPL allows normal life almost immediately, apart from a few days in which the treated marks darken.
Which is safer on darker skin?
In skin types IV to VI, intense pulsed light is among the technologies with the lowest risk of post-inflammatory hyperpigmentation. CO₂ can be done, but it requires more conservative settings, preparation of the skin and strict sun protection.
Can I have both?
Yes, with planning: not on the same day and with intervals respected. It is decided at the assessment according to which matters more in your case.
Can they be done in summer?
Neither of the two is advisable in summer. The sun is the main risk factor for marks appearing afterwards, with either of them.
What do they cost?
Intense pulsed light starts at €190 a session, with courses that bring the price per session down. The CO₂ laser ranges from €220 for a CoolPeel to €4,900 for a full facial resurfacing with sedation: the more power and the larger the area, the higher the cost and the greater the results, in exchange for a longer recovery. Comparing the price of one with the other does not help you choose, because they treat different problems; when the plan combines the two, the quotation is given together and in writing after the assessment.
Sources
- Xu Y, Deng Y. Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars. Facial Plast Surg. 2018;34(2):205-219. 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/
- Sales AFS, Pandolfo IL, Cruz MA, et al. Intense Pulsed Light on skin rejuvenation: a systematic review. Arch Dermatol Res. 2022. https://pubmed.ncbi.nlm.nih.gov/34609598/
- Yi J, Hong T, Zeng H, et al. A Meta-analysis-Based Assessment of Intense Pulsed Light for Treatment of Melasma. Aesthetic Plast Surg. 2020. https://pubmed.ncbi.nlm.nih.gov/32055937/
- Hu S, Atmakuri M, Rosenberg J. Adverse Events of Nonablative Lasers and Energy-Based Therapies in Subjects With Fitzpatrick Skin Phototypes IV to VI. Aesthet Surg J. 2022. https://pubmed.ncbi.nlm.nih.gov/35019139/
- 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. 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. 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/
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If you have reached this point still unsure, it is probably because your case has more than one component, which is the usual thing. An in-person assessment makes it possible to separate which part is colour, which part is texture and which part is slackness, and to decide in what order each is treated.
Clinical confirmation by the surgeon
Clinical review: Dr Enrique Salmerón González and Dr Elena García Vilariño, specialists in Plastic, Aesthetic and Reconstructive Surgery, registered with the Valencia Medical Council under numbers 46/4624077 and 46/4624503 respectively. Last medical review: 2 August 2026. This information is for general guidance and does not replace individual medical assessment in consultation.
Registration no. 46/4624077
Registration no. 46/4624503
