In short
- The protocol is three sessions of intense pulsed light and three of fractional CO₂ laser, at one month, two months and three months after surgery.
- That schedule is not arbitrary. A 2025 meta-analysis of 14 trials and 492 patients found that starting within the first month improves the scar significantly, and that beyond three months the benefit is no longer significant.
- The two tools do different things: CO₂ works on the raised profile and the texture and pulsed light on the colour. In the trial that compared them, only the combined group improved significantly in both at once.
- The evidence is promising, not conclusive. The standard systematic review of early intervention found improvement in 6 of 16 studies in the proliferative phase and calls for higher-quality work before protocols are standardised.
- This does not erase a scar. It guides its maturing while it is still alive, which is the only time it can be influenced.
A scar is not removed: it is guided while it matures. Over the first few months the tissue is inflamed, produces collagen in a disorderly way and responds to what is done to it. After that it settles, and from then on what you have is what you keep.
This protocol of the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, is applied to the scars of recent surgery. It explains what is done, at exactly what point, why that point and not another, what the literature says about each element and what should not be expected.
The window: why the first month decides it
This is the most important part of this page, and the one almost nobody explains: in treating a surgical scar, the when weighs as much as the what.
A meta-analysis published in 2025 brought together 14 controlled trials with 492 participants on fractional CO₂ laser in surgical scars, and measured it:
- Starting in the first month after surgery improved the scar to a statistically significant degree — a mean difference of −1.66 (95% CI −2.31 to −1.01; p < 0.001).
- Starting beyond three months showed no significant benefit — a mean difference of −0.17 (95% CI −0.56 to 0.21; p = 0.37).
The explanation is biological. Re-epithelialisation is complete by the second or third week, and over the following weeks the scar is still immature: there is active inflammation and collagen is being laid down. Acting then means influencing how that tissue organises itself. Acting a year later means trying to reorganise something that has already closed.
From that comes the practical consequence of this whole page: if you have just had surgery, the window is open now and it closes by itself. It is not an emergency, but it is an opportunity with a date on it.
What each tool does
The protocol combines two devices because a scar has two different problems — the raised profile and the colour — and they are not corrected by the same thing.
Fractional CO₂ laser: the raised profile and the texture
It perforates the scar in microscopic columns spaced apart from one another, leaving intact skin around them to act as a reservoir for repair. That controlled stimulus reorganises the collagen and softens the tissue.
It is the best-supported technique of the group. The standard consensus document, signed by eight experts in JAMA Dermatology, concluded that ablative fractional laser is safe and effective in traumatic and burn scars, and that it should be used within combination therapy, not on its own.
Pulsed light: the colour
It acts on the vessels that make a recent scar look red or purple. That is a different target from the one above: it does not soften raised tissue, it takes away redness.
The randomised trial that compared the two approaches is explicit about what combining them adds: against the control group and against CO₂ alone, only the combined group improved to a statistically significant degree in both colour and texture. With one detail that should not be hidden: the difference in the overall score on the Manchester scale did not reach statistical significance.
The foundation: silicone and sun protection
This is not the ornament of the protocol, it is its floor. Silicone sheeting or gel and strict sun protection of the scar throughout its maturing are the most established measures there are, and without them the rest performs less well. A recent scar exposed to the sun pigments, and that pigmentation is genuinely difficult to reverse afterwards.
The schedule of the protocol
Three sessions of intense pulsed light and three of fractional CO₂ laser, spread over the first three months:
| When | What is done |
|---|---|
| One month after surgery | First session of pulsed light and first of fractional CO₂ |
| At two months | Second session of each |
| At three months | Third session of each |
In between, and from the moment the stitches come out, come the silicone and the sun protection, which do not stop when the sessions end: the scar goes on maturing for months.
The schedule coincides with the window the literature describes: the first session falls within the first month, which is where the meta-analysis finds the benefit, and the last is done at three months, right at the limit beyond which that benefit stops being significant.
It is a starting scheme, not a dogma. If the scar does better than expected the sessions are spaced out, and if a hypertrophic component appears the plan is reconsidered — that is where corticosteroid injection comes in, which is a different tool again.
What this protocol does not promise
This deserves to be said with the same figures used to argue the case above.
The standard systematic review of early laser intervention examined 25 studies and concluded that acting in the inflammatory, proliferative or remodelling phase “has the potential to reduce scar formation”. But the results were heterogeneous: there was improvement in 3 of 4 studies in the inflammatory phase, 6 of 16 in the proliferative phase and 2 of 5 in the remodelling phase. The authors expressly call for higher-quality studies before protocols are standardised.
Translated into what matters at the consultation:
- The scar does not disappear. The aim is for it to end up flatter, paler and less visible; never for it not to be there.
- There is no guarantee of result, and anyone offering one is not reading the same literature.
- The response depends on skin type, on the site, on the tension of the wound and on individual factors that cannot be controlled.
Who it is not applied to in the same way
- An active keloid: it is not a large hypertrophic scar, it is something else — it grows beyond the edge of the original wound — and its management starts elsewhere, usually with injection.
- Darker skin types: the risk of hyperpigmentation after laser is greater and calls for adjusted settings, more widely spaced sessions and the strictest sun protection.
- Irradiated skin or a history of healing problems: assessed case by case, and it may be advised against.
- Active infection in the area or a wound not fully closed: it is not treated until the skin is intact.
- Recent isotretinoin: the appropriate interval is observed before any ablative treatment.
Risks of the treatment
Both devices deposit energy in the skin and have predictable effects and real risks:
- Redness and swelling for a few days after each session, and a sensation like sunburn. That is to be expected, not a complication.
- Changes in pigmentation, both more and less, above all in darker skin and where there is sun exposure.
- A burn or a blister, uncommon but possible with any energy device.
- Infection or reactivation of a cold sore if an area with a history of it is treated.
- Worsening of the scar itself in patients with a tendency to keloid, which is why the prior assessment is not a formality.
Price
The full protocol — three sessions of pulsed light and three of fractional CO₂ laser — comes to around 800 to 1,400 €.
The difference between one end and the other depends above all on the size and the number of scars to be treated: an eyelid scar does not cost the same as the scar of a tummy tuck. The quotation is fixed at the assessment, with the scar in front of us.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
I had surgery a year ago. Is it no use now?
It is not that it is no use: it is that the benefit the literature shows for laser in surgical scars is concentrated in the first few months, and from three months onwards it stops being statistically significant. With a mature scar the approach is different and the result to be expected is smaller. It is assessed, but without selling what is not there.
Does it hurt?
The CO₂ sessions are uncomfortable and are done with a topical anaesthetic; pulsed light is better tolerated. Afterwards there is a sensation like sunburn for a few hours.
Can I have only one of the two?
You can, and sometimes it is indicated — if the scar is only red or only raised. What the trial that compared them says is that the combination was the only one that improved colour and texture at once.
How many sessions are really needed?
The protocol is three of each. The meta-analysis found that even a single session within the first month has an effect, although most of the trials used two or three.
Can it be started before the first month?
You have to wait until the skin is closed and intact. That is why the protocol starts at one month: it is the point at which the wound has re-epithelialised and the scar is still immature.
Sources
- Ji Q, Luo L, Ni J, Pu X, Qiu H, Wu D. Fractional CO2 Laser to Treat Surgical Scars: A Systematic Review and Meta-Analysis on Optimal Timing. J Cosmet Dermatol. 2025;24(1):e16708. PMID 39780524 — the time window: significant benefit within the first month, not significant from three months onwards.
- Daoud AA, Gianatasio C, Rudnick A, Michael M, Waibel JS. Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO2-Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial. Lasers Surg Med. 2019;51(8):678-685. PMID 31090087 — only the combined group improved significantly in colour and texture; the overall score did not reach significance.
- Karmisholt KE, Haerskjold A, Karlsmark T, Waibel J, Paasch U, Haedersdal M. Early laser intervention to reduce scar formation — a systematic review. J Eur Acad Dermatol Venereol. 2018;32(7):1099-1110. PMID 29419914 — 25 studies, heterogeneous results and an express call for higher-quality work.
- Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, Uebelhoer NS, Waibel JS. Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing: Consensus Report. JAMA Dermatol. 2014;150(2):187-193. PMID 24336931 — ablative fractional laser is safe and effective, and should be used within combination therapy.
- Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids. Plast Reconstr Surg. 2021. PMC8687618 — silicone, intralesional corticosteroid and scar maturation.
Book your consultation
If you have had surgery recently, the scar assessment is the moment to decide whether this protocol makes sense in your case. If it does not, we say so. Book an appointment at ICPM.
Clinical confirmation by the surgeon
Last medical review: 8 August 2026. This information is for general guidance and does not replace an individual medical assessment at a consultation.
