Ablative CO2 Laser: Treatment, Recovery & Results

Treatment type: Fully ablative laser skin resurfacing

Common concerns treated: Deep wrinkles, severe acne scars, significant sun damage, uneven skin texture, perioral lines

Procedure length: Typically 60–120 minutes depending on the treatment area

Anaesthetic: Local anaesthetic or sedation — topical numbing cream alone is not sufficient for fully ablative treatment

Recovery time: 10–14 days of initial healing, with redness that may persist for several weeks

Results visible: Significant improvement visible from 4–6 weeks, with continued collagen production over 6–12 months

Ablative CO2 laser treatment is the most intensive form of laser skin resurfacing, using a carbon dioxide laser to remove the entire outer layer of skin in the treated area. Unlike fractional CO2 laser which treats only a fraction of the skin’s surface at one time, fully ablative CO2 laser resurfacing treats 100% of the skin in the targeted area, removing damaged cells layer by layer and stimulating significant new collagen production during the healing process.

Because fully ablative CO2 laser penetrates deeper and treats the entire skin surface, it can produce more dramatic improvements in a single session than fractional treatment. This makes it particularly effective for deep wrinkles, severe acne scarring, significant sun damage and perioral lines. However the more intensive nature of the treatment means a longer recovery period of 10 to 14 days or more is required.

Fully ablative CO2 laser is considered an advanced procedure that should only be performed by highly experienced practitioners using surgical-grade laser equipment. It is not offered by all aesthetic clinics — patients should specifically seek out practitioners with a proven track record in ablative resurfacing.

Fully ablative and fractional CO2 laser both use carbon dioxide laser technology to resurface the skin and stimulate collagen production, but they differ significantly in the depth of treatment, the recovery required and the results achieved. Understanding the difference helps patients choose the most appropriate treatment for their skin concerns, lifestyle and tolerance for downtime.

For a detailed side-by-side comparison of fractional and ablative CO2 laser including recovery time, cost and suitability, see our Fractional vs Ablative CO2 Laser comparison table.

Fully ablative CO2 laser is particularly effective for skin concerns that require deep resurfacing and significant collagen remodelling. Because the laser removes the entire outer layer of skin in the treated area, it can address more severe and complex skin concerns than fractional treatment in a single session.

Common skin concerns treated with ablative CO2 laser include:

• Deep wrinkles and significant facial lines
• Severe acne scars including boxcar, rolling and ice pick scars
• Perioral lines (smokers lines around the mouth)
• Significant sun damage and photoageing
• Uneven skin texture and rough skin surface
• Surgical scars and hypertrophic scarring
• Skin laxity and crepey skin texture

Fully ablative CO2 laser requires particularly careful patient assessment before treatment, as the more intensive nature of the procedure carries a higher risk of side effects in certain skin types. Patients with darker or olive skin tones have a significantly higher risk of post-inflammatory hyperpigmentation following fully ablative treatment compared to fractional CO2 laser.

Skin type is assessed using the Fitzpatrick scale, which classifies skin from Type I (very fair) to Type VI (very dark). Fully ablative CO2 laser is most commonly recommended for Fitzpatrick Types I to III. Experienced practitioners may treat Type IV skin with adjusted settings and extensive pre-treatment preparation, but this requires specialist expertise and careful monitoring during recovery.

Patients with darker skin types considering laser resurfacing should seek practitioners with specific experience treating their skin tone. In many cases, fractional CO2 laser resurfacing with conservative settings may be a safer alternative, or a combination approach may be recommended.

During a consultation, a qualified practitioner will assess skin type, medical history and treatment goals to determine whether fully ablative CO2 laser is appropriate or whether an alternative approach would produce better results with lower risk.

Fully ablative CO2 laser is one of the most effective treatments available for severe acne scarring, particularly for deep atrophic scars including boxcar scars, rolling scars and ice pick scars that have not responded adequately to fractional laser or other treatments. By removing the entire outer layer of skin and stimulating deep collagen remodelling, fully ablative CO2 laser can produce dramatic improvements in skin texture and scarring that would typically require multiple fractional sessions to achieve.

Because fully ablative resurfacing removes 100% of the skin surface in the treated area, it is particularly effective for patients with widespread acne scarring affecting the overall texture and quality of the skin. The procedure allows the practitioner to precisely control the depth of resurfacing, targeting the deeper layers where scar tissue forms.

Some patients with complex acne scarring benefit from a combination approach — using surgical techniques such as subcision or punch excision to release tethered scars before performing fully ablative CO2 laser resurfacing to smooth the overall skin surface.

During a consultation, the practitioner will assess the depth, type and distribution of scarring to determine whether fully ablative CO2 laser is the most appropriate option, or whether fractional CO2 laser or a combination approach would produce better results for your specific scarring pattern.

Fully ablative CO2 laser resurfacing can produce some of the most dramatic skin transformation results available from any non-surgical aesthetic procedure. Before treatment, patients typically present with significant concerns such as deep wrinkles, severe acne scarring, extensive sun damage or perioral lines. After healing is complete, most patients notice a profound improvement in skin texture, tone and overall quality that continues to develop over several months.

Because fully ablative CO2 laser removes the entire outer layer of skin and stimulates deep collagen remodelling, results are typically more significant than those achieved with fractional treatment. Most patients see meaningful improvement from 4 to 6 weeks after treatment, with continued enhancement over 6 to 12 months as new collagen matures beneath the skin surface.

Common improvements seen in ablative CO2 laser before and after results include:

• Significant reduction in deep wrinkles and facial lines
• Dramatic improvement in acne scar texture and depth
• Near elimination of perioral lines in many patients
• Substantially more even skin tone and texture
• Reduced appearance of sun damage and pigmentation
• Improved skin firmness and overall skin quality

Results from fully ablative CO2 laser are generally long lasting — because the procedure stimulates the formation of new skin and collagen, many patients report sustained improvement for several years following treatment. For patients seeking improvement with shorter downtime, fractional CO2 laser resurfacing may be a more appropriate option.

Fully ablative CO2 laser treatment is typically more expensive than fractional CO2 laser resurfacing, reflecting the higher level of practitioner expertise required, the more intensive nature of the procedure, and the more significant results achieved. In the UK, fully ablative CO2 laser resurfacing typically costs between £1,000 and £3,500 per session. Full face ablative resurfacing performed by a highly experienced specialist practitioner will be towards the higher end of this range.

Because fully ablative CO2 laser typically produces significant improvement from a single session, the overall cost of treatment may compare favourably with the cumulative cost of multiple fractional CO2 laser sessions required to achieve similar results.

Factors that influence ablative CO2 laser cost include:

• Treatment area size and complexity
• Depth of resurfacing required
• Practitioner expertise and specialist experience
• Type of surgical-grade laser equipment used
• Anaesthetic requirements — local anaesthetic or sedation
• Aftercare products and follow-up appointments

When comparing prices for fully ablative CO2 laser, practitioner expertise should be the primary consideration. This is an advanced procedure that requires significant specialist experience to perform safely and effectively. Verify practitioner credentials through the Joint Council for Cosmetic Practitioners (JCCP), General Medical Council (GMC) or Save Face, and where possible seek practitioners who are members of the British Association of Aesthetic Plastic Surgeons (BAAPS) or British College of Aesthetic Medicine (BCAM).

Recovery after fully ablative CO2 laser resurfacing is more intensive than fractional treatment and requires careful planning and preparation. Because the laser removes the entire outer layer of skin in the treated area, the healing process takes longer and the visible signs of recovery are more pronounced during the first two weeks.

Patients should plan for a minimum of 10 to 14 days of visible recovery before returning to normal activities. During this period the skin will be red, swollen and raw as it regenerates. Most patients require someone to assist them during the first few days of recovery and should arrange time away from work and social commitments accordingly.

Aftercare following fully ablative CO2 laser resurfacing is more demanding than fractional treatment and must be followed carefully to support healing, minimise complications and achieve the best possible results.

Practitioners commonly recommend the following aftercare guidelines after fully ablative CO2 laser:

• Keep the skin clean and moisturised using the specific products recommended by your practitioner — do not use standard skincare products during early recovery
• Apply prescribed ointments or healing balms as directed to keep the skin surface moist and protected during the first week
• Avoid all sun exposure during recovery — the newly regenerated skin is extremely sensitive to UV damage
• Apply a high-SPF sunscreen every day once the skin has healed sufficiently — sun protection is essential for at least 6 months post-treatment
• Do not pick, scratch or peel the skin under any circumstances during recovery
• Avoid all heat exposure including saunas, steam rooms, hot baths and strenuous exercise for at least two weeks
• Attend all scheduled follow-up appointments — your practitioner needs to monitor healing closely after fully ablative treatment
• Sleep with your head elevated during the first few days to reduce swelling
• Take any prescribed medications including antivirals and antibiotics exactly as directed

Full recovery from fully ablative CO2 laser requires patience. Most patients see significant improvement from 4 to 6 weeks, but the skin continues to improve for up to 12 months as collagen remodelling progresses.

Fully ablative CO2 laser carries a higher risk profile than fractional treatment due to the more intensive nature of the procedure. Patients should be fully informed of potential risks and side effects before proceeding and should only undergo fully ablative treatment with a highly experienced practitioner.

Most patients experience significant redness, swelling and skin peeling during the first two weeks of recovery. These effects are a normal and expected part of the healing process following fully ablative resurfacing.

More serious side effects, while uncommon when the procedure is performed correctly, can include prolonged redness lasting several months, infection, changes in skin pigmentation and in rare cases scarring. The risk of complications is significantly higher when fully ablative CO2 laser is performed by inexperienced practitioners or using inadequate equipment.

Possible ablative CO2 laser side effects include:

• Significant redness and swelling during recovery
• Skin crusting and peeling as new skin forms
• Prolonged redness lasting weeks to months
• Post-inflammatory hyperpigmentation — particularly in darker skin types
• Hypopigmentation — permanent lightening of skin in treated areas
• Infection — requires immediate medical attention
• Reactivation of cold sores — antiviral medication is usually prescribed preventatively
• Scarring — rare but possible if aftercare is not followed correctly

Choosing a highly qualified and experienced practitioner is essential for fully ablative CO2 laser. For doctor-led clinics verify GMC registration. Check accreditation with the Joint Council for Cosmetic Practitioners (JCCP) or Save Face. Where possible seek practitioners who are members of the British Association of Aesthetic Plastic Surgeons (BAAPS) or British College of Aesthetic Medicine (BCAM). Care Quality Commission (CQC) registration is not currently mandatory for cosmetic laser clinics in England, but voluntary registration demonstrates a higher level of clinical governance.

Choosing the right clinic for fully ablative CO2 laser treatment is more critical than for most aesthetic procedures. Because fully ablative resurfacing is an intensive procedure with a significant recovery period and higher risk profile, practitioner expertise and clinic standards are paramount.

Not all aesthetic clinics offer fully ablative CO2 laser — many only offer fractional treatment. Patients seeking fully ablative resurfacing should specifically look for practitioners with a proven track record in ablative laser surgery and access to surgical-grade laser equipment.

When choosing an ablative CO2 laser clinic, consider:

• The practitioner’s specific experience and volume of fully ablative CO2 laser procedures performed
• Whether the clinic uses surgical-grade CO2 laser equipment — not all CO2 lasers are capable of true full ablation
• Whether the clinic carries out a thorough consultation including skin type assessment, medical history review and realistic expectation setting
• Whether antiviral and antibiotic prophylaxis is prescribed as standard — this is essential for ablative procedures
• Professional body membership such as the General Medical Council (GMC) for doctor-led clinics, British Association of Aesthetic Plastic Surgeons (BAAPS) or British College of Aesthetic Medicine (BCAM)
• Accreditation with the Joint Council for Cosmetic Practitioners (JCCP) or Save Face
• Voluntary Care Quality Commission (CQC) registration — not currently mandatory for cosmetic laser clinics but a strong indicator of clinical governance standards
• Clear aftercare protocols and follow-up support during recovery

Patients looking for fully ablative CO2 laser treatment can find experienced clinics across major UK cities. The Aesthetic Standard has reviewed and verified clinics offering ablative CO2 laser resurfacing in the following locations:

• Ablative CO2 Laser Clinics in London
• Ablative CO2 Laser Clinics in Manchester
• Ablative CO2 Laser Clinics in Birmingham

For patients considering their options, read our comparison of fractional vs ablative CO2 laser or visit our full CO2 laser treatment guide.

Fully ablative CO2 laser is best suited to patients with significant skin concerns who want dramatic improvement and are prepared for a more intensive recovery period. It is particularly appropriate for patients who have not achieved satisfactory results from fractional CO2 laser or other less invasive treatments.

Good candidates for fully ablative CO2 laser typically:

• Have deep wrinkles, severe acne scarring or significant sun damage
• Have fair to medium skin tones — Fitzpatrick Types I to III are most suitable
• Are in good overall health with no active skin infections or conditions
• Are not taking medications that affect wound healing or immune function
• Have no history of keloid scarring
• Are not pregnant or breastfeeding
• Can commit to a full 10 to 14 day recovery period with appropriate support
• Have realistic expectations and understand that results develop gradually over several months
• Are not prone to cold sores without antiviral medication cover — or are willing to take antiviral prophylaxis

Patients who want improvement but cannot commit to the recovery period required for fully ablative treatment may be better suited to fractional CO2 laser resurfacing, which offers meaningful results with a shorter recovery time of 3 to 7 days.