fractional co2 vs pico laser

“Doctor, I have acne scars. Which is better pico laser or co2 fractional laser?

I have 8 years of experience using lasers to treat acne scars, both fractional co2, and pico lasers. Which is better, fractional co2 vs. pico laser? A simple question. But to determine which laser system has the upper hand, we need to consider several factors, which include efficacy, recovery time, safety profile, and patient comfort.

What is a Fractional CO2 Laser?

Carbon dioxide (Co2) laser is an ablative and coagulative laser system. It can remove unwanted skin tissue and stop bleeding simultaneously. It is among the popular laser for skin resurfacing, anti-aging, and atrophic acne scars treatment.

How it works to improve acne scars:
The Fractional Co2 Laser system emits multiple small beams of laser targeted to the skin. The treated skin vapourises upon contact with laser energy. The heat generated stops bleeding and breaks down surrounding skin collagen. The skin inflammation and repair process kicks in, and over a couple of days to weeks, new skin cells and collagen structure form. The fractional Co2 Laser treatment improves the skin structure, elasticity, and acne scars’ appearance.

What is a Pico Laser?

Picosecond Nd-YAG laser, commonly known as pico laser, is a non-ablative laser system. The pico laser is a laser system designed for tattoo removal. Besides tattoo removal, this laser can help lighten skin pigmentation and acne scarring. It has gained tremendous popularity in recent years. Among the popular pico laser system are PicoWay, PicoSure, PicoStar, Discovery Pico, and Fotona StarWalker PQX. I am personally using the PicoStar, the third-generation pico laser

How it works to improve acne scars:
The fractionated pico laser creates a laser-to-skin reaction known as LIOB. The laser-induced optical breakdown creates microscopic bubbles within the skin epidermis and dermis laser. The microscopic injury within the skin structure initiates the repair mechanism, which leads to improved skin texture and treated acne scars.

Now, let us compare which is better for acne scars. Fractional co2 vs. Pico laser?

After using the fractional co2 laser for 8 years and the pico laser for 4 years, here’s my comment.

Patient comfort:
Fractional co2 laser creates a lot of heat during treatment. Without proper anesthesia, the treatment is painful. Although not painless, the pico laser is relatively more comfortable and tolerable. Hence, both lasers will require adequate local anesthesia to perform comfortably.

Recovery time:
Both fractional co2 and pico laser treatments will require time to heal. After the treatment, the skin will be reddish, mildly swollen, and scabbed. Generally, the fractional co2 treatment takes longer to recover. After the fractional co2 laser, the patient usually takes 7-10 days to heal, while the pico laser may only need 3-5 days. Among my patient, the downtime from pico laser is generally more favorable.

Adverse effect:
Adverse events are possible with both laser systems. However, the rates of adverse events from the pico laser are lesser. Fair skin patients generally have better tolerance to fractional co2 laser treatment. Proper post-laser care is crucial after fractional co2 laser treatment to avoid adverse effects.

Treatment result/efficacy:
From my clinical observation, compared to pico laser, the fractional co2 laser treatment gives better results for acne scars. My findings correspond to the results from several clinical studies.

“Ablative Laser seems to achieve the highest degree of efficacy, however, poses a higher risk of adverse effect.” [1]

“Non-ablative Fractional Lasers (Fractional Pico Laser) have much safer and yet effective in treating atrophic acne scars.” [1],[2]

Fractional co2 vs. Pico laser on acne scars, which is better?

While there is no clear winner here, fractional co2 lasers are more effective. However, pico laser treatments have a much safer profile and are yet effective in acne scars. Because I practice in Malaysia and generally deal with patients with tanned skin tones, I do use more pico laser for my acne scar treatment.

For a fair-skin patient who can accept a longer recovery time, I would be happy to suggest a fractional co2 laser. I will offer patients with tanned skin or who wish for a more rapid recovery the pico laser treatment.

Before deciding on laser treatment, do speak to your doctor. After an examination of your skin condition, your doctor should be able to advise you appropriately. As a saying goes, prevention is better than cure. Hence, it is much better to treat acne early than to deal with acne scars.