This is why so many people eventually start exploring resurfacing solutions like the CO2 laser. When you first hear about it, the idea of a powerful fractional laser that removes layers of damaged skin may sound intense. But for the right person, CO2 laser resurfacing can deliver life-changing improvements especially for deep, indented scars that haven’t responded to anything else.
In this article, I’m going to walk you through exactly how CO2 laser works, the type of scars it treats best, how many sessions you may need, what kind of results you can realistically expect, and what the healing timeline looks like. My goal is to help you understand whether this treatment could genuinely help your skin and to make the decision with clarity rather than guesswork. Let’s begin by looking at how deep acne scars form, because understanding that makes it much easier to see why CO2 laser can be such a powerful solution.
What Exactly Are Deep Acne Scars?
Deep acne scars aren’t just marks on the skin. They are structural changes caused by severe inflammation during acne outbreaks. When inflammation destroys collagen, your skin loses support. Instead of healing flat and smooth, the skin sinks or dips, creating indented scars.
The most common deep acne scars include:
1. Ice Pick Scars
These scars look like small but very deep holes in the skin, almost like the skin was pierced with a sharp needle. They are narrow at the surface but extend deep into the dermis. Ice pick scars are some of the toughest scars to treat because of their depth.
2. Boxcar Scars
These scars are wider than ice pick scars and have sharply defined edges. They look like shallow pits or craters and often form on the cheeks or temples. Boxcar scars respond well to resurfacing because their edges can be smoothed.
3. Rolling Scars
Rolling scars create a wave-like appearance on the skin. They are caused by fibrous bands that pull the skin downwards from underneath. Rolling scars often require a combination of treatments, including subcision and resurfacing.
Even though the three scar types look different, they share one thing in common:
they sit deep in the skin, far beyond the reach of daily skincare.
This is where CO2 laser becomes relevant because it can reach layers that no serum or exfoliant ever could.
How CO2 Laser Works: A Deep Treatment for Deep Scars
A CO2 laser is an ablative, fractional resurfacing laser. That means it removes (“ablates”) tiny columns of skin tissue while leaving surrounding areas intact to speed up healing.
Here’s how CO2 laser helps deep acne scars:
1. It Removes Damaged Surface Skin
The laser vaporises micro-layers of the outer skin so that newer, healthier skin can take its place. By removing layers in a controlled way, the skin looks smoother as it regenerates.
2. It Heats the Deeper Dermis to Trigger Collagen Remodelling
Deep acne scars exist because the skin lost collagen.
CO2 laser heats the deeper dermis, which stimulates fibroblasts to create new collagen. This collagen fills the depressions over time.
3. It Breaks Down Scar Tissue
Laser beams can disrupt and soften rigid scar fibres, making them more flexible and less tethered.
4. It Improves Texture and Skin Tightness
As collagen increases, the overall surface becomes tighter, firmer, and more even.
The combined effect is skin that looks:
– smoother
– healthier
– tighter
– more uniform in tone and texture
For deep acne scars, this combination is essential because only resurfacing that reaches the dermis can create meaningful change.
Types of Deep Acne Scars That Respond Best to CO2 Laser
Even though CO2 laser is powerful, it’s not equally effective for all scar types. Here’s how it performs with each of the major deep scar categories.
1. Boxcar Scars Excellent Improvement
CO2 laser typically does very well with boxcar scars because the defined edges can be smoothed and softened. After resurfacing, the contrast between the “pit” and the surrounding skin blends more naturally.
2. Rolling Scars Good Results, Often with Subcision First
Rolling scars are caused by internal bands pulling the skin downward. A CO2 laser improves the surface texture, but for best results, those bands often need to be released through subcision first. When combined, the improvement can be dramatic.
3. Ice Pick Scars Moderate Results, Often Combined with Other Techniques
Ice pick scars are very deep and narrow. CO2 laser helps soften the edges and improve the appearance, but these scars often require a combination approach, such as TCA CROSS or punch excision. When combined properly, they respond well.
In summary, CO2 laser is strongest for boxcar scars, effective for rolling scars with extra support, and helpful for ice pick scars when layered with other methods.
How Much Improvement Can You Expect? (Realistic Outcomes)
Many people ask whether CO2 laser can “remove” deep acne scars completely.
The honest answer is: no treatment can erase deep scars 100%.
But CO2 laser can significantly improve the skin.
Here is what most patients experience:
40–70% improvement after one strong session
A single session can make a noticeable difference, especially for boxcar and rolling scars.
Up to 80–90% improvement after multiple sessions and combination therapy
When combined with subcision, microneedling, or chemical reconstruction techniques, the results can be transformative.
Progressive improvement for 6–12 months
Collagen continues to rebuild long after your treatment, so your skin may keep improving for a year.
Texture becomes smoother and softer
The skin often looks fresher, healthier, and more refined.
Factors that influence your results include:
– scar depth
– skin type
– healing ability
– aftercare routine
– whether combination treatments are used
– practitioner skill and device quality
If you enter treatment expecting smoother, firmer, more even skin rather than “perfect” skin you’re more likely to be delighted with the results.
How Many CO2 Laser Sessions Do You Need?
Not everyone needs the same number of sessions. Your scar type, depth, and skin’s healing capacity all play a role.
As a general rule:
Most people need 1–3 strong CO2 laser sessions
Some need only one powerful session, while others benefit from two or three spaced months apart.
Sessions are usually spaced 3–6 months apart
This allows the skin time to heal, regenerate, and produce collagen.
Combination therapy may increase effectiveness
Adding subcision, microneedling, or TCA CROSS can enhance the final result significantly.
Your clinician will assess your skin and recommend a treatment plan based on your goals.
What to Expect During the Treatment Session
If you’ve never had a CO2 laser treatment before, it can feel intimidating. But knowing what happens step-by-step makes everything easier.
Here’s what typically occurs during your session:
1. Consultation and Assessment
Your practitioner assesses your scar types, skin thickness, sensitivity, and suitability for laser.
This stage is crucial to choosing the right settings.
2. Numbing Cream Application
A high-strength numbing cream is applied and left on for 30–60 minutes.
This makes the procedure much more comfortable.
3. Eye Protection and Preparation
You’ll wear eye shields, and the skin is cleaned thoroughly.
4. Laser Passes Begin
The laser device is moved across the skin in sections.
You’ll feel a warm, prickling or snapping sensation.
5. Cooling and Post-Laser Care
A cooling device or cold air may be applied.
After the session, you may get an ointment to protect the skin.
6. Treatment Time
A full-face CO2 resurfacing session usually takes 30–60 minutes, depending on depth and density.
After treatment, the real journey the healing begins.
What the Healing Timeline Looks Like (Day by Day)
A CO2 laser is a powerful treatment, so the downtime can be between 7–14 days.
Here’s what you can expect in a typical healing timeline.
Day 1–2: Redness, Warmth, and Swelling
Your skin will be red, tight, and warm almost like a strong sunburn.
You may also experience swelling, especially around the eyes.
Day 3–5: Peeling and Crust Formation
The treated skin starts to peel and form tiny brown crusts.
This is completely normal. Do not pick or scratch.
Day 6–7: Significant Improvement in Appearance
Most of the peeling completes by day 7.
Your skin may still be pink, but it feels smoother.
Day 8–14: Returning to Normal
Redness fades gradually, especially with proper aftercare.
Makeup may be allowed after a week depending on your practitioner’s advice.
Week 2 onwards: Collagen Production Begins
Your skin starts repairing from within.
Scars gradually rise and soften as collagen forms.
Months 1–12: Continuous Improvement
This is when the real transformation becomes visible.
Texture smooths, scars become shallower, and the skin tone evens out.
Is CO2 Laser Safe for All Skin Types?
CO2 laser is most suitable for lighter skin tones (Fitzpatrick types I–III).
It can be used on deeper skin tones, but only with extreme caution and specialist expertise due to the risk of:
– post-inflammatory hyperpigmentation
– prolonged redness
– uneven healing
If you have a deeper skin tone, fractional CO2 may still be possible, but your clinician may recommend non-ablative lasers or microneedling RF instead.
Potential Side Effects
CO2 laser resurfacing is generally safe when performed by a skilled practitioner, but side effects can occur.
These may include:
– redness
– swelling
– crusting
– temporary darkening or lightening of the skin
– sensitivity
– minor bleeding
– infection (rare)
Following aftercare properly minimises these risks significantly.
Who Is a Good Candidate for CO2 Laser?
You may be a good candidate if:
– you have deep, indented acne scars
– you want a significant change in skin texture
– you’re in good overall health
– you understand the downtime
– you can avoid sun exposure during healing
– you prefer impactful results over mild treatments
You may not be a candidate if:
– you are pregnant
– you have active acne
– you have uncontrolled skin conditions
– you are prone to keloid scarring
– you cannot commit to downtime
– your skin tone poses a high risk for hyperpigmentation
Your clinic will advise you after a proper consultation.
Should You Combine CO2 Laser With Other Treatments?
In many cases, combination therapy delivers the best outcome for deep acne scars.
Some of the most effective combinations include:
1. CO2 Laser + Subcision
Perfect for rolling scars and tethered scars. Subcision releases the internal bands while CO2 resurfacing smooths the top.
2. CO2 Laser + TCA CROSS
Ideal for ice pick scars. TCA CROSS helps fill deep holes while CO2 blends the surface.
3. CO2 Laser + Microneedling RF
A good option for deeper skin tones or for those wanting staggered improvements.
4. CO2 Laser + Dermal Fillers
Collagen-stimulating fillers like Sculptra can complement CO2 by boosting volume.
If you want the best possible improvement, these layered approaches can deliver exceptional results.
What Results Look Like Before and After CO2 Laser
Even though every person’s skin is unique, most people see the following changes:
Before Treatment
– deep pits
– uneven texture
– skin laxity
– scars that create shadowed areas
– roughness
After CO2 Laser Treatment
– smoother texture
– reduced depth of scars
– tighter skin
– brighter complexion
– more even tone
– softened edges of pits
– fewer shadows
– improved confidence
It’s common to feel emotional when you see the skin you’ve been struggling with for years finally transform.
Preparing for Your CO2 Laser Treatment
To get the best outcome, preparation is essential.
Here are steps most practitioners recommend:
1. Avoid Sun Exposure for Several Weeks Before Treatment
Tanned or sun-damaged skin increases the risk of pigmentation problems.
2. Stop Retinoids and Strong Exfoliants Beforehand
These can increase sensitivity.
3. Treat Active Acne First
Laser resurfacing should not be done on inflamed or infected skin.
4. Follow Any Pre-Treatment Skincare Routine Provided
Some clinics prescribe pigmentation-preventing creams.
5. Stay Hydrated and Moisturised
Healthy skin heals faster.
When you prepare properly, your treatment becomes smoother and safer.
Aftercare Essentials
Aftercare plays a huge role in your final result.
Here are the most important guidelines:
Apply the recommended healing ointment
Usually several times a day for the first few days.
Avoid touching or scratching the skin
Peeling is normal but must not be disturbed.
Keep the skin moisturised and hydrated
Dryness slows healing.
Avoid direct sunlight
Wear SPF once your practitioner allows.
Avoid makeup until cleared
Typically after about 7–10 days.
Avoid exercise, heat, and steam rooms
Heat can worsen inflammation.
Follow your clinic’s full aftercare guide
Everyone’s skin is different.
When you respect the healing process, your outcome improves dramatically.
Cost of CO2 Laser Resurfacing for Acne Scars
The cost varies depending on:
– clinic location
– practitioner expertise
– size of the area
– number of sessions
– whether combination treatments are added
On average, a full-face CO2 laser session in the UK ranges from £500 to £3,000.
This seems like a big range, but the price usually reflects the strength and depth of the session.
A deeper, single session often costs more but may deliver stronger results.
FAQs:
1. Is CO2 laser painful?
Most people find CO2 laser tolerable because a strong numbing cream is applied beforehand. You may still feel a warm, prickling or snapping sensation as the laser pulses, but it is usually manageable. During the procedure, many clinics also use cooling air or devices to reduce discomfort. After the treatment, the skin can feel hot or sunburn-like for a few hours, which gradually settles as the healing ointment begins to soothe the skin.
2. How long does it take to see visible results after CO2 laser?
You will notice early improvements once the peeling phase ends, usually after the first week, but the real transformation takes time. Collagen production begins around the second week and continues for several months. Most people see meaningful, visible improvement between three and six months, with additional refinement continuing up to a year. This is because collagen slowly strengthens, smooths, and lifts the depressed scar areas over time.
3. Can CO2 laser completely remove deep acne scars?
No treatment can permanently erase deep acne scars, but CO2 laser can significantly reduce their appearance. Many patients achieve smoother, firmer, and more even skin after just one session, with improvements often ranging from 40–70%. For more dramatic results, multiple sessions or a combination approach can help achieve up to 80–90% improvement. The goal is not perfection, but noticeable softening, reduced depth, and a smoother texture overall.
4. How long does the downtime last after CO2 laser?
Most people experience about seven to fourteen days of visible downtime. The first few days involve redness, warmth, swelling, and crusting, which is normal. Peeling typically completes within a week, after which the skin remains pink for several more days. Makeup may be allowed after about a week depending on your practitioner’s advice. Although the surface heals in two weeks, the internal healing and collagen remodelling continue for months.
5. Is CO2 laser safe for darker skin tones?
CO2 laser can be more risky for deeper skin tones because of the higher chance of post-inflammatory hyperpigmentation. While it is not completely off-limits, it should only be performed by a specialist who has extensive experience treating darker complexions with ablative lasers. In many cases, milder alternatives like microneedling radiofrequency may be recommended first because they stimulate collagen without creating as much surface injury or pigment risk.
6. How should I prepare for a CO2 laser session?
Preparation is important because it reduces complications and improves your final results. You will usually be advised to avoid sun exposure for at least a few weeks beforehand, as tanned or recently burnt skin raises the risk of pigmentation issues. Strong exfoliants, retinoids, or acids may need to be stopped several days in advance to prevent sensitivity. Any active acne should be treated first, and your clinic may recommend pre-treatment skincare to strengthen the skin and reduce inflammation before the session.
7. When can I return to work after CO2 laser resurfacing?
This depends on your job and comfort with visible redness. If you work from home, you may be able to resume light tasks within a day or two. For in-office roles, most people prefer to return after seven to ten days when most crusting and peeling have settled. Even after returning to work, some residual pinkness may remain, but it can usually be covered with makeup once your practitioner confirms it is safe.
8. Are the results of CO2 laser permanent?
Yes, the collagen your body produces after the treatment is permanent, making the improvements long-lasting. However, your skin will still continue to age naturally. While the improvement in acne scars does not reverse, factors like ageing, sun exposure, and lifestyle habits can influence the skin’s overall quality over time. Some people choose maintenance treatments every few years to keep the skin firm and smooth.
9. Can CO2 laser be done if I still have active acne?
It is not recommended to undergo CO2 laser while active acne is present because inflammation and bacteria on the skin can interfere with healing and increase the risk of complications. The laser should be performed on calm, non-inflamed skin for the safest and most effective results. Your clinician may suggest treating acne first with medications or skincare so that resurfacing can be done on a stable, healthy base.
10. How do I know if CO2 laser is the right treatment for my scars?
The best way to determine this is through a professional assessment, where your scar type, depth, skin tone, sensitivity, and healing ability are evaluated. CO2 laser tends to work especially well for boxcar and rolling scars, while ice pick scars often require a combination of methods. If you are seeking strong improvement and are willing to commit to downtime and proper aftercare, CO2 laser may be an excellent choice. A specialist can guide you on whether you are suitable or if another treatment would be safer or more effective for your skin.
Final Thought: CO2 Laser for Acne Scars
Deep acne scars can be challenging to treat, especially when creams, serums, and lighter procedures no longer make a meaningful difference. CO2 laser resurfacing remains one of the most effective options for improving texture, softening scar depth, and stimulating long-term collagen renewal. With the right specialist, realistic expectations, and proper aftercare, many people achieve smoother, firmer, and noticeably clearer skin.
If you’re considering CO2 laser acne scar clinic in London, feel free to get in touch with us at the London Medical & Aesthetic Clinic. Our team can guide you through a personalised treatment plan and explain how this advanced laser technology can safely and effectively improve skin texture, smoothness, and overall appearance.
References:
1. Ptaszek, B., Czernecka, M. & Podsiadło, S. (2025) ‘The Use of a Fractional Laser in Acne Scar Treatment A Systematic Review’, Life, 15, 915. https://www.researchgate.net/publication/392417140_The_Use_of_a_Fractional_Laser_in_Acne_Scar_Treatment-A_Systematic_Review
2. Pan, Z., Tang, Y., Hua, H., Hou, Z. & Zhou, B. (2023) ‘“Multiple Mode Procedures” of Ultra-Pulse Fractional CO₂ Laser: A Novel Treatment Modality of Facial Atrophic Acne Scars’, Journal of Clinical Medicine, 12(13), 4388. https://www.mdpi.com/2077-0383/12/13/4388
3. Majid, I. (2014) ‘Fractional CO₂ Laser Resurfacing as Monotherapy in the Treatment of Acne Scars’, Journal of Cosmetic and Laser Therapy, [online]. https://pmc.ncbi.nlm.nih.gov/articles/PMC4134658/
4. Elcin, G. & Yalici-Armagan, B. (2017) ‘Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation’, Lasers in Medical Science, 32(9), pp. 2047–2054. https://pubmed.ncbi.nlm.nih.gov/28894992/
5. Anupama, Y. G. & Wahab, A. J. (2016) ‘Effectiveness of CO₂ laser with subcision in patients with acne scars’, Journal of Cosmetic Laser Therapy, 18(7), pp. 367–371. https://pubmed.ncbi.nlm.nih.gov/27231159/
