Key facts
- First 24 hours
- Cool compresses, gentle cleansing, bland ointment kept on; antiviral cover if prescribed; head raised
- First week
- Crusting and peeling shed on their own; no picking, actives, make-up or exercise that causes sweating
- Sun
- Shade and a hat while the surface is open; broad-spectrum sunscreen once it has closed, every day after
- Sleep
- Face-up with the head raised on two pillows; clean pillowcase each night
- Normal
- Redness, swelling, pinpoint bleeding, oozing, tightness, a sandpaper feel, then peeling; pinkness that fades slowly
- Call
- Thick yellow or oozing crusts, blisters, cold sore, increasing pain or heat, fever, skin darkening or a firm raised area
What should you do in the first 24 hours after CO2 laser?
In the first 24 hours after CO2 laser, treat your face as a fresh wound, because that is what fractional resurfacing creates. The DEKA SmartXide Tetra Pro vaporises microscopic columns of skin and leaves intact skin between them, so the surface is red, swollen, warm and may ooze or show pinpoint bleeding. Cool compresses with clean gauze soaked in cooled boiled water or saline, held gently for a few minutes at a time, ease the heat. Do not use ice directly on the skin.
Cleanse with lukewarm water and a very gentle cleanser or plain saline, using fingertips only, then pat dry with a clean towel kept for the face. Apply the bland ointment or recovery balm you were given in a thin, continuous layer and keep the surface moist at all times; a dry, cracked surface heals more slowly and scars more readily than a moist one. If antiviral tablets were prescribed because of a history of cold sores, take the full course as directed, whether or not you feel a tingle.
Rest with the head raised, avoid bending forward and avoid alcohol and hot drinks, which increase swelling. The written aftercare given before you leave is specific to the depth and density used and takes priority over this page.
What should you avoid in the first week after CO2 laser?
For the first week, do not pick, peel, rub or scrub. Fine crusting and then peeling develop as the microscopic channels close, and how long that takes depends on the depth and density used. Crusts that are pulled off early take new skin with them and are a common cause of patchy pigment or a small scar. Let them lift in the shower and on the pillow in their own time, and keep ointment on until the surface has closed.
No retinoids, exfoliating acids, vitamin C, brightening creams, scrubs, cleansing brushes or face masks until you are told the surface has healed, and no make-up over an open surface. No facials, microneedling, other lasers or injectables in the area, no swimming, saunas or steam, and no exercise that leaves you sweating, because sweat stings and bacteria thrive on a warm, moist surface. Keep hands, phones and pillowcases clean.
“The laser is only half the treatment. The pulse shape chosen for each scar is the other half.”
Dr Sin YongOn the DEKA Tetra Pro and the judgment applied through it
How should you handle sun, make-up, exercise and sleep?
Sun protection is the part of CO2 laser aftercare that cannot be relaxed, particularly in Fitzpatrick III to V skin under Singapore's year-round ultraviolet. While the surface is open, sunscreen is not applied; shade, a wide hat and staying indoors in the middle of the day do the work. Once the surface has closed and peeling has finished, a broad-spectrum sunscreen goes on every morning and is reapplied outdoors, for as long as the skin is pink, which is the window in which post-inflammatory hyperpigmentation forms.
Make-up waits until the surface has fully closed and peeling has finished. Mineral powder is kinder than liquid foundation when you restart, and brushes should be freshly washed. Exercise returns in stages: gentle walking once swelling is easing, harder exercise only once the surface has closed, because heat and sweat both prolong redness.
Sleep face-up with the head raised on two pillows for the first nights, which limits swelling and keeps the face off the fabric. Change the pillowcase each night while the surface is open.
What is normal after CO2 laser, and what is not?
Normal after fractional CO2 is redness, swelling, warmth, pinpoint bleeding and oozing in the first day or two, then tightness, a sandpaper or bronzed look, fine crusting and peeling, followed by new pink skin that gradually blends in. Swelling is often worse on the second morning than the first, especially around the eyes, and itching is common as the skin heals. Pinkness can persist for some time after peeling; how long depends on the depth and density used and on your skin.
Not normal is anything that suggests infection, a cold sore flare or a burn deeper than intended: crusts that become thick, yellow or honey-coloured, oozing that increases rather than dries, blisters, small painful clusters of sores around the mouth or elsewhere on the face, pain or heat that increases after the second day, redness spreading beyond the treated area, or fever. A retrospective study of 490 deep fractional CO2 treatments recorded adverse events after 13.6% of treatments, most often acne-like eruptions, cold sore outbreaks and bacterial or yeast infections, which is why these signs are looked for rather than waited out.
Darkening of the treated skin in the weeks after peeling is post-inflammatory hyperpigmentation, the risk that matters most in Asian skin; it is reviewed and managed rather than treated over, and sun protection is the main defence. A firm, raised or thickened area, or a patch that stays red far longer than the rest, is also reviewed promptly, because early scarring is easier to manage than established scarring. How density, energy and preparation are chosen to lower these risks is decided before treatment begins, and the Tetra Pro page sets out who should wait.
When should you call the clinic after CO2 laser?
Call or message +65 8023 7170 during clinic hours (Monday to Friday 10am to 8pm, Saturday 11am to 3pm), and say so if it is urgent, if you notice any of the following:
Crusts that are thick, yellow or honey-coloured, or oozing that increases rather than dries.
Blisters, or a cluster of small painful sores suggesting a cold sore.
Pain, heat or swelling that is increasing after the second day, or redness spreading beyond the treated area.
Fever, chills or feeling generally unwell.
Skin that is darkening after peeling, or a patch that stays red far longer than the rest.
A firm, raised or thickened area forming within the treated skin.
Outside clinic hours, fever with a spreading red, hot face needs a doctor the same day, and the complication care page sets out which signs go straight to a hospital emergency department. You will be told plainly whether what you describe is expected healing, needs to be seen, and how soon.
What happens at the review, and what comes next in a scar plan?
The review checks that the skin has healed before anything further is planned. Dr Sin Yong examines the treated area in good light, looks for pigment change, persistent redness or early scarring, and compares the skin with the photographs in your medical record. Collagen remodelling continues beneath the surface for months after the crusts have gone, so what you see at the first review is healing rather than the outcome.
Within the SCAR3 sequence, fractional CO2 is the resurfacing step, usually placed after subcision and TCA CROSS have released tethered scars and narrow tracts. The next step, if any, is timed to healed skin rather than to a calendar, and sun protection and acne control continue between stages. How fees are quoted for a staged plan is explained on the how we quote page.
