Key facts
- Treatment day
- Redness, swelling, pinpoint bleeding and oozing are expected and are part of healing
- Following days
- Crusting and peeling develop and shed on their own; no picking
- Settling
- Pinkness fades gradually; collagen remodels beneath for longer than the surface takes to close
- Needs a call
- Thick yellow or oozing crusts, blisters, increasing pain, swelling or warmth, spreading redness, fever
- Sun
- Strict protection throughout; darkening is the risk most relevant to Asian skin
- Make-up
- Only once the surface has closed and you have been told it is safe
What happens on the day of a fractional CO2 laser?
On the day of a fractional CO2 laser the treated skin is red, swollen and dotted with pinpoint bleeding, and it oozes a clear or straw-coloured fluid for a period afterwards. That is the expected appearance of a fractional wound, not a complication: the laser has vaporised fine columns of skin and left intact skin between them, and the surface is beginning to heal from those bridges. Topical or local anaesthetic is used beforehand, and most people describe heat and tightness afterwards rather than pain. The platform and protocol are described on the Tetra Pro fractional CO2 page.
You leave with written aftercare that sets out how to cleanse, what to apply, what to avoid and which signs to report. Where there is a history of cold sores, antiviral cover is started before treatment, because a flare on freshly resurfaced skin is one of the more common problems recorded after deep fractional CO2.
What do the first days look like?
Over the following days the oozing settles and the surface darkens to a bronzed, sandpaper-like crust as the treated columns dry. The skin feels tight and can itch; swelling is usually greatest in the first mornings, particularly around the eyes, and eases through the day. The crust then flakes and peels on its own, revealing pink new skin underneath. How many days each stage takes depends on how deep and how dense the treatment was: a light pass over texture heals faster than a deep pass over established boxcar scars.
Care in this phase is deliberately plain: gentle cleansing, a bland moisturiser or the ointment advised, sleeping with the head raised, and no picking. Scrubs, exfoliating acids, retinoids and vitamin C are set aside until you are told to restart them. Picking a crust off early exposes skin that is not ready and is the commonest cause of a mark that outlasts the rest of the healing.
“The laser is only half the treatment. The pulse shape chosen for each scar is the other half.”
Dr Sin YongOn planning fractional CO2 for acne scars
What is expected, and what needs a call?
Expected: redness, swelling, oozing, bronzing, crusting, peeling, tightness, itch and pinkness that fades over time. Needs a call: crusts that become thick, yellow or weepy; blisters; pain, swelling or warmth that is increasing rather than settling; redness that spreads beyond the treated area; fever; or a cluster of small blisters suggesting a cold sore. These point to infection, a burn or a viral flare, and each is treated more easily early. Contact the clinic on +65 8023 7170 during clinic hours; outside hours, urgent signs go to an emergency department, as the complication care page explains.
Darkening that appears after the skin has healed is usually post-inflammatory hyperpigmentation, more likely in Asian skin and after sun exposure. It is reviewed rather than treated over, and strict sun protection matters in the meantime.
When can make-up and sun exposure resume after CO2 laser?
Make-up waits until the surface has closed and you have been told it is safe, because applying it over open micro-wounds introduces bacteria and traps debris. Mineral products are usually the first permitted. Sun is the larger issue: resurfaced skin is more vulnerable to ultraviolet light for longer than it looks, and in Singapore's climate the risk of darkening is the reason sun protection is treated as part of the treatment rather than aftercare. Shade, a hat and avoidance of direct sun apply from the start; broad-spectrum sunscreen is added once the skin has re-epithelialised and you are told to use it.
How should you plan work and social commitments?
Plan on the basis that the crusting and peeling phase is visible and not concealable with make-up, and schedule treatment when you can be at home or on video with the camera off for that period. Exercise, swimming, saunas and anything that heats or soaks the skin wait until the surface has closed. Travel to a hot or sunny destination is better placed well after, not during, the healing phase. What that means for your diary depends on the depth planned, and it is discussed honestly before treatment, as set out under what happens at a consultation.
What happens at review, and what does pinkness mean?
Pinkness after the surface has closed is new skin with a rich blood supply, and it fades gradually; it is not the result, and it is not a problem unless it is spreading or painful. At review the healed skin is checked for pigment change, for any delayed healing, and for how the scars have responded, and the next step in the scar plan is timed to the healed skin rather than to the calendar. Where fractional CO2 is one stage of a sequence, the acne scar treatment page explains how release, support and resurfacing are ordered.
