Published 20 October 2026 · Reviewed by Dr Sin Yong
What to expect at a fractional CO2 laser visit with Dr Sin Yong begins with preparation: acne controlled, no tan, actives paused, antiviral cover where there is a history of cold sores. The session is a mapped resurfacing under anaesthetic with heat and tightness afterwards, the first week is a deliberate wound healing by crusting and peeling, and the review is timed to when darkening would appear.
Short answerFractional CO2 creates a wound on purpose, so the visible healing is part of the treatment rather than a complication, and most of the work of preventing darkening happens before and after the laser rather than during it. This page sits under CO2 laser in Singapore; recovery phase by phase is on CO2 laser downtime.
Preparation for fractional CO2 starts at the consultation, which is a separate visit from the laser. Dr Sin Yong maps the scars by type, because a boxcar or shallow rolling scar is resurfaced while a tethered scar or ice-pick tract is released first by subcision or TCA CROSS; depth decides whether FSX or the S3 Resurfacing Lift is the right laser. History covers cold sores, keloid tendency, diabetes, immunosuppression, smoking, isotretinoin and photosensitising medicines, and the skin type is examined, because darkening is the risk most relevant to Fitzpatrick III to V skin. You leave with a written plan and the option of no treatment, or of a gentler tool that spares the surface.
Illustrative image — not a patient.
Between that visit and the laser the skin is brought to a settled state. Acne is brought under control, because resurfacing inflamed skin adds new marks to old. A tan is allowed to fade fully, and daily broad-spectrum sunscreen begins before the first visit. Retinoids and exfoliating acids are paused as advised. Where there is any history of cold sores, antiviral tablets are usually prescribed to cover the healing period, because a flare on freshly resurfaced skin is one of the more common problems recorded after deep fractional CO2. Where the reaction is uncertain, a test area may be treated first; the logic is on fractional CO2 in Asian skin.
What does the fractional CO2 session involve?
On the day the plan is confirmed and the scars are checked against the map. The skin is cleansed and anaesthetic is applied: topical for most areas, with local anaesthetic where the plan calls for deeper work over a scar field. Dr Sin Yong delivers the laser himself on the DEKA SmartXide Tetra Pro as the S3 Resurfacing Lift: the handpiece places a pattern of fine columns of vaporised skin with intact skin between them, and the depth of each column and the density of the pattern are set per scar and per skin type. In Fitzpatrick III to V skin density is the setting pulled back most, because coverage drives darkening more than depth.
Most people describe heat with each pass, building to a hot, tight feeling over a treated zone, rather than sharp pain; a scar field treated deeply is felt more than a broad shallow pass. The treated skin reddens and swells as the session proceeds, and pinpoint bleeding from the columns is expected. Afterwards an occlusive or healing ointment is applied, and you leave with written aftercare for the depth and density used.
“A fractional CO2 wound is one I make on purpose, so I do not get to call the healing a complication. The complication is the dark patch that arrives weeks later, and most of the work of preventing it is done before I pick up the handpiece.”
Dr Sin YongOn what a CO2 laser visit is really about
What does the first week of healing look like after CO2 laser?
Straight afterwards the skin is red, swollen and dotted with pinpoint bleeding, and it oozes a clear or straw-coloured fluid for a period. That is the expected appearance of a fractional wound, healing inward from the bridges of intact skin between the columns. Over the first evening the heat and tightness ease; the face is cleansed gently, the ointment is reapplied so the surface stays moist, and the head is raised overnight to limit swelling, which is most noticeable the next morning around the eyes and cheeks.
Over the following days the columns darken into a fine, sandpaper-like crust and the skin peels as new epidermis forms beneath; how long that takes depends on the depth and density used. The crusts shed on their own and are never picked, because picking is the surest route to a mark that outlasts the scar. Nothing goes on the skin but the cleanser and ointment the clinic named until the surface has closed; it is then pink, smooth and tight, and sunscreen goes on daily. What is expected and what is not, phase by phase, is on CO2 laser downtime; the checklist is on CO2 laser aftercare.
What needs a call
A cold sore, or a cluster of blisters, on resurfaced skin.
Yellow crusting, spreading redness, warmth, pus, or pain that increases instead of settling.
Any area that is not healing at the same pace as the rest.
How is darkening (PIH) prevented after fractional CO2?
Post-inflammatory hyperpigmentation is the complication that Fitzpatrick III to V skin is most prone to after resurfacing, and it is usually delayed: the surface closes, peeling finishes, the skin looks pink and clean, and then over the following weeks patches darken, most often over the cheeks and wherever the sun reaches. Prevention spans the whole sequence: the preparation already described and the density chosen for the skin type before the laser; moist, undisturbed healing and shade while the surface is open, because ultraviolet light on a healing wound is the strongest signal to the melanocytes.
Once the surface has closed, broad-spectrum sunscreen goes on daily and is reapplied outdoors, hats and shade are used, and strong sun, saunas and heat are avoided while the skin is pink. Pigment-suppressing creams are sometimes used around resurfacing in darker skin; the evidence is mixed, and whether one suits you is decided with the doctor. A patch that darkens is reviewed and managed, not treated over with more laser. Background on why the darkening follows and how settings are chosen is on post-inflammatory hyperpigmentation.
What happens at the CO2 laser review?
The review is timed to when darkening would appear rather than to the day the crusts come off, because a face that looks clean the day the peeling ends can still change. Dr Sin Yong checks that every zone has healed evenly, looks for pinkness that is slow to fade and for any patch that is darkening, stretches the skin over the scar field to see which scars have changed and which still tether, and compares the findings with the photographs in your record.
From that reading comes the next step in the sequence, which is timed to healed skin: a further resurfacing pass, a release step the laser cannot do, pico laser for pigment where the two coexist as pico laser with the S3 Resurfacing Lift explains, or nothing further. The wider plan by scar type is on acne scar treatment.
Your next step
1. MessageWhatsApp +65 8023 7170 with what is bothering you. A reply comes from the clinic, not a bot.
2. AssessmentDr Sin Yong examines you himself on Orchard Road, with ultrasound where earlier filler is involved.
3. A plan in writingWhat he would do, what he would not, the fee factors, and the option of no treatment.
Every treatment is performed by Dr Sin Yong personally. Singapore Medical Council registered · invited to share his clinical expertise internationally for CLASSYS, DEKA, Fotona, Hironic and Ilooda.
Book an assessment with Dr Sin Yong on Orchard Road; come without a tan and with your acne under control, so the scars can be mapped. How consultations work.
Acne is brought under control first, any tan is allowed to fade fully, daily sunscreen starts before the visit, and retinoids and exfoliating acids are paused as advised. Anyone with a history of cold sores says so, because antiviral tablets are usually prescribed to cover healing. A test area may be treated first where the reaction is uncertain.
Topical anaesthetic is used for most areas, with local anaesthetic where deeper work over a scar field is planned. Most people describe heat building to a hot, tight feeling over a treated zone rather than sharp pain, and a deeply treated scar field is felt more than a broad shallow pass.
Red, swollen and dotted with pinpoint bleeding on the day, with clear or straw-coloured ooze; swelling that is most noticeable the next morning; then a fine sandpaper-like crust that darkens and peels as new skin forms beneath. The crusts shed on their own and are never picked.
By density chosen for the skin type, preparation with no tan and controlled acne, moist undisturbed healing, shade while the surface is open, and daily broad-spectrum sunscreen once it has closed. A patch that darkens is reviewed and managed rather than treated over with more laser.
It is timed to when post-inflammatory darkening would appear, not to the day the crusts come off. Dr Sin Yong checks that every zone has healed evenly, looks for lingering pinkness or darkening, and stretches the skin to see which scars have changed and which still tether. The next step in the scar sequence, including no further laser, is decided from that reading.
References
The adverse events of deep fractional CO2: a retrospective study of 490 treatments in 374 patients. Lasers in Surgery and Medicine 43(6), 2011. source
The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers in Surgery and Medicine 39(5), 2007. source
Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians. Acta Dermato-Venereologica 95(2), 2015. source
About this page: written and medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last reviewed 20 October 2026 · Illustrative images only, not patients · Editorial policy
