The CO2RE (by Candela) Carbon Dioxide (C02) Fractional Laser Resurfacing removes layers of skin tissue in a fractionated method (columns of skin are removed, leaving the skin surrounding each column intact to aid in healing) to help reduce “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer of the face, neck, and chest.
CO2RE is the best treatment if you wish to get the most results with one treatment. If you have the ability to take some time to heal (7-14 days), having this one treatment is like having multiple other non-invasive treatments at once. It is also the best single treatment for advanced skin damage and wrinkling.
CO2RE is an in-office procedure that requires pre and post-treatment medications to ensure proper healing and comfort during the procedure. Discomfort varies on the depth of the treatment. For your comfort during the treatment, we may apply a topical anesthetic or inject local anesthetic and/or tumescent anesthetic and prescribe sedative medications to reduce discomfort. After the treatment most patients describe the post-procedure feeling as a bad sunburn for about 12 hours to 2 days. Please also follow the instructions for all other prescribed pain medication is needed post treatment. We also recommend pain or relaxation medications prior to treatment therefore you will need to have somebody drive you home after treatment.
Typically one laser treatment with C02RE is recommended. Occasionally, in an area that cannot be treated aggressively, we may need to do more than one treatment to optimize results. Maintenance treatments may also be necessary to maintain results, especially if sun is not avoided or proper skin care used. Occasionally, even with the best care, another treatment may be necessary in a few years (in the area around the eyes, it may only be 1-2 years).
How do I know if I need CO2RE?
Anyone who has sun damaged, aging skin, irregularly pigmented skin, wrinkles, sagging, irregular texture of the skin or other skin condition that could be expected to be improved with this treatment that understands the risks, costs and time necessary to achieve the full benefit of the procedure and who has realistic expectations of the ultimate outcome.
This is not a good treatment for skin of color. The reason is that this is an aggressive treatment that does result in prolonged healing of the surface. Pigmented skin tends to heal with hyperpigmentation and that does occur with this procedure upwards of 30% of the time. It can take many months of topical treatments and sometimes additional laser treatments to correct this. If this treatment is to be undertaken on dark skin, it will need to be part of a series of gentler treatments and not a single treatment.
This is also not a treatment for any woman who is pregnant or anyone who has been treated with isotretinoin (or Accutane) within 6 months. In addition, if there are any conditions resulting in delayed or abnormal healing or a history of cold sores or herpes virus it is important to tell your physician at the pre-treatment stage to prevent complications.
How does CO2RE work?
The C02RE (by Candela) Carbon Dioxide (C02) Fractional Laser Resurfacing removes layers of skin tissue in a fractionated method (columns of skin are removed, leaving the skin surrounding each column intact to aid in healing) to help reduce “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer of the face, neck, and chest.
What benefits can I expect?
Results that are expected are a very significant and noticeable reduction in the components of sun damaged skin such as “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer. The skin will continue to improve for a period of 6 months following the procedure provided proper skincare is used and sun exposure is minimized. Sometimes the results are not significant until the 6th and even the 9th month, depending on the person’s age, their aftercare routine and their history of smoking
What are the risks and side effects?
The main negative of the CO2RE is the downtime. Depending on the area and the aggressiveness of the treatment, it will take 7-14 days for the skin to heal. This downtime will include significant redness crusting (possibly minor bleeding and oozing depending on treatment depth), dryness, and peeling and flaking (it is important to keep the skin moist after treatment). This does mean that social and work activities will have to be curtailed during this time, although you should be perfectly capable of working from home after the first day or two. It could be a very painful procedure but at Advanced Dermatology we provide full facial anesthesia so there should be no or minimal pain during the procedure or even in the hours following it. Other potential side effects may include but are not limited to: skin wound, infection and scarring, hypo and hyper-pigmentation.
Prior to treatment all potential risks and side effects will be discussed with you by your medical provider and cosmetic coordinator.
How will I look and feel after the treatment?
After the treatment, you will go home and sleep mostly for the first day. After the first day your skin will be raw and you will follow the instructions as to how to keep it healing maximally. We usually see you in the office on the first, second or third day after the procedure to ensure that healing is going according to plan. By the 7th day you can usually apply makeup or venture out in public, but your skin will still be pink and will be very sensitive for the better part of 1-3 months. It is most important to follow the instructions given to you by your provider. A strict skincare regimen and sun avoidance is recommended for best healing and optimal results for a period of 6 months following treatment. Failure to do so may result in sub-optimal results or side effects such as listed above.
Your skin will continue to age as time goes on due to sun exposure, environmental stress, overall health and lifestyle choices such as smoking. To maintain your results we recommend a healthy skincare routine including cosmeceutical products, medical grade facials, and other procedures as directed by your provider.
Is there another way to get the same effect?
Alternatives to the CO2RE Fractional Laser Resurfacing treatment include photodynamic photorejuvenation (using Levulan with IPL), Fraxel laser, E3 (Ematrix with Sublime and IPL) or other brands of C02 Laser resurfacing. Typically, there are no other treatments that can give you as much of an overall effect with only one treatment. You would have to combine the above with fillers or tissue tightening devices to achieve similar effects.
Can this be combined with other treatments?
CO2RE can be combined with other treatments although we cannot do other treatments in the same area(s) treated on the same day. Many choose to have Wrinkle Relaxers such as BOTOX Cosmetic, Dysport or Xeomin to reduce unwanted wrinkles caused by muscle contraction in addition to having Dermal Fillers such as Restylane, Restylane Lyft, Juvederm and Belotero to plump and fill areas where volume has been lost such as the cheeks, nasolabial folds, lower eyelids and lips. We may recommend botulinum toxin 2 weeks prior to the treatment as studies have shown that this may enhance the effect on wrinkles caused by movement, but we typically wait one month before or after doing fillers.
What is the cost of CO2RE?
Depending on the area treated the cost of a CO2RE treatment ranges from $1250 to $3500. If multiple areas are treated (such as adding on neck and chest), this may be more.
To learn more about CO2RE, please call 618-235-6000 or 314-681-0101 to make an appointment with one of our cosmetic coordinators.