From the Guidelines
The recommended treatment for photoaging using Fractionated CO2 laser is a combination of Fractionated CO2 laser with autologous platelet-rich plasma (PRP) injections, which has been shown to be a safe and effective therapeutic regimen for improving skin texture and reducing the appearance of fine lines and wrinkles. This treatment approach has been supported by recent studies, including one published in 2025 1, which found that the combination of Fractionated CO2 laser and PRP injections resulted in significant clinical improvements in skin texture and a higher degree of patient satisfaction compared to Fractionated CO2 laser alone.
The treatment protocol typically involves 1-3 sessions spaced 3-6 months apart, with each session delivering laser energy at settings of 10-70 mJ and 5-70% coverage depending on the severity of photoaging and skin type. Before treatment, topical anesthesia (such as EMLA or BLT cream) should be applied for 45-60 minutes, with some patients requiring oral anxiolytics or pain medication. Post-treatment care includes gentle cleansing, application of petroleum jelly or healing ointments for 3-5 days, strict sun avoidance, and daily SPF 30+ sunscreen use. Patients should expect 7-10 days of downtime with redness, swelling, and peeling.
Key benefits of this treatment approach include:
- Improved skin texture and reduced appearance of fine lines and wrinkles
- Increased collagen and elastin fiber deposition
- Enhanced patient satisfaction and reduced downtime
- Safe and effective for a wide range of skin types, including darker skin tones (Fitzpatrick IV-VI)
It's worth noting that the addition of PRP to Fractionated CO2 laser therapy has been shown to aid in wound healing and promote scar resolution, leading to shorter downtime and improved clinical outcomes 1. Overall, the combination of Fractionated CO2 laser and PRP injections is a highly effective treatment approach for photoaging, offering significant improvements in skin texture and appearance with minimal downtime and risk of adverse effects.
From the Research
Fractionated CO2 Laser Treatment for Photoaging
- The fractionated CO2 laser has been shown to be effective in treating photoaging, with studies demonstrating significant improvements in wrinkles, skin texture, and overall cosmetic outcome 2, 3, 4, 5.
- A study published in the Journal of Cosmetic Dermatology found that combining platelet-rich plasma with fractional CO2 laser treatment resulted in similar improvements in wrinkles as fractional CO2 laser treatment alone 2.
- Another study published in Photobiomodulation, Photomedicine, and Laser Surgery found that combining fractional CO2 laser treatment with rhodamine-intense pulsed light resulted in better wrinkle reduction and shorter healing times compared to fractional CO2 laser treatment alone 3.
- A long-term study published in Lasers in Surgery and Medicine found that fractional CO2 laser resurfacing resulted in significant and sustained improvements in photoaging over a period of five years 4.
- A clinical and histologic study published in Dermatologic Surgery found that ablative fractionated CO2 laser treatment resulted in significant improvements in dyschromia, skin texture, skin laxity, and rhytides, with a mean improvement of 61.5% in overall cosmetic outcome 5.
Treatment Parameters and Safety
- The treatment parameters for fractional CO2 laser treatment of photoaging vary depending on the study, but typical settings include pulse durations of 500-1,800 μs and densities of 25% or higher 5.
- Ablative fractionated CO2 laser treatment has been shown to be safe and effective for treating hypopigmentation induced by CO2 laser resurfacing, with significant improvements in hypopigmentation and line of pigmentary demarcation 6.
- The safety profile of fractional CO2 laser treatment is generally considered to be good, with minimal adverse effects reported in the literature 2, 3, 4, 5.
Combination Therapies
- Combination therapies, such as combining fractional CO2 laser treatment with platelet-rich plasma or rhodamine-intense pulsed light, may result in better outcomes and shorter healing times compared to fractional CO2 laser treatment alone 2, 3.
- Further studies are needed to fully evaluate the efficacy and safety of combination therapies for the treatment of photoaging.