Fractional CO2 Laser vs Fully Ablative CO2

"Fractional" — sometimes written "fractionated" — describes the pattern a CO2 laser treats in, not a different kind of laser.

Cleveland Clinic explains that traditional CO2 and erbium resurfacing injure the whole treatment area uniformly, while fractional CO2 drills numerous narrow columns of holes into the skin and leaves the surrounding skin untreated and intact.

Both modes are ablative.

The American Society for Dermatologic Surgery (ASDS) defines ablative resurfacing as treatment that removes layers of skin, against non-ablative laser rejuvenation, which creates heat without injuring the skin surface.

Fractional CO2 sits in the ablative family, so the fractional-versus-traditional choice is about how much of the treatment area is injured, not about ablative versus non-ablative.

The devices are FDA-cleared, not FDA-approved.

As an example, the Candela/Syneron CO2RE fractional CO2 system (K181523, cleared 2018) is cleared for dermatological procedures requiring ablation, coagulation and resurfacing of soft tissue, including skin.

A clearance is not a treatment plan, and it is not permission for a particular profession to operate the laser — the state rules we found on that are covered below.

What resurfacing treats, who makes a good candidate, and the procedure day itself are covered in our CO2 laser resurfacing guide.

We found no head-to-head trial comparing final fractional CO2 results with final fully ablative CO2 results in the sources reviewed for this page.

What the published studies measure is fractional treatment on its own: two small studies around the eyes, each with its own outcome measure, so their figures are not one progression.

In a randomized split-face trial of 28 people treated around the eyes, a single fractional session — fractional CO2 on one side, fractional Er:YAG on the other — reduced wrinkle depth by about 20%, with no meaningful difference between the two lasers.

The authors concluded that multiple sessions may be needed for full effect, which they noted cancels out fractional lasers' proposed advantages of fewer side effects and less downtime.

One small trial's average is not a prediction for any individual.

In a separate 25-patient prospective study of ablative fractional CO2 on the lower eyelids, 2 to 3 sessions — an average of 2.44 — produced a mean improvement of about 62 to 66% in texture, laxity and wrinkles at 6 months.

Redness and swelling resolved by 1 week, and minor crusting and oozing within 48 to 72 hours.

That study was small and physician-performed, and its numbers describe its own patients.

So the honest center of the comparison: trials show single fractional sessions have a limited effect, while fully ablative CO2 injures the entire treatment area at once and carries the longer recovery described below.

For tightening specifically, the American Academy of Dermatology (AAD) calls ablative laser resurfacing, without separating fractional from fully ablative, the most effective non-surgical procedure for tightening loose skin — attaching the price of staying home for 5 to 7 days and a greater risk of side effects such as scarring.

What resurfacing studies measured, and why no before-and-after photo predicts an individual result, is on our CO2 laser resurfacing before and after page.

Cleveland Clinic puts recovery at up to two weeks for traditional CO2 resurfacing and one full week for fractional laser resurfacing, with erbium also at one full week; treated areas generally heal in 5 to 21 days depending on the condition treated and the laser used.

Other sources slice the same question differently, because they measure different lasers and depths.

ASDS says healing after laser resurfacing takes 3 to 10 days depending on the depth of resurfacing and the type of laser, with daily soaks, ointment and re-dressing.

The AAD's figure for ablative resurfacing is a stay-home window of 5 to 7 days, and it dates tightening and fewer wrinkles within 2 weeks after healing — not after the treatment itself.

Read side by side, the sources agree on the direction: where a source splits the two modes, fractional sits at the shorter end — one full week against up to two for traditional CO2 — and fully ablative CO2 at the longer end.

None of them supports presenting fractional CO2 as a zero-recovery treatment — Cleveland Clinic's figure is one full week.

The day-by-day healing course after resurfacing, with the aftercare that goes with each stage, is on our CO2 laser recovery day by day page.

We found no national count of med spas offering fractional CO2, fully ablative CO2 or both, and no source reviewed for this page says which mode is performed more often.

Treat any split quoted online as unverified unless it names its source.

We found no national rule on who may perform CO2 resurfacing.

The rules we found are state rules, and they address ablative lasers as a group; both CO2 modes are ablative.

In Rhode Island, procedures using ablative lasers may be performed only by physicians, physician assistants and certified nurse practitioners.

In Illinois, a physician may delegate ablative laser procedures to an LPN, RN or other person only with the physician on site.

In New Mexico, certified medical assistants may use only non-incisive, non-ablative devices.

Each rule holds only in its own state, so check your state's rules and ask each practice directly.

The detailed procedure descriptions in the medical sources come from physician-led settings: Cleveland Clinic describes resurfacing as an outpatient procedure done with local anesthesia, often plus oral or IV sedation, with general anesthesia possible for a full-face treatment — timing a partial face at 30 to 45 minutes and a full face at 1.5 to 2 hours.

The depth, numbing and sedation for your own session follow the practice's plan for your skin — questions to ask in advance.

The national framework and the state-by-state rules are collected in the med spa laws by state guide.

The one national figure we found is not fractional-specific.

The American Society of Plastic Surgeons (ASPS) lists an average of $1,829 for skin resurfacing procedures like laser skin resurfacing, citing its latest statistics.

It is a plastic-surgeon fee, not a med spa price; it is a single average, so its page does not separate fractional from traditional CO2; and it excludes related costs — facility, anesthesia and prescriptions.

We could not confirm a national med spa price for fractional or fully ablative CO2, and we found no source that compares the prices of the two modes.

Cleveland Clinic adds one budget line that applies to either mode: insurance does not cover cosmetic resurfacing.

What drives a CO2 laser quote — the area treated, anesthesia, the device, and whether a price covers one session or a course — is broken down in our CO2 laser resurfacing cost guide.