Ablative Fractional Carbon Dioxide Laser Reduces Facial Scarring, Improves Quality of Life

The effect of ablative fractional carbon dioxide laser therapy on facial scarring and quality of life was analyzed.

An ablative fractional carbon dioxide laser (CO2-AFL) treatment was effective for treating disfiguring facial scars and was associated with improvements in emotional well-being and social functioning, according to study data published in the Journal of Cosmetic Dermatology.

This retrospective study included 16 patients (age, 43.6±16.8 years) who had undergone CO2-AFL laser treatment for facial scars from 2019 to 2020. The majority of these patients were Fitzpatrick skin type 2 (87.5%), and the remaining patients were type 1 (6.3%) and type 5 (6.3%). Most of the facial scars in these patients were caused by either burns (43.8%) or trauma (31.3%).

Researchers evaluated the post-intervention course as well as patient- and/or observer-reported outcomes before and 3 months after treatment. The primary outcomes of the study included changes in the Patient and Observer Scar Scale (POSAS) and QoL (Short Form (SF) 36). The study also featured 2 independent examiners who examined the aesthetic outcome by comparing photographs of the initial scarring with the post-intervention findings.

Overall, complete healing was observed within 14 days after the laser treatment. There were no reports of blisters or viral or bacterial infections in the study period. Transient mild hyperpigmentation was reported in 1 participant, but this resolved after 14 days. Scabs and erythema resolved within 3 weeks after treatment.

Observers reported significant post-CO2-AFL improvements in pigmentation (P =.002), thickness (P =<.0001), relief (P <.0001), pliability (P <.0001), and surface area (P <.0001). Treatment with CO2-AFL also resulted in a significant and positive change in the overall impression of scars in patients (P <.001) and observers (P <.00).

In addition, the researchers found significant improvements in emotional well-being (P =.043) and social functioning (P =.01) in patients. The independent reviewers also reported significantly enhancements of aesthetic outcome at 3 months aftertreatment (P =.001).

Limitations of this study included its small sample size, retrospective nature, non-randomized design, and lack of a control group.

The investigators of this study concluded that “the response to CO2-AFL was irrespective of scar maturity, etiology, and thickness” and should therefore “be included in the facial scar treatment concept.”


Meynköhn A, Fischer S, Neuss C, Willkomm LM, Kneser U, Kotsougiani-Fischer D. Fractional ablative carbon dioxide laser treatment of facial scars: Improvement of patients’ quality of life, scar quality, and cosmesis. Published online November 18, 2020. J Cosmet Dermatol. doi:10.1111/jocd.13850