RealSelf Q&A with Dr. Buka

Q:  CO2 laser on entire face. Lots of redness and blisters almost 3 weeks post?

A:  This powerful laser treatment can produce amazing results, but requires more downtime and recovery.

CO2 Laser is perhaps the most powerful laser we have in our dermatologic armamentarium. The laser’s target is water and, since we’re 70% water, that a lot of target to hone in on. The laser’s frequency (how fast the energy oscillates) is 10,600 nanometers which also means it penetrates deeper than any of our other lasers, up to 4mm in depth (!), well into the dermis. The result is powerful collagen reshaping and rejuvenation, but also the potential for a lot of “down time” when the face looks weepy, inflamed, and swollen. If we turn the CO2 energy down, we can get modest results with redness that lasts a few hours. If we turn the energy up, we can see weeks to months of redness but with remarkable improvement in scars and signs of photoaging. So depending upon the settings your doctor used, redness 3 weeks out is very expected. And severe enough redness may even result in pin-point bleeding. Generally, that’s all part of the healing process.

It is critical to keep the treated areas of the face out of the sun. If you must have some sun exposure, please use sunscreen. My favorite is Elta SPF 30. Moisturize 5 times daily with something thick and ceramide-based. My favorite is FAB’s Ultra Repair Cream. Petroleum-based emollients are OK but can occlude pores and your skin needs to breathe while it heals! I’m glad you’re using a gentle cleanser – that’s key. I like the FAB Gentle Cleanser. It’s common sense, but I’ll say it anyway – no smoking, healthy eating as your body heals. It’s more important now than ever. Recently, I’ve begun to recommend over-the-counter biafine and bromelein oral supplements to our patients post-CO2. This seems to expedite healing in my experience.

The only part of your account that I would certainly call in to your treating physician is the “very visible blisters underneath the eyes.” This can be due to trauma as discussed above, to be sure, but it can also represent viral and bacterial infection and requires evaluation by a medical professional.

Hope this helps!