Lesson 1Basic physics and tissue interaction of CO2 ablative fractional lasers (ablation, coagulation, thermal zone)This section reviews CO2 laser physics and tissue interaction, including wavelength, water absorption, ablation and coagulation dynamics, microthermal zones, and how pulse structure shapes depth, thermal damage, and clinical endpoints.
CO2 wavelength and water absorption basicsAblation versus coagulation balanceMicrothermal zones and lattice patternsThermal relaxation time and pulse designDepth of injury and collagen remodelingLesson 2Evidence base and guidelines for fractional CO2 in acne scarring (efficacy, comparative data with other modalities)This section summarises clinical evidence for fractional CO2 in acne scarring, including efficacy data, response by scar subtype, durability, comparative studies with other modalities, and key consensus recommendations and guidelines.
Key randomized and prospective trialsOutcomes by scar type and skin typeDurability of results and retreatment needsComparisons with erbium, RF, and microneedlingGuideline and consensus recommendationsLesson 3Treatment planning: number of sessions, intervals, cumulative approach, and combination therapiesThis section explains how to design individualised treatment plans, including session number, spacing, cumulative strategies, and integration with other scar therapies while balancing efficacy, safety, cost, and patient expectations.
Setting realistic goals for scar improvementDetermining number of sessions and intervalsCumulative treatment concepts and endpointsCombining CO2 with microneedling or RFIntegrating fillers, PRP, and subcisionLesson 4Patient selection, contraindications, and risk factors specific to CO2 (skin type considerations, isotretinoin interval, active acne, keloid risk)This section reviews ideal candidates and key contraindications for fractional CO2, emphasising skin type, isotretinoin history, active acne, keloid tendency, systemic disease, and medication use to minimise adverse outcomes.
Assessing scar type and severity patternsFitzpatrick skin type and PIH riskIsotretinoin timing and acne controlHistory of keloids and abnormal scarringSystemic illnesses and drug interactionsLesson 5Practical technique: anaesthesia options (topical, local blocks), technique for uniform coverage, overlapping strategy, periocular and perioral modificationsThis section covers practical execution of fractional CO2 treatments, including anaesthesia choices, eye protection, grid alignment, overlap strategy, plume control, and technique modifications for periocular and perioral regions.
Topical and injected anesthesia optionsMarking, positioning, and eye protectionUniform coverage and overlap techniquePeriocular and perioral safety tweaksSmoke evacuation and room safetyLesson 6Parameter selection rationale: energy density (mJ/MTZ), pulse modes, density/coverage percentage, number of passes and spacingThis section explains how to select and adjust CO2 parameters, including energy per MTZ, density, coverage, pulse modes, passes, and spacing, tailoring settings to scar depth, anatomic site, and skin type for safe efficacy.
Energy per MTZ and depth of ablationDensity, coverage, and overlap limitsPulse modes and stacking strategiesAdjustments for skin type and regionTest spots and titration over sessionsLesson 7Expected downtime and postprocedure care: wound care, dressings, topical agents, sun protection, timeline of healingThis section outlines expected downtime, wound evolution, and structured postprocedure care, including cleansing, dressings, topical agents, infection prevention, sun protection, and patient counselling on the healing timeline.
Typical healing timeline day by dayCleansing routines and wound hygieneUse of occlusive dressings and emollientsTopical antibiotics, steroids, and antiviralsSun avoidance, SPF, and pigment controlLesson 8Complications specific to CO2: prevention and management of infection, prolonged erythema, hypertrophic scarring, and postinflammatory hyperpigmentation (PIH)This section details complications specific to fractional CO2, including infection, prolonged erythema, hypertrophic scarring, and PIH, with emphasis on risk reduction, early recognition, and evidence-based management strategies.
Bacterial, viral, and fungal infectionsProlonged erythema and telangiectasiaHypertrophic scarring and contracturePostinflammatory hyperpigmentation careHypopigmentation and textural changes
