CO2 Laser: Fractional vs. Fully Ablative

CO2 Laser: Fractional vs. Fully Ablative

• 16 September 2026
• Dr Mark Chernoff

Last updated on September 16, 2026

Laser treatments are often grouped into two main categories: ablative and non-ablative. While both are designed to improve skin quality and stimulate collagen production, they work in very different ways and are suited to different skin concerns, lifestyles, and recovery preferences.

Fractional vs Fully Ablative CO₂ Laser: What’s the Difference?

CO₂ laser resurfacing can be used to address a range of concerns, including sun damage, uneven texture, acne scarring, fine lines & wrinkles, and changes in skin quality. However, not all CO₂ laser treatments are the same. One of the most important differences is whether the laser is used fractionally or in a fully ablative mode. Both approaches remove controlled layers of skin and stimulate a healing response, but they do this in very different ways.

Understanding the difference can help you make a more informed decision about your treatment.

What is CO₂ laser resurfacing?

CO₂ laser uses a wavelength of light that is strongly absorbed by water within the skin. This allows us to precisely remove controlled amounts of tissue while creating thermal effects in the surrounding skin. As the skin heals, new skin forms and collagen remodelling occurs.

The treatment settings can be adjusted according to the area being treated, the concern we are addressing and the amount of downtime that is appropriate. This is where fractional and fully ablative treatments differ.

What is fractional CO₂ laser?

Fractional CO₂ laser treats columns of skin while leaving areas of untreated skin between them. Rather than resurfacing the entire treatment area, the laser creates microscopic treatment zones. The untreated skin helps support the healing process.

Fractional CO₂ can be adjusted from relatively conservative treatments through to deeper resurfacing. It may be considered for concerns such as:

• Acne scarring
• Surgical and traumatic scars
• Fine lines and wrinkles
• Uneven skin texture
• Sun damage
• Enlarged pores
• Skin quality and tone

Because some skin remains untreated, fractional resurfacing can offer a balance between treatment intensity and recovery time. However, deeper fractional treatment can still involve significant swelling, redness and peeling. Fractional does not automatically mean a mild treatment.

What is fully ablative CO₂ laser?

Fully ablative CO₂ laser treats the entire surface of the selected treatment area rather than leaving untreated columns between treatment zones. This allows us to perform more extensive resurfacing in a single treatment. Fully ablative CO₂ may be considered when a more intensive resurfacing approach is appropriate, particularly for significant photoageing, deeper textural changes or selected scars.

The trade-off is a more substantial recovery period. The skin can remain red, swollen and sensitive while the treated surface heals. Careful aftercare and sun protection are particularly important during this period.

Which one is right for you?

There is no single CO₂ treatment that is appropriate for everyone.

When I assess a patient, I consider the skin concern, depth of the problem, skin type, treatment area, previous treatments and the amount of downtime they can realistically manage. For example, someone with acne scarring may benefit from fractional treatment, while another patient with more extensive photodamage may be considered for a more intensive resurfacing approach. Sometimes we also use different treatment settings across different areas of the face.

The important point is that the treatment should be selected based on your skin rather than simply choosing the most aggressive option.

Does Fully Ablative Mean Better Results?

Not necessarily. At Queensland Skin and Laser, we perform mostly fractional CO₂ laser treatments, and this is generally our preferred approach.

One important point is that fractional CO₂ is not a single treatment setting. There is a significant range of settings and treatment intensities available within fractional resurfacing. The depth, density and energy can all be adjusted depending on what we are treating and how intensive the treatment needs to be.

This means fractional CO₂ can be used for more conservative resurfacing through to much deeper, more intensive treatments (performed under sedative). It is therefore not accurate to think of fractional treatment as simply a lighter version of fully ablative CO₂. For example, the approach we use for fine lines and overall skin texture may be quite different from the settings selected for deeper acne scarring or more significant textural changes.

For most of the concerns we treat, I prefer the flexibility of fractional CO₂. It allows me to adjust the treatment according to the patient’s skin and the problem we are trying to address, rather than using the same intensity for everyone.

The right treatment is not simply the most aggressive treatment. It is the treatment that is appropriate for the individual patient, their skin and their goals.

Considering CO₂ laser?

Fractional and fully ablative CO₂ laser are different approaches to skin resurfacing, and neither should be viewed as a one-size-fits-all treatment.

At Queensland Skin and Laser, we primarily use fractional CO₂ laser because of the wide range of settings available. This allows us to adjust the depth, energy and treatment density to suit the individual skin concern and the level of resurfacing required. Importantly, fractional does not mean superficial or mild. Deeper fractional treatments can provide significant resurfacing while still allowing us to tailor treatment to the patient.

Ultimately, the most appropriate approach depends on your skin, the concern being treated and your tolerance for downtime. A consultation allows us to assess your skin properly and determine whether fractional CO₂, fully ablative CO₂ or another treatment is appropriate for you.

Book a consultation to discuss the options for CO2 laser treatment and whether this approach is suitable for your skin.