In short. CO2 resurfacing improves the texture of acne scarring rather than removing it. Which scars respond, which need a different approach, and what a course involves.
Key points
- Most people get a real improvement in how light falls across the skin, and the scarring remains visible on close inspection.
- Stated plainly: the aim is that scarring bothers you less in ordinary life, not that a stranger would see nothing.
- A clinic that describes removal is describing something resurfacing does not do.
Acne scarring is the reason many people first consider resurfacing, and it is also where expectations go most wrong. The honest description is improvement in texture rather than removal of scars. Scars are not erased, they are softened, and the change is judged over months rather than days.
Why scars change at all
Resurfacing removes a controlled amount of the surface and prompts the skin to rebuild collagen underneath. Where a scar is shallow and its edges are the main problem, that rebuild flattens the transition between scar and normal skin, so the scar catches the light less obviously. Where a scar is deep and tethered, removing surface changes little, because the problem lies underneath and the surface is not what holds it.
Which scars respond, and which do not
Shallow rolling and boxcar scars usually soften with resurfacing. Ice-pick scars are narrow and deep, and often need a different approach before resurfacing makes sense. Raised or thickened scars behave differently again, and may need a vascular treatment or an injection rather than resurfacing. A scar that is tethered down has to be released; resurfacing a tethered scar treats the surface of a problem that lives lower.
Partial improvement is the honest expectation
Most people get a real improvement in how light falls across the skin, and the scarring remains visible on close inspection. Stated plainly: the aim is that scarring bothers you less in ordinary life, not that a stranger would see nothing. A clinic that describes removal is describing something resurfacing does not do.
How the plan is usually shaped
Acne must be settled first. Treating scars on skin that is still breaking out is treating a moving target, and some acne medicines change how skin heals and when treatment can start at all. After that, plans are either one stronger treatment or a series of lighter ones spaced several months apart, sometimes with other procedures used on specific scars within the same programme.
What the recovery costs
Resurfacing for scarring is not a lunchtime appointment. It carries the same five to seven days of open skin, the same weeks of redness and the same pigment risk as any resurfacing, and the risk is higher when treatment goes deeper. The result is judged in months rather than weeks, and sun protection afterwards is part of the treatment rather than advice about it.
Reconsider when
- Acne is still active, or you take a medicine that changes healing and timing has not been discussed.
- Your scars are mostly deep and tethered, and resurfacing is being offered as the whole plan.
- You need the scarring gone rather than reduced, and nobody has said plainly that it will not be.
Resurfacing is a reasonable choice for the right scars in the right skin at the right time, and a disappointing one when it is asked to do something it cannot. The consultation that helps is the one that tells you which scars yours are.
Frequently asked questions
Can CO2 resurfacing remove acne scars completely?
No. Resurfacing softens scars and improves how light falls across the skin; it does not erase them. On close inspection the scarring is still there. The honest aim is that your scarring bothers you less in ordinary life, not that a stranger would see nothing. Anyone describing removal is describing something this treatment does not do.
Which acne scars respond best to resurfacing?
Shallow rolling and boxcar scars generally soften well, because their main problem is the transition between scar and normal skin. Ice-pick scars are narrow and deep and often need a different approach first. Raised or thickened scars behave differently again, and a scar that is tethered down needs releasing rather than resurfacing.
Should acne scarring be treated on its own or with other procedures?
Often with others. Different scar types in the same face respond to different techniques, and a plan that uses one tool for all of them will improve some areas and leave others untouched. Whatever the combination, acne has to be settled first, because treating scars on skin that is still breaking out is treating a moving target.
Risks & Limitations
- The treated surface is usually open for five to seven days, weeping and crusting, with redness that persists for weeks afterwards.
- Post-inflammatory hyperpigmentation is the commonest unwanted effect; it is more frequent and more stubborn in darker skin and can take months to settle.
- Pigment loss (hypopigmentation) is uncommon but can be permanent, and there is no reliable way to restore pigment that has been lost.
- Infection of open skin, which is why antiviral cover is ordinarily prescribed; increasing pain after the third day, spreading redness or fever needs same-day review.
- Scarring, uncommon but real, and more likely after infection, after treatment that was too deep for the skin, on the neck, and in people with a keloid tendency.
- The improvement is long-lasting but not permanent, and sun exposure after treatment fades it faster than anything else.
When to Seek Care
- Increasing pain after the third day, or one area much hotter and more swollen than the rest of the treated skin.
- Fever, spreading redness, or discharge from the treated area.
- Blistering, dusky or grey patches, or a sore that is not crusting like the rest of the face.
- A cold sore erupting across healing skin, which should be reported the same day.
- Swelling that makes it difficult to see, or any new change in vision, which needs urgent review.
References & Further Reading
- American Society for Laser Medicine and Surgery (ASLMS) — patient information on laser and energy-based treatment
- American Academy of Dermatology (AAD) — guidance on laser resurfacing and post-inflammatory hyperpigmentation
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance on skin treatments
- Cochrane Library — systematic reviews in skin resurfacing and scar management
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.