The CO2 Laser for Acne Scars - My Experience So Far

Thinking about laser resurfacing to fade acne scars but not sure where to start? We pull back the curtain on fractional CO2 with a step-by-step guide to matching treatments to scar types and a candid look at real downtime, pigment changes, and the slow arc of collagen remodeling. You’ll hear why some scars respond beautifully to fractional CO2 while others demand TCA cross, punch excision, or subcision first—and how sequencing those choices makes all the difference.

We begin by mapping the three major scar types: ice pick (deep, narrow channels), boxcar (shallow to moderate depressions with sharp edges), and rolling (wavy, tethered skin). From there, we outline a practical roadmap: TCA cross or excision for ice pick, subcision plus CO2 for rolling, and microneedling priming followed by fractional CO2 for boxcar. Along the way, we demystify the tech—how carbon dioxide energy creates microcolumns that trigger collagen and elastin—and compare fractional versus fully ablative approaches, including realistic recovery windows and comfort strategies.

I also share my own procedure day and three-week check-in: painless under the right meds, five days of sticky occlusives and vinegar soaks, then the reality of pinkness and temporary pigmentation as the barrier rebuilds. We get specific about who should hold off: anyone with active acne, rosacea, a fragile barrier, or a strong tendency to hyperpigment. The golden rule stands—clear first, treat second. Stabilize inflammation for six to eight weeks or more, then use scar-specific tools for results that last. Ready to plan your path to smoother skin with fewer setbacks? Follow the show, share this episode with a friend who’s scar-curious, and leave a review to get a free first module of the Seven-Week Clear Skin Program.

Click here to book a FREE call to learn more about my 1:1 Clear Skin Program.

Leave a Review and Start my 7-Week Clear Skin Program for FREE:

To get immediate access to the first module of my 7-Week Clear Skin Program, leave a podcast review!  Take a screen shot of your review and email it to customersupport@naturopathicbeauty.com and you will be sent your login information!

Here's a short video showing how to leave a podcast review:
https://vimeo.com/1050913528?share=copy#t=0

Transcript

Welcome And Episode Focus

SPEAKER_00 0:00

Welcome to Naturopathic Beauty's Clear Skin Sessions, where we heal your acne from the inside out. Hello, beauties, and welcome to the Clear Skin Sessions. I'm Dr. Stacy Shillington, Naturopathic Doctor. This podcast is for you if you are on your clear skin journey battling acne. And this episode is specifically for those that want to heal their acne scars. I had an experience, I've been experiencing something over the last few weeks. It is recovery from a CO2 resurfacing laser, and I want to share my experience with you. Now I'm 52 years old, so my reasons for wanting to do this laser are a little bit different. Um I do have, I did, hopefully did, have some leftover boxcar scars, acne scars, that I wanted to get rid of. And the scars were not that deep. They were fairly mild, but I did want to get rid of those. I also wanted to treat some aging skin around my eyes and you know do some tightening. So I had a number of different reasons why I wanted to do CO2 laser resurfacing, but I also wanted to do it because I wanted to report back to you on what the treatment is like, share my results with you, and help you decide what treatments you need to do to get rid of any acne scarring that you may have. So let's talk first about acne scarring, and then I'm gonna tell you a little bit about my experience with this treatment. So, you know, acne scarring, it's you know, if your body is inflamed, you're going to be more vulnerable to scarring. And, you know, there's different types of scarring. So not all acne scars can be treated the same. And that's one thing that I really want to emphasize. So there's really three different types of acne scars. And there's ice pick scars, boxcar scars, and rolling scars. So the ice pick scars, you know, we know what those look like. Those are the deep acne scars. They're usually fairly narrow, they're like deep tunnels, and these don't necessarily respond well to CO2 resurfacing laser treatment. There's a completely different protocol for that. I'm gonna share that with you in a moment. Then there's boxcar scars, and those are the scars that have developed because the inflammation from a blemish basically stopped collagen production. So this looks as though something has been pressed into the skin. Usually, you know, they're they're wider, they have defined edges, they're shallow to moderate depth. And then there's rolling scars. These are wavy, kind of tethered depressions in the skin. And, you know, again, these all these scars need to be treated just a little differently. So I'm gonna go through how you would address each type of scar. So for the ice pick scar, because they are so deep, doing surface treatments is not going to do much for these types of scars. So there's two treatments that are really quite popular and successful. One is TCA cross, that's where you actually put some TCA, that's a very strong exfoliant, very, very strong exfoliant, right to the bottom of the scar. It dissolves the tissue and then it encourages new tissue to be rebuilt, thus reducing the depth of the scar. Then there's punch excision. And this is when a dermatologist or a plastic surgeon actually removes the tissue surrounding the deep scar and encourages new collagen and tissue growth to replace what's missing. So ice pick scars, they are not really candidates for CO2 resurfacing. It's not going to do much, it's not gonna hurt it, but it's not gonna help the way you want. Then there's the boxcar scars. That's what I had, the kind of depressions in the skin. So the CO2 laser is excellent for this type of scarring. And it's even better when you do some microneedling sessions before you do CO2 resurfacing, because the microneedling is really going to disrupt the fibrotic tissue and stimulate collagen production. So that's box scar scars. And then rolling scars. This is a different type of scars because it's tissue that's being pulled down by fibrous bands. So just using laser alone is not going to do enough because it's the laser is not going to release those bands. So you need to do something called subscision first. That's when you actually um, like a plastic surgeon, a dermatologist, somebody goes in and they actually destroy those fibrous bands so the skin is able to lift. Then you do the CO2 laser, and that's when you get the really good results. So those are the three types of scarring. That's how you want to approach each. The boxcar is when you you really get great results, and the rolling scars after you do subsistion. So different scars require different tools. And I'm gonna talk a little bit about how CO2 laser works. So if you decide you have the right type of scarring for CO2 laser, and as I said, you're gonna do microneedling before, you're gonna do subscision before, you're not just gonna jump into the CO2 laser because it doesn't work perfectly on its own. Getting rid of acne scars, it's a it's a journey. There's a system to do it. So the CO2 laser it uses carbon dioxide light, it's absorbed by the water in the skin, and then it vaporizes damaged outer tissue. So what this is doing is creating microscopic columns of controlled injury, and this triggers wound healing. So you're gonna get collagen, an elastin production, and this is gonna improve the firmness and the texture of the skin. So it resurfaces, it increases collagen remodeling. And so this is why you're not gonna see the full results from a CO2 resurfacing laser treatment for a good few months because you have to let that collagen rebuild. And that's why I'm gonna tell you about my experience, but I'm not going to give my final verdict on how well this treatment worked for a couple of months because I'm gonna get into this later, but right now I'm still at a place where I'm like, I don't know. But okay. So back to CO2 resurfacing. There's two types. There's fully ablative, that's where it takes off all the skin. This is extreme. This is like two to three weeks of downtime. I didn't do that. I did the fractional CO2 resurfacing laser where it just treats microcolumns. So it leaves the surrounding skin intact. Doing this this way, it reduces the downtime from about one to two weeks to just five days. And that's what I experienced. I experienced five days of recovery. Um, and it was not that bad. So when I went in for the treatment, I did not know what to expect because I did not think about it a lot before I went in because I thought if I spent too much time thinking about what it was going to actually be like, I probably wouldn't go. So I tried not to think about it. I just showed up, I laid down on the chair, and Victoria, the nurse practitioner that did the treatment on me, she did it, and the place I went to is called V Beauty. It's in Toronto. She did a little bit of CO2 on the tops of my hands. And as soon as she did it, I was like, you know what? I can't do this treatment. This treatment is way too painful. There's no way. And she said, Don't worry, I have some really great medication. You're going to inhale it and you are not going to feel a thing. And so I was like, okay. And I did it. And she was right. I did not feel a thing. In fact, I was incredibly relaxed. I had a great time just relaxing with the medication coursing through my body. And so the treatment itself was absolutely painless. The next five days, however, those were not as easy as I thought. So the first couple days after the treatment, my skin was raw. It was oozing. It was just so very tender. And I had to wear aquapore all over my face, all over my neck for three days. Aquaphys kind of like Vaseline, it just protects the skin from anything and everything. And I had to do vinegar baths a couple of times a day. And those were not super comfortable. They weren't painful, but they just weren't comfortable. And luckily, Victoria was with me, you know, texting me the entire time. So I knew exactly what to do. There was no infection. There was nothing really, you know, dramatic that happened other than I was uncomfortable. And there was no way I was going to leave the house. Like zero. For five days, I stayed at home and nobody could have convinced me to go outside. But, you know, after day five, I was okay. And so it's been three, three weeks today since I've had the treatment done. There's pigmentation. And I'm a little, you know, I'm not nervous about it because I know how to get rid of pigmentation, but I'm a little bit really, why did I do this? You know, that these are my thoughts. And my skin's a little pink. So I'm still waiting for the full results. And that's why I'm going to share with you in a couple of weeks what exactly has happened. But my skin is still, it's very tender. It's um, there's some browns in it. I'm struggling a little bit with covering things up because my sunscreen is so goopy, it's hard for me to put powder on top of it. So minor, very minor, I understand, but I just want to share my whole entire experience with you. So, what do I see so far? So far, I see the skin around my eyes looks a lot better. Like honestly, I think it took about five to ten years off my crow's feet in the area around my eyes, which was actually what I wanted. My acne scars, they seem less visible, but again, I want to wait until the collagen has fully um restored itself to give my final verdict there. My skin does look, the pores are pretty much gone, except for one really bad pore that I've had for years. Nothing seems to help that pour. But otherwise, things are looking pretty good. But like I said, you know, I'm still waiting it out. My skin is still very, very fragile. So I'm focusing on rebuilding the barrier. That's when I'm layering so many different things on my skin. So who should not do this treatment? If you have a medium to deep skin tone, if you're prone to hyperpigmentation, if you have a compromised barrier, do not do this treatment. There's a real risk of hyperpigmentation. Even for me, I'm not prone to hyperpigmentation. I experienced after this treatment. And like I said, I know how to manage it. It is temporary, but it can happen. And redness, there can be prolonged redness. I'm experiencing this, and usually my skin is not red at all, and it's red and it's it's different for me. So I'm patient. I understand that it's gonna clear, but I just want to give you the entire picture. So, and if you currently have acne, if your skin is inflamed, do not do this treatment. If you currently have rosacea, do not do this treatment. You are not ready for it. You're the inflammation in your body needs to resolve before you do this treatment. Otherwise, you're just adding inflammation upon inflammation. It's going to be far more difficult for you to recover and get the results you want if your body's currently inflamed. So if you currently have acne and you're listening to this and you're like, oh, this would be my dream to get rid of my acne, to have no acne scars, to have that skin that I'm, you know, I covet so much. If that's where you're at, you need to do my seven-week clear skin program or my one-on-one clear skin program to cut that inflammation out. And once you've been clear for six to eight weeks, and I would say even a little bit more than that, then you can do something like this. Um, but definitely do not do it beforehand at all. So yeah, so if you and if you have the acne scars that are the ice pick scars or the rolling scars, please believe me, you need to do, you know, the TCA cross, excision or subscision first. You need to work with somebody that's very experienced in dealing with acne scars to really resolve them and get to the place that you want to get. So this has been my experience so far. And, you know, I'm telling you, I'm being so very honest with you about this treatment. I really expect great results. I really expect that my skin is going to be so much better than it was before this treatment, but I'm I'm not telling you it totally is yet. I'm still waiting. And yeah, that's where I am. So I hope that this podcast has helped you. I hope that you know understand a little bit more about how you have to treat acne scars and how some of these treatments actually do work, and that you have to be healed before you do them. You have to resolve the inflammation. Your current acne, your current rosacea, you know, your skin has to be in good shape before you do a treatment like this. This is like a final touch. It's not a healing treatment. And that's a huge distinction because I know some people with skin issues, they go into doing lasers without healing their acne first. That's the wrong way around. You need to heal your acne first, then do the laser treatment. So if you're interested in healing your acne, check out my seven-week clear skin program or my one-on-one clear skin program. This is how I've helped thousands of women achieve clear skin in my one-on-one clear skin program. This is where you go when you have cystic complex acne that has not responded to anything. This is my signature program. We do the testing, we interpret everything, we understand what's going on in your body, we map out the strategy, and then we hold your hand as you heal for an entire seven months. And in my seven-week clear script, it's a program where there's still a ton of coaching, but it's it's a more strategy where we don't necessarily need to do the testing to understand what's going on. It's based on my 20 years of experience reading thousands of lab tests. I know the patterns of acne. So this program takes you through that. Both links to the program are in my show notes. And if you'd like to experience the first module, the seven-week clear skin program for free, leave a review for this podcast and we will happily send you a link so you can get started right away with no money down at all. So hopefully, this podcast has helped you on your clear skin journey. That's completely my intent to help you get clear skin so you can move beyond your current place. So I'm sending you so much love. I will see you in the next podcast. And until then, have a beautiful, beautiful day.