CO2 Laser Resurfacing in NYC

What CO2 laser resurfacing does

A CO2 laser is absorbed almost entirely by water in the skin, which lets it remove a controlled depth of tissue and leave the surrounding structures intact. Removing that layer clears sun-damaged surface skin and starts a healing response in the dermis that lays down new collagen over the following weeks and months.

On the Tetra PRO, the manufacturer's indications are fine lines and wrinkles, sun damage and brown spots, skin laxity in the sense of texture and tone, and scars including acne scars. Treatment is not a substitute for surgery: if the concern is loose skin, descended fat or lost volume, a facelift, eyelid surgery or another operation is the right answer, and Dr. Smith will say so.

The treatment modes on the Tetra PRO

CoolPeel®

CoolPeel is Cartessa's superficial ablative treatment, delivered with a very short, high-peak-power pulse so that heat does not spread far into the surrounding skin. It is the minimal-downtime end of the range: a full-face CoolPeel is performed in under ten minutes, and patients are treated with topical numbing only.

Fractional CO2 through the DOT scanner

The DOT scanner delivers energy in a pattern of microscopic columns separated by untreated skin, which is what allows the surface to heal quickly. Using DEKA's pulse shapes (Smart Pulse, DEKA Pulse and High Pulse), the same scanner covers progressively deeper and hotter treatment, which is how etched lines and established scarring are addressed.

Moveo

Moveo is an in-motion delivery mode, glided over the skin rather than stamped. The Tetra PRO is the first CO2 platform to offer it, and it suits areas such as the neck and décolletage where feathering the boundary matters.

Continuous wave

Continuous wave is the traditional fully ablative mode, used for aggressive full-field resurfacing and for freehand work. This is the deepest setting the platform offers and the one with the longest recovery.

Underneath all four modes sit the platform's engineering features: Pulse Shape Design (PSD™), SmartTrack heat management, 40 watts of power and a 20 × 20 mm scan area. They matter because they are what make precise depth control possible, not because the numbers themselves mean anything to a patient.

How treatment is staged in this practice

What anesthesia is used?

CoolPeel is performed with topical numbing. Deeper fractional and fully ablative treatments are often performed under IV sedation or general anesthesia, and in practice these are frequently done at the same time as a larger surgical procedure such as a facelift, so that one anesthetic covers both.

How many sessions will I need?

CoolPeel is a series of three sessions, spaced about a month apart. Deeper treatments are a single session, because the depth of that one treatment does the work a series of light treatments would otherwise build up to.

How much downtime should I plan for?

Recovery follows depth. At the CoolPeel end it is short, usually a day or two of redness that feels like mild sunburn. At the deepest CO2 settings it is about 10 to 14 days before you would be comfortable in public, followed by a longer period of pinkness that resolves with strict sun protection. Everything in between falls between those two points, which is why the plan is settled at consultation rather than chosen from a menu.

How is the right depth chosen?

At consultation your clinician examines the skin, reviews your history, medications and prior treatments, and asks how much recovery time you can give the process. A patient who cannot take two weeks away is treated differently from one who can, even with the same skin. Sun protection before and after treatment, and an antiviral if you have a history of cold sores, are part of every plan.

Candidacy and risk

CO2 resurfacing lasers are FDA-cleared devices, which is not the same as FDA-approved. Cleared means the manufacturer showed the device is substantially equivalent to one already on the market. Approved means a new safety and effectiveness review. Good candidates are adults in general good health with photoaging, fine to moderate lines, uneven pigment or texture, and atrophic acne or traumatic scars. Candidacy is skin-type dependent: every ablative laser carries a higher risk of post-inflammatory pigment change in deeper skin tones, so settings are chosen conservatively and the discussion happens before treatment rather than after.

Known risks include prolonged redness, swelling, crusting during healing, pigment change in either direction, reactivation of herpes simplex, infection, burns, and, rarely, scarring. Treatment is not carried out over an active infection or active acne in the treatment area. Recent isotretinoin, a tendency to keloid scarring, recent radiation to the area, immunosuppression, a bleeding disorder or ongoing anticoagulation, recently tanned skin, and pregnancy or breastfeeding all change whether and how treatment can proceed. Matching the depth to the skin in front of you is how the risk of a burn, a scar or a lasting pigment change is kept down.

Tell the practice before treatment about any history of cold sores, any isotretinoin in the past year, any keloid scarring, any autoimmune or immunosuppressive condition or medication, any blood thinner or supplement that acts as one, any radiation to the area, any recent tanning or sun exposure, and any possibility of pregnancy. This is not a formality. It decides which setting can be used, whether an antiviral is started beforehand, and whether treatment happens at all. Results build over the months after treatment as new collagen forms, and how much any individual patient changes varies.

Why a plastic surgeon directs the treatment

Dr. Smith is board-certified by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons, with dual fellowship training in craniofacial surgery at the Hospital for Sick Children in Toronto and in aesthetic surgery at Manhattan Eye, Ear and Throat Hospital. He has over 200 peer-reviewed publications, lectures and book chapters, and is President of the New York Regional Society of Plastic Surgeons for 2025-2026.

Two things follow from that training. The first is anatomic: the eyelid, the vermilion border and the hairline each behave differently under a laser, and knowing where the tissue is thin is what keeps treatment safe. The second is that the continuous wave setting is a surgical instrument, and scar revision and lesion work call for surgical judgment about tissue rather than a device setting. Treatments are delivered under Dr. Smith's medical direction at his Manhattan office.

If you are researching resurfacing more broadly, our laser skin resurfacing page covers how the different laser categories compare and where a CO2 platform fits among them.

CO2 laser resurfacing cost and financing

Dr. Smith's practice is out of network with all insurance plans, and resurfacing is a cosmetic treatment that insurance does not cover. Fees depend on which mode is used, how many areas are treated and whether the treatment is combined with surgery, and they are quoted individually after your consultation. Financing is available through CareCredit and Alphaeon Credit. A medical aesthetics consultation with Leah Corredora, PA-C is $100, collected to reserve your time and credited toward any procedure.

Common questions about CO2 laser resurfacing

Is CoolPeel a real CO2 treatment?

Yes. CoolPeel is delivered on the Tetra PRO CO2 laser; it is a way of using that laser, not a different device and not a chemical peel. The short pulse means the treatment is superficial and leaves minimal residual heat, which is why recovery is so much shorter than with deeper CO2 settings.

Will one CoolPeel session be enough?

Most patients notice a change after a single session, but the treatment is designed as a series of three, about a month apart, and the cumulative result is what the protocol is built around. If your goal needs more than a light treatment can deliver, your clinician will tell you at consultation and propose a deeper single session instead.

Does CO2 laser resurfacing hurt?

CoolPeel is well tolerated with topical numbing; most patients describe warmth and prickling. Deeper treatments need more than topical anesthesia, which is why they are performed under IV sedation or general anesthesia, often alongside a surgical procedure.

Can CO2 treat acne scars?

Yes. Atrophic acne scars are one of the better-established indications for fractional CO2, treated at a deeper setting than a CoolPeel. Ice-pick scars in particular usually respond best when resurfacing is combined with another technique, which your clinician will plan with you.

Can the laser remove moles or skin tags?

The continuous wave setting can precisely remove benign lesions such as seborrheic keratoses, sebaceous hyperplasia and skin tags. A pigmented lesion that looks suspicious is never lasered; it is evaluated and biopsied first. Our mole removal page explains how that assessment works.

Can resurfacing be combined with other treatments or with surgery?

Yes, and it often is. Resurfacing sequences well with neuromodulators, fillers and radiofrequency microneedling, and deeper CO2 is frequently performed at the same time as a facelift so that skin quality and skin position are addressed together. Sequencing is planned around healing.