The short answer
These lasers do different jobs. Pigment sits in the epidermis and upper dermis, and scar walls sit deeper. So the first question is which problem matters more to you, and which is present.
Dr Sin Yong maps scar types with the skin stretched under directed light, and examines pigment with a dermatoscope where needed. He performs each treatment personally.
CO2 vs pico laser at a glance
| Pico laser | Fractional CO2 | |
|---|---|---|
| Protocol here | T2 Frax Radiance on the DEKA TORO | S3 Resurfacing Lift on the DEKA SmartXide Tetra Pro |
| Wavelength | 785 nm picosecond, with 532 nm and 1064 nm nanosecond | 10,600 nm |
| Mechanism | Fragments pigment, mainly through pressure | Makes ablative columns with intact skin between |
| Target | Sun spots, freckles, some post-inflammatory marks | Boxcar and rolling scar walls, surface texture |
| Surface afterwards | Redness and warmth, with treated spots crusting and shedding | Redness, swelling, oozing, crusting and peeling |
| Main limit | Does not rebuild a boxcar scar wall | A poor way to remove a discrete sun spot |
| Main risk in Asian skin | Post-inflammatory darkening | Post-inflammatory darkening |
When a face needs both
A face with both problems may need both lasers, and the order depends on which problem dominates and on pigment risk. Where scarring dominates, CO2 usually goes first, and pico follows once the skin has healed. They are not stacked on the same area in one visit. Treating different zones on the same day is a separate decision. The plan may be staged further than seems necessary, and it may conclude that the second laser is not needed.
Spacing between the two
Wait until the surface has closed, peeling has finished and pinkness is settling. Darkening can appear weeks later.
Resurfacing is planned only after the pinkness has gone and no late darkening has appeared.
Spacing is set at review, with no fixed interval. A recent tan defers either laser.
Who should avoid combining them
Active melasma over the field, active acne, infection or a cold sore in the area, and a keloid or hypertrophic scarring tendency.
A recent tan, photosensitising medicines, pregnancy, and recent isotretinoin until the interval has been discussed.
Conditions that slow healing.
A history of marked darkening after laser does not rule treatment out, but it changes settings and spacing.
These are examined first and may be referred.
What neither can do
It does not rebuild scar walls, release tethered scars or treat melasma's drivers, and it does not stop new pigment forming.
It does not remove a sun spot cleanly or treat pigment without a wound, and it does not return skin to an unmarked state.
A combination is not a promise of outcome.
Risks
Post-inflammatory hyperpigmentation can take months to fade. Prolonged redness, and pale or mottled spots after frequent toning, can also occur. While CO2 channels are open, infection, acne-like eruptions or cold sore flares are possible. Blistering or new scarring can follow if either laser is used too aggressively. In a retrospective study of 490 deep fractional CO2 treatments in 374 patients, adverse events followed 13.6% of treatments. These risks are reduced, not removed, by separate mapping, suitable settings, spacing and strict sun protection.
Fees
Fees depend on the area and zones, the assessment findings, the pico wavelengths and modes, the CO2 depth and density, whether subcision or TCA CROSS is included, and how the plan is staged. A written, itemised quote follows consultation. The second laser is quoted as a decision to be confirmed at review, not as part of a package. No prices are listed.