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Ablative Laser Resurfacing Explained

Ablative lasers remove the outer layers of the skin so it regenerates. Non-ablative lasers heat the dermis and leave the surface intact. Understanding that distinction is the clearest way to judge which resurfacing route suits your skin and your schedule.

At Berkshire Aesthetics, ablative resurfacing is assessed and delivered under the clinical supervision of Dr Selena Langdon at our CQC-registered clinic. We deliver CO2 fractionally on the Alma Hybrid platform rather than as a fully ablative treatment.

Last updated:

GMC Physician Oversight
CQC-Registered Medical Clinic
Clinical Governance
Est. 2016

What ablative means

To ablate tissue is to vaporise it. An ablative laser is tuned to a wavelength that water absorbs strongly, so when the beam meets skin the water within the cells absorbs the energy, heats past boiling point and the tissue is removed as vapour. The two established ablative wavelengths are CO2 at 10,600nm and Er:YAG at 2,940nm.

Removing the epidermis is not incidental to how the treatment works — it is the mechanism. The controlled injury triggers a wound-healing cascade: inflammation, then fibroblast activation, then deposition of new collagen and elastin over the following months. The skin that replaces what was ablated is structurally new tissue, which is why ablative resurfacing can change established scarring and photoageing in a way that surface treatments cannot.

That mechanism also explains the trade-off. Skin that has had its outer barrier removed needs to heal before it can be exposed to the world, and that healing period is real. There is no ablative treatment without downtime, and any clinic offering one is describing something other than ablation.

Ablative vs non-ablative resurfacing

Both approaches stimulate collagen. They differ in whether the epidermis is removed to do it, and almost every practical difference — downtime, number of sessions, depth of change, risk profile — follows from that one decision.

AblativeNon-ablative
EpidermisRemoved and regeneratedLeft intact
Typical wavelengthsCO2 10,600nm, Er:YAG 2,940nm1570nm, 1565nm, 1927nm
Social downtime7–10 daysHours to 2 days
Sessions typically needed1–34–6
Depth of change per sessionSubstantialIncremental
Best suited toEstablished scarring, significant photoageing, deeper linesEarly textural change, mild pigmentation, skin quality
Pigmentation risk in Fitzpatrick IV–VIHigher — needs careful assessmentLower, though not absent

Neither column is the better treatment in the abstract. The right answer depends on what you are treating and how much recovery you can accommodate, and outcomes vary by individual. For a non-ablative option we use the Lumenis M22 with ResurFX.

Fully ablative and fractional ablative

Ablative is not a single setting. The more important distinction within it is how much of the surface is treated.

Fully ablative CO2

The entire epidermal surface of the treatment area is removed in a continuous sheet. This was the standard approach when CO2 resurfacing was introduced, and it produced dramatic results alongside a correspondingly serious risk profile — weeks of open healing, months of erythema, and meaningful rates of permanent hypopigmentation and scarring. It is rarely performed today.

Fractional ablative CO2

The laser is delivered as a grid of microscopic columns, each ablating a narrow channel down into the dermis, with untreated skin left between them. Those untreated bridges hold an intact reservoir of cells that migrate across to close the wounds, so re-epithelialisation happens in days rather than weeks. The depth of the individual columns still reaches the dermis, so the collagen response is preserved. This is how we deliver CO2.

Hybrid delivery

The Alma Hybrid platform carries both an ablative CO2 wavelength and a non-ablative 1570nm wavelength, and can deliver them in the same session. The ablative fraction resurfaces the surface; the non-ablative fraction heats the dermis beneath without adding to the surface wound. The balance between the two is set to your skin type and the recovery you can accommodate.

The practical consequence: when a clinic quotes “CO2 laser”, ask whether it is fractional and what coverage density is planned. Those two answers determine your recovery far more than the platform name does.

When ablative treatment is the right call

Ablative resurfacing earns its downtime when the concern is structural — when tissue has been lost or disorganised and needs rebuilding rather than refreshing.

Established atrophic acne scarring, particularly ice pick and boxcar patterns
Significant photoageing with textural roughness and solar lentigines
Perioral and periorbital lines that have not responded to non-ablative treatment
Surgical or traumatic scars requiring surface remodelling
Patients who can commit to 7–10 days of recovery and strict sun avoidance
Fitzpatrick I–III skin, or IV–VI with modified protocols after assessment

Equally, there are patients for whom we do not recommend it: active skin infection or cold sores in the area, pregnancy, recent isotretinoin, a history of keloid scarring, or an inability to accommodate the recovery. In those cases a non-ablative or non-laser route is the better plan, and we will say so. Our consultation process exists to reach that decision properly.

Resurfacing pathways

The options below run from the most ablative to the least. Your plan may combine more than one, staged over time.

Fractional Ablative CO2

Deepest resurfacing, longest recovery

Non-Ablative Fractional

Gentler renewal, minimal downtime

Morpheus8

RF remodelling, epidermis left intact

Chemical Peels

Chemical rather than thermal resurfacing

Related topics

Explore related pages within our CO2 Laser Resurfacing service:

CO2 Laser CostRecovery & DowntimeCO2 for Acne ScarsComplete CO2 GuideCO2 vs Morpheus8

Why we start with a consultation

Every treatment begins with a medical assessment. We need to understand your medical history, current health, skin condition and concerns before prescribing any procedure. This protects your safety and ensures the treatment is clinically appropriate for you.

During your consultation, your clinician will explain what the treatment can realistically achieve, any risks specific to you, and whether an alternative might be more appropriate. Consultations are carried out by our doctors or advanced aesthetic practitioners, depending on the treatment or concern being assessed.

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Frequently Asked Questions: Ablative Laser Resurfacing

Ablative laser resurfacing uses laser energy to vaporise — ablate — the outer layers of the skin. Removing that damaged tissue triggers the body’s wound-healing response, which lays down new collagen and elastin as the surface regenerates. CO2 (10,600nm) and Er:YAG (2,940nm) are the two established ablative wavelengths.
Ablative lasers remove the epidermis; non-ablative lasers pass through it and heat the dermis beneath, leaving the surface intact. Ablative treatment generally produces more change per session but requires a genuine healing period, typically 7–10 days. Non-ablative treatment has far less downtime and usually needs a longer course to achieve a comparable result. Outcomes vary by individual.
Yes. Fractional CO2 is ablative — it vaporises tissue — but it does so in a grid of microscopic columns rather than across the whole surface. The untreated skin between each column supplies the cells that drive healing, which is why fractional ablative treatment recovers faster than fully ablative resurfacing.
Fully ablative CO2 removes the entire epidermal surface of the treatment area in a continuous sheet. Fractional ablative CO2 treats a percentage of the surface in columns. Fully ablative resurfacing carries a substantially higher risk of prolonged redness, pigment change and scarring, and is rarely used today. We deliver CO2 fractionally.
We use CO2 at 10,600nm on the Alma Hybrid platform, delivered fractionally. The same platform also carries a non-ablative 1570nm wavelength, so ablative and non-ablative energy can be combined in a single session and the balance adjusted to your skin and your tolerance for downtime.
Ablative resurfacing carries a higher risk of post-inflammatory hyperpigmentation in Fitzpatrick IV–VI skin. That risk can be reduced with lower energy settings, pre-treatment preparation and a test patch, but for some patients a non-ablative or non-laser route is the safer recommendation. Your doctor will assess this honestly rather than proceed by default.
Fractional ablative CO2 typically involves 7–10 days of social downtime, with swelling peaking in the first 2–3 days and crusting and peeling through days 4–7. Residual pinkness can persist for 2–6 weeks. Our recovery guide sets out the healing process day by day.
It depends on the depth of the concern and how much downtime you can accommodate. Established scarring and significant photoageing usually need ablative depth to change meaningfully; early textural change, mild pigmentation and skin-quality concerns often respond well to non-ablative treatment. This is the central question your consultation is there to answer.
Clinically reviewed by

Dr Selena Langdon — Medical Director, MBBS

GMC 6159259

This content is for informational purposes only and does not constitute medical advice. Individual suitability for any treatment is assessed during a consultation. Always seek the guidance of a qualified medical professional with any questions regarding a medical condition or treatment.

Clinical governance

Page last reviewed: August 2026

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