Why do my acne scars look worse after CO2 laser?
During the first weeks following fractional CO2 laser the skin is swollen, red and actively healing, and acne scars very commonly appear worse before they appear better. This is expected and does not indicate that anything has gone wrong.
For the first five to seven days the treated skin is red, swollen and crusted, and Vaseline should be applied regularly with no attempt made to remove any crusting. Over the following two to six weeks the crusting resolves and the skin remains pink, sometimes markedly so. The result itself arrives considerably later, since new collagen forms over three to six months and remodelling continues for up to a year. Assessing the outcome at three weeks therefore tells you very little.
A common source of alarm is that the scars appear deeper at around two to three weeks than they did immediately after treatment. This is because swelling initially fills out the depressions, so the skin looks better in the first few days than it genuinely is. When that swelling resolves you are simply seeing your original baseline again, and after a brief period of apparent improvement this reads as a deterioration.
Certain features are more concerning - pain that increases rather than decreases after the third day, spreading redness, pustules or a yellow discharge suggest bacterial infection. Clustered painful blisters, particularly in a patient with a history of cold sores, suggest herpes simplex infection. Both require urgent treatment. Darkening of the treated skin at three to six weeks represents post-inflammatory hyperpigmentation, which is more common in darker skin types, usually settles over months and is treatable.
Generally I would advise against judging the result of a session before three months, and against booking a further session before then, since it is not yet possible to determine what the first one achieved.
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