Scars form as part of the body’s natural healing process. Most of the time, they respond well to first-line treatments such as silicone sheeting and gentle massage (see our post on scar-massage & silicone sheeting). These methods help flatten and soften the tissue over time.
But some scars remain raised, firm, or tight despite these efforts. When that happens, I often recommend combining fractionated CO₂ laser with microneedling to encourage deeper collagen remodeling and smoother healing.
How the CO₂ Laser Works
The CO₂ laser creates controlled micro-thermal zones within the scar tissue. These tiny, targeted areas of heat stimulate the body’s repair response without damaging the surrounding skin. In the process, new collagen fibers form in a more organized way, improving texture and flexibility.
This approach doesn’t “burn away” the scar—it reminds your body to rebuild it more evenly.
Why Combine It with Microneedling
Microneedling adds another layer of precision. It creates microscopic channels on the surface of the scar, which supports healing in the upper layers of the skin. When combined with CO₂ laser energy, the two techniques work together to enhance collagen remodeling at multiple depths.
For patients whose scars haven’t improved with silicone or massage, this combination often offers a meaningful next step.
What to Expect During Treatment
Before starting, I apply a numbing cream to the skin. If the area is particularly sensitive, I might add a small local anesthetic injection.
The actual treatment usually takes 15 to 30 minutes, depending on the size of the scar. Afterward, your skin may feel slightly rough—similar to fine sandpaper. Over the next 7 to 10 days, tiny flakes or scabs will form and naturally shed as your skin renews itself.
Healing and Recovery
Your scar may look pink and feel sensitive for several days. I recommend gentle cleansing, a soothing moisturizer, and daily sun protection. Around six weeks after treatment, most patients notice that the scar feels softer and more pliable.
Because collagen takes time to rebuild, some patients may benefit from up to three to four treatment sessions, spaced a 8 weeks apart, to support cumulative improvement.
Why This Approach Works
What makes this process so interesting is how it harnesses your body’s natural healing to refine the scar. The controlled thermal injury from the laser stimulates better healing. Collagen fibers reorganize, the surface texture improves, and the scar gradually becomes less noticeable.
In other words: rather than simply covering up a scar, we support your skin in rebuilding itself for the better.
Final Thoughts
For scars that haven’t fully responded to silicone sheeting and massage, combining CO₂ laser with microneedling offers a thoughtful, science-based next step. Each treatment builds on your body’s own repair process, helping skin remodel gradually and naturally.
At the Oregon Cosmetic & Reconstructive Clinic, I view this as part of a continuum of care—supporting healing with both reliable, time-tested methods and newer technology-guided approaches.
