CO2 laser resurfacing training, what it involves and who it suits

Last reviewed: 30 July 2026.

Who wrote this: Aurelia Institute trains healthcare professionals in medical aesthetics, so we have a commercial interest in this subject. We are not currently running laser courses and hold no awarding organisation approval. This page is a guide, not a course for sale, and it is not clinical advice.

CO2 resurfacing is the treatment where the gap between a good result and a lasting problem is narrowest.

It is ablative. It removes tissue rather than heating it from underneath, which is why it produces changes other devices cannot and why the recovery is a genuine event rather than an inconvenience. Patients need time off, aftercare compliance and realistic expectations, and the practitioner needs judgment about who should not have it at all.

That last part is the difference between practitioners who do this well and those who eventually stop offering it.

The short version

Question	Answer
What is CO2 resurfacing?	An ablative laser that removes layers of skin to drive remodelling.
Fractional or fully ablative?	Most aesthetic practice is fractional. Fully ablative is a bigger undertaking.
Who is it not for?	Higher Fitzpatrick types carry markedly greater pigmentation risk. Selection is the main safeguard.
What must happen before treatment?	Assessment, HSV history and prophylaxis where indicated, and a patch test.
What is the downtime?	Real. Days of visible healing, not hours.
Prerequisites for training?	Core of knowledge and device training at minimum. Most providers want prior laser experience.
Is it regulated?	As with all laser work, it depends on your nation and local authority.

Ablative is a different category

Non-ablative devices heat the dermis and leave the epidermis intact. Ablative lasers remove it.

That single difference drives everything else. The results can be better because you are producing a controlled wound and the healing response does the work. The risks are correspondingly higher because you have removed the barrier that keeps infection out and moisture in, and because the healing process itself can go wrong in ways that show.

Fractional delivery, where the beam is split into columns leaving untreated skin between them, moderated this considerably. Healing is faster because the surrounding tissue provides a reservoir of intact skin. Most aesthetic CO2 work is fractional for that reason. Fully ablative resurfacing remains a more significant procedure with a longer recovery and a higher complication profile.

The pigmentation problem

This is the central clinical issue and it deserves stating plainly.

Post-inflammatory hyperpigmentation is the most common significant complication, and the risk rises substantially with Fitzpatrick phototype. Patients with higher phototypes are considerably more likely to pigment after ablative treatment, and in that group the discussion is often about whether to treat at all rather than about settings.

That does not mean darker skin cannot be treated. It means the risk conversation is different, the settings are different, pre and post treatment regimes matter more, and the threshold for choosing a non-ablative or entirely different approach is lower. A course that teaches CO2 without spending real time on this is preparing you for one part of the population.

Practitioners who get into difficulty here usually do so by applying a protocol learned on one skin type to another.

What has to happen before you treat

A proper assessment. Indication, the scar or rhytid pattern you are actually treating, Fitzpatrick phototype, pigmentation history, and whether laser is the right answer at all.

HSV history and prophylaxis. Ablative resurfacing can reactivate herpes simplex, and a reactivation across a resurfaced face is a serious complication. Anyone with a cold sore history needs antiviral prophylaxis, and many practitioners give it regardless of history for full-face work. This is a prescribing question, which means it is also a question about your prescribing arrangement.

Keloid and scarring history. Previous hypertrophic or keloid scarring shifts the risk profile substantially.

Medication and photosensitivity review. Including recent isotretinoin, where practice varies and a considered position is expected rather than a blanket rule applied without thought.

A patch test. Non-negotiable in higher phototypes and sensible generally.

Photographs. Standardised, before, in the same light and position you will use afterwards.

The occupational hazard nobody mentions

Ablative laser treatment produces surgical plume, and this is a genuine risk to you rather than to the patient.

The plume from tissue ablation contains particulate matter, chemical by-products and, in some circumstances, viable biological material. It is an inhalation hazard for everyone in the room, and it is the reason theatre-grade plume extraction exists.

In practical terms that means a dedicated smoke evacuator with an appropriate filter positioned close to the treatment site, not a room extractor fan, plus appropriate respiratory protection for the operator and assistant. This sits under general health and safety obligations rather than under aesthetics-specific rules, which is partly why it gets overlooked on course pages.

If a CO2 course does not cover plume management, it has left out the part that affects your own health across a career.

Aftercare is most of the outcome

With ablative work the practitioner’s technique sets the ceiling and the patient’s aftercare determines whether they reach it.

Patients need to understand the healing sequence before they consent: what the skin will look like at day one, day three and day seven, when they can wear makeup, what they must not do, and how strictly they must avoid sun. They also need to know who to call and when, because the difference between normal healing and early infection is not obvious to a frightened person looking in a mirror.

Written aftercare, a review appointment booked before they leave, and a reachable phone number are worth more here than in any other treatment.

Training prerequisites

Providers vary, but a sensible sequence is core of knowledge first, then device-specific training on the platform you will actually use, then treatment training.

Most reputable CO2 courses expect prior laser experience rather than taking complete beginners, and that expectation is reasonable given the consequences. If a provider will put you on a CO2 course with no prior laser background, ask why.

Our guide to laser core of knowledge covers the safety layer underneath all of this, including where it is legally required and where it is not.

Regulation

CO2 resurfacing is laser work and follows the same pattern as the rest of the field. Purely cosmetic laser treatment in England was deregulated in 2010 and no longer requires CQC registration, with requirements now depending on whether your local authority licenses under a local act. Scotland, Wales and Northern Ireland remained regulated.

Where the treatment is being used for a medical indication rather than a cosmetic one, the position may differ, and that is worth establishing rather than assuming.

Health and safety law applies everywhere, and given the plume issue it applies here with more force than in most aesthetic treatments.

What to check before booking

What prior laser experience does the provider expect, and why?
Is the training on the platform you intend to use?
How much time is spent on patient selection and Fitzpatrick considerations?
Does the course cover HSV prophylaxis, and the prescribing implication of that?
Is plume management taught, including extraction and respiratory protection?
How many live patients will you treat, and at what settings?
What does the course say about treating higher phototypes?
Is there post-course support for a patient who is not healing as expected?

What it costs

Training is the smaller number. A CO2 platform is a substantial capital purchase, and there are consumables, servicing, a laser protection adviser, controlled area setup, eyewear rated for the wavelength, and plume extraction equipment.

Model the treatment volume you realistically expect before committing to a device, and remember that CO2 patients need longer appointments and more follow-up than most treatments, so the throughput assumptions that work for injectables do not transfer.

Where you can train

Training and local information by city: London, Manchester, Birmingham, Leeds, Glasgow, Edinburgh, Bristol, Liverpool, Cardiff, Newcastle.

Frequently asked questions

What is the difference between ablative and non-ablative laser?

Ablative lasers remove the epidermis to drive remodelling through controlled wounding. Non-ablative devices heat the dermis while leaving the surface intact. Ablative produces greater change and carries greater risk and downtime.

Is fractional CO2 the same as fully ablative?

No. Fractional delivery treats columns of skin and leaves untreated tissue between them, which speeds healing and reduces complications. Most aesthetic CO2 work is fractional.

Can CO2 be used on darker skin?

It can, but the risk of post-inflammatory hyperpigmentation rises substantially with Fitzpatrick phototype. Selection, settings, patch testing and pre and post treatment regimes all matter more, and in some cases a different modality is the better answer.

Do patients need antiviral prophylaxis?

Anyone with a herpes simplex history should have prophylaxis before ablative resurfacing, and many practitioners give it for full-face work regardless of history. Since this involves prescribing, it interacts with your prescribing arrangement.

What is surgical plume and why does it matter?

The vapour produced when tissue is ablated. It contains particulate and chemical by-products and can carry biological material, making it an inhalation hazard for everyone in the room. Dedicated extraction close to the treatment site and respiratory protection are the controls.

Is CO2 resurfacing regulated in England?

Purely cosmetic laser work was deregulated in England in 2010 and does not require CQC registration. Local authority licensing may apply depending on your council. Scotland, Wales and Northern Ireland remained regulated.

What prior experience do I need before CO2 training?

Most reputable providers expect core of knowledge and prior laser experience. A provider willing to train a complete beginner on an ablative device is worth questioning.

Does Aurelia Institute run CO2 courses?

Not at present, and we hold no awarding organisation approval. This page exists as a guide.

Sources

Peer-reviewed literature on complications of dermatologic lasers in higher Fitzpatrick phototypes, on pigmentation risk and management.
Clinical references on ablative CO2 resurfacing, including assessment, technique selection and complications.
Health and Safety Executive guidance on control of substances hazardous to health, as it applies to surgical plume.
Care Quality Commission registration scope and the 2010 deregulation of cosmetic laser in England.
Provider course outlines reviewed 30 July 2026.

This page describes what training should contain and is not clinical advice. Confirm regulatory requirements with your local authority and insurer.