The combination mechanism relies on the simultaneous use of thermal ablation and pneumatic physical separation to treat the full depth of the scar. The Carbon Dioxide (CO2) Fractional Laser delivers thermal energy to reconstruct tissue structures at depths up to 4mm, while injected CO2 gas uses high mechanical pressure to physically sever the fibrous bands tethering the scar to deeper layers.
By integrating thermal remodeling with mechanical release, this dual approach addresses the root causes of deep scarring: the laser repairs the dermal structure from the surface, while the gas releases tension and stimulates blood flow from underneath.
The Mechanism of Pneumatic Subcision (CO2 Gas)
Mechanical Severing of Fibrous Bands
Deep acne scars are often held in a depressed position by rigid fibrous bands pulling the skin downward.
In this protocol, CO2 gas is injected subcutaneously using high-pressure needles. The force of the gas acts as a "pneumatic scalpel," utilizing mechanical pressure to physically sever these fibrous tethers (subcision), allowing the skin to elevate.
Oxygenation and Neovascularization
Beyond the physical release, the presence of the gas induces a biological response in the tissue bed.
The injected CO2 increases local oxygen content within the tissue. This stimulates the formation of new blood vessels (angiogenesis), which creates a nutrient-rich environment that supports faster healing and more robust collagen synthesis.
The Mechanism of Fractional CO2 Laser
Creation of Micro-Ablative Zones
While the gas works subcutaneously, the laser targets the epidermis and dermis through Microscopic Treatment Zones (MTZs).
The laser vaporizes damaged tissue in precise columns, known as ablation columns, reaching depths of up to 4mm. These microscopic injuries trigger the body's wound-healing response to remove damaged scar tissue physically.
Thermal Stimulation and Remodeling
Surrounding the ablated columns, the laser generates deep thermal zones that stimulate fibroblasts.
This heat shock triggers the production of new collagen and elastic fibers (neocollagenesis). Because the laser operates fractionally—leaving "islands" of healthy, untreated tissue between the columns—the skin heals rapidly, utilizing the healthy cells to assist in epidermal remodeling.
Synergistic Effects on Tissue
Comprehensive Collagen Reorganization
The combined protocol attacks the scar structure from two distinct angles.
The laser induces collagen contraction and tightening in the upper layers via heat. Simultaneously, the subcision triggers collagen reorganization in the deep dermal layer via mechanical trauma and increased oxygenation.
Enhanced Healing Environment
The synergy of these two methods creates an optimal environment for tissue regeneration.
The laser removes the old, damaged surface texture. The gas subcision ensures the new tissue is not pulled back down by tethers, while the increased blood flow ensures the metabolically active fibroblasts have the oxygen required to build new structure.
Understanding the Trade-offs
Controlled Trauma is Necessary
To achieve these results, the skin must undergo significant controlled injury.
The creation of ablative zones and the physical tearing of fibrous bands triggers inflammation. This is the catalyst for healing, but it means the treatment is not "no-downtime"; the body requires energy and time to resolve the thermal and mechanical injury.
Depth vs. Recovery
Deeper treatment yields better results for deep scars but extends the recovery window.
While the fractional pattern significantly shortens healing compared to fully ablative lasers, reaching a depth of 4mm is aggressive. Patients must balance the need for deep structural correction with the reality of the re-epithelialization timeline.
Making the Right Choice for Your Goal
This combination therapy is a potent tool for structural skin revision. Here is how to assess if it aligns with your objectives:
- If your primary focus is releasing deep, tethered rolling or boxcar scars: The pneumatic subcision component is essential to physically break the bands that laser alone cannot reach.
- If your primary focus is surface texture and pore size reduction: The fractional laser component will drive the necessary epidermal turnover and collagen tightening.
- If your primary focus is minimizing total recovery time: Be aware that combining deep mechanical subcision with 4mm laser ablation creates a compound recovery period that requires strict post-procedure care.
The most effective treatment plans respect the biology of the scar, treating the deep tethering first and the surface texture second to ensure long-term smoothness.
Summary Table:
| Mechanism Component | Action Type | Primary Function | Treatment Depth |
|---|---|---|---|
| CO2 Fractional Laser | Thermal Ablation | Creates MTZs, stimulates collagen & resurfaces | Up to 4mm |
| CO2 Gas Subcision | Mechanical Pressure | Severs fibrous tethers (pneumatic scalpel) | Subcutaneous |
| Synergistic Effect | Biological Response | Enhances oxygenation & neovascularization | Full Skin Depth |
Elevate Your Clinic’s Scar Treatment Results with BELIS
Are you looking to provide your patients with the ultimate solution for deep structural skin revision? BELIS specializes in professional-grade medical aesthetic equipment designed exclusively for clinics and premium salons. Our advanced CO2 Fractional Laser systems and specialized care devices provide the precision and power needed for high-impact protocols like combined laser-subcision therapy.
By partnering with BELIS, your clinic gains access to:
- Advanced Laser Systems: High-performance CO2 Fractional, Nd:YAG, and Pico lasers.
- Comprehensive Solutions: From body sculpting (EMSlim, Cryolipolysis) to skin health (Hydrafacial, Skin Testers).
- Unmatched Value: Superior technology that ensures faster healing, robust collagen synthesis, and higher patient satisfaction.
Ready to upgrade your treatment offerings?
Contact us today to discuss your equipment needs!
References
- The efficacy and safety of combination therapy using deep penetrated CO2 fractional laser and subcision with CO2 gas for acne scar. DOI: 10.1016/j.jaad.2016.02.1121
This article is also based on technical information from Belislaser Knowledge Base .
Related Products
- Fractional CO2 Laser Machine for Skin Treatment
- Fractional CO2 Laser Machine for Skin Treatment
- Pico Picosecond Laser Machine for Tattoo Removal Picosure Pico Laser
- Hydrafacial Machine Facial Clean Face and Skin Care Machine
- Pico Laser Tattoo Removal Machine Picosure Picosecond Laser Machine
People Also Ask
- How does fractional CO2 laser work? The Science Behind Powerful Skin Renewal
- What is a CO2 fractional laser good for? Dramatic Skin Rejuvenation for Wrinkles & Scars
- Why am I not seeing results after a CO2 laser? Your Patience is the Key to Long-Term Skin Rejuvenation
- What does a CO2 laser do to your face? Achieve Profound Skin Resurfacing & Renewal
- Is CO2 laser for all skin types? A Critical Guide to Skin Type Safety and Risks
