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Fractional CO2 Resurfacing - Related Questions

Q: I am 52 years old and I have tried Botox for my crow's feet, but it really does not work as well for me as it used to. Please tell me my other options.

A: Botox is really good for crow's feet. I was an investigator in the clinical trial that resulted in the FDA approval of Botox for crow's feet. Unfortunately, it is not the home run in the crow's feet as we age. This is for several reasons. First, sun damage over time weakens and thins the skin making total effacement of the lines much harder. In addition, the muscle that raises our cheeks when we smile cannot be injected with Botox (if it was, we could not smile and that's NOT good), so the smile muscle pushes the cheek up, causing those lower crow's feet that proper Botox cannot improve. Finally, loss of cheek volume and temple volume make crow's feet worse but Botox does nothing to correct that cause of crow's feet. Fillers can improve crow's feet caused by volume loss, but an even better option is skin resurfacing with a fractional CO2 laser. The CO2 laser smoothes the sun damaged skin and increases dermal skin volume by stimulating new collagen production. The results last years if sun avoidance is practiced to prevent new sun damage.

Q: I am considering fractional CO2 resurfacing laser treatment to improve my wrinkles. What questions should I ask my doctor?

A: First, make sure the treating physician is a BOARD CERTIFIED dermatologist, plastic surgeon, or facial plastic surgeon. Ideally, they should have been in practice for several years, and have done resurfacing treatments many times. The equipment should be top of the line (I am of the opinion that the Lumenis Encore Active/Deep FX laser system is superior to all others). If possible, make sure you are pretreated for several weeks with a prescription retinoid, a very good sunscreen, and in some cases, hydroquinone. Be sure you get all the recommended supplies before hand, and take all medications (like valcyclovir) that your dermatologist prescribes. Make sure you plan to lay low at home for a week to avoid the sun and avoid people that could give you a secondary infection. This is like an open wound and you need to be careful for the 5-7 days it takes to heal.


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Meet one of the countrys leading experts in the field of non-surgical skin rejuvenation.

Lupo Center for Aesthetic and General Dermatology
Mary P. Lupo, M.D. - Connect on Linkedin

Our mission at the Lupo Center is to provide patients with innovative, effective and ethical care to make each person look and feel their personal best. To fulfill our goal, we provide state-of-the-art medical, surgical and cosmetic treatments to all patients.

Board certified dermatologist and clinical professor of dermatology Mary P. Lupo, MD has been a leader in the field of non-surgical rejuvenation since 1983. She travels internationally to teach her innovative techniques, and her reputation brings in patients from around the country. She started the first formal residency training program for injectables and peels in 1983 at Tulane Medical School and served as past president of Women’s Dermatologic Society, adjunct professor of dermatology at Tulane and a founder of Cosmetic Boot Camp. Dr. Lupo holds membership in many prestigious dermatology associations, participates in clinical trials for approval of new drugs and devices and acts as an advisor for numerous aesthetic-minded companies.

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Lupo Center for Aesthetic and General Dermatology
Review From Casey C.
I’ve been injected by several physicians over the years and Dr Lupo is the best. She gave me an eyebrow lift with filler and it looks like I had surgery.
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