Why This Decision Shapes Your Resurfacing Practice
Skin resurfacing is one of the fastest-growing lines in aesthetic practice, driven by clients arriving with acne scars, sun damage, and fine lines they want corrected properly rather than masked. As that demand has broadened, so has the mix of people walking in: different skin types, different severities, and different tolerances for time away from normal life. Choosing a resurfacing approach therefore requires consideration of the indication, the treatment area, the client’s history, and the recovery profile of the specific protocol.
CO2 ablative laser resurfacing and non-ablative 1570 nm resurfacing use different mechanisms.
CO2 and non-ablative 1570 nm approaches can both have a role in resurfacing practice. The appropriate choice depends on the indication being treated, the protocol and parameters used, the treatment area, the patient’s characteristics and history, and the recovery profile that is acceptable for that individual.
How CO2 Ablative Laser Resurfacing Works
CO2 ablative laser resurfacing works by removing targeted tissue and prompting the skin to rebuild it. The CO2 laser emits at 10,600 nm, a wavelength strongly absorbed by water, so it can vaporize microscopic columns of tissue in the treated area while delivering thermal energy into surrounding tissue.
Fractional CO2 treatment creates microscopic treatment columns separated by areas of untreated skin. The supplied evidence supports collagen remodeling and changes in collagen staining following fractional CO2 treatment in specific studied indications, including abdominal striae. These findings should be interpreted in the context of the indication and protocol studied rather than generalized to every resurfacing application.
Recovery varies according to the treatment protocol, settings, treatment area, and whether the treatment is fractional or fully ablative. The clinical evidence does not establish a universal 7–14 day recovery period for fractional CO2. Clinical studies of Hybrid protocols reported mean downtime in the range of approximately 4.3–7.3 days in the cited studies, with a periorbital Hybrid study reporting approximately 5.9 days. These observations should not be presented as a universal recovery time for standalone CO2.
How Non-Ablative 1570 nm Resurfacing Works
Non-ablative 1570 nm resurfacing works by delivering thermal energy to deeper skin without intentionally ablating the surface. The clinical standalone clinical evidence reported visible improvement in photographic appearance and moderate laxity and wrinkles after treatment.
What the Evidence Shows Across the Two Approaches
The available evidence should be read as a collection of studies with different designs, indications, populations, and protocols, rather than as a validated head-to-head comparison. The table below separates the mechanisms and study-specific observations without assigning an unsupported treatment hierarchy.
| Factor | CO2 Ablative | Non-Ablative 1570 nm | Hybrid / Combined Evidence |
| Mechanism | Ablates targeted tissue and delivers thermal energy to surrounding tissue. | Delivers thermal energy without intentional surface ablation. | Combines CO2 ablative and 1570 nm non-ablative energy in the same system. |
| Wavelength | 10,600 nm | 1570 nm | 10,600 nm CO2 + 1570 nm |
| Evidence base | Evidence clinical includes fractional CO2 studies in specific indications, including acne scars, facial aging and striae. | Standalone clinical evidence clinical includes a small uncontrolled cohort studying rejuvenation-related outcomes. | Avdulaj (2025) compared CO2 alone with a Hybrid protocol; the clinical evidence did not establish a significant between-group efficacy or adverse-reaction difference. |
| Indications studied in the supplied evidence | Specific CO2 studies include acne scars, facial aging and striae, depending on the study. | Moderate laxity/wrinkles and photographic appearance in the cited standalone cohort. | Specific combined-protocol studies, with indications and outcomes varying by study. |
| Skin types studied | Varied by study; no supplied trial establishes categorical recommendations across Fitzpatrick I–VI. | Standalone cohort included Fitzpatrick II–IV. | Varies by study; no supplied evidence validates a universal phototype-selection rule. |
| Recovery observations | Protocol-dependent. No universal recovery duration is established. | Standalone cohort reported immediate routine return; no fixed 24–48 hour redness duration was established. | Reported mean downtime varied by study, including approximately 4.3–7.3 days in cited Hybrid studies. |
| Sessions | Varies by indication and protocol. | Three monthly sessions in the cited standalone study; no optimal range was established. | Schedules vary by study and protocol. |
| Safety observations | Risks depend on parameters, treatment area and patient characteristics. | Small standalone cohort reported no adverse events, but this cannot establish lower comparative risk or a complete safety profile. | Avdulaj (2025) reported no significant between-group adverse-reaction difference in the evaluated protocol. |
How to Approach Treatment Selection
Treatment selection should be considered as a set of clinical factors rather than a validated decision algorithm. Relevant considerations include the indication and its severity, the patient’s skin type and history, treatment area, previous treatments, expected recovery, and the parameters and protocol being considered.
Why the Hybrid Approach Changes the Equation
Hybrid laser resurfacing combines ablative and non-ablative energy within a single treatment system. Alma Hybrid combines a CO2 ablative laser at 10,600 nm with a non-ablative 1570 nm fibre laser.
HyGrid mode allows the clinician to program the ratio of ablative to non-ablative energy within a matrix of micro-dots. This is a technical capability of the system. The supplied clinical evidence does not establish that particular ratios predict a specific depth, recovery period, or outcome for a given skin type or indication.
The clinical evidence for combined treatment should be interpreted proportionately. Avdulaj (2025) compared CO2 alone with a Hybrid protocol and found no significant between-group difference in efficacy or adverse reactions in the evaluated study. Other cited studies are small, retrospective or uncontrolled, and the evidence base includes calls for prospective controlled comparisons.
For IMPACT ultrasound, Trelles (2013) evaluated CO2 alone against CO2 combined with ultrasound and a serum. The combined treatment side had better scores at six months, but the study could not isolate the contribution of ultrasound from the serum and included only 14 participants. The paper describes ultrasound as being used to assist absorption; it did not directly quantify penetration. These findings should therefore be presented as study-specific rather than as proof that ultrasound extends outcomes beyond laser energy alone.
From a practice perspective, a platform that combines different resurfacing modalities can give clinicians access to multiple treatment approaches within one system. Claims about replacing other devices, serving every patient, or providing universal treatment coverage are not established by the supplied clinical publications.
The Bottom Line
The evidence supports treating CO2 ablative and non-ablative 1570 nm resurfacing as distinct approaches with different mechanisms and study profiles. It does not establish a universal head-to-head hierarchy in which one technology is better, safer, faster, or more suitable for particular skin types across all indications.
The most defensible treatment-planning approach is to consider the indication, treatment area, patient characteristics and history, expected recovery, protocol and parameters, and the evidence and official manufacturer guidance applicable to the treatment being considered.
A platform offering ablative, non-ablative, and Hybrid capabilities can give a practice flexibility in how it approaches different resurfacing protocols. The clinical rationale and expected outcomes should nevertheless be communicated in proportion to the evidence for each specific protocol.
To see how ablative, non-ablative, and Hybrid options fit your treatment menu, explore Alma’s skin resurfacing treatment page and the Alma Hybrid platform.
Dr. Dean Berman, Global VP Medical, Alma LTD 
