Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Fully Ablative Vs Fractional CO₂: Choosing Optimal Scar Treatment
Understanding the distinction between fully ablative vs fractional CO₂ laser treatments is crucial for effective scar revision. This article details how fully ablative resurfacing completely removes the epidermis for severe damage, while fractional photothermolysis creates microthermal treatment zones for faster re-epithelialization and reduced downtime. Expert practitioners tailor laser intensity and treatment density based on scar type and patient skin, ensuring optimal results and managing recovery expectations. The choice between fully ablative vs fractional CO₂ impacts tissue ablation, coagulation, and overall healing, guiding patient selection for various dermatological concerns.
London Skin Clinic provides consultant-led CO₂ laser resurfacing, performed by GMC-registered plastic surgeons and elite laser specialists. This content reflects their expertise in advanced dermatological surgery, ensuring evidence-based guidance for optimal patient outcomes and safety.
To explore your options, contact us to schedule your consultation. You can also reach us via: Schedule your Consultation
Fully Ablative vs. Fractional CO₂ Lasers: The Core Difference
The difference between these CO₂ laser approaches is their interaction with the skin’s surface. A fully ablative laser removes the entire epidermis, while a fractional laser creates microscopic treatment zones, leaving surrounding tissue untouched as a healing reservoir. This distinction alters the treatment’s intensity, downtime, and risk profile.
What is Fully Ablative CO₂ Laser Resurfacing?
Fully ablative resurfacing is the complete removal, or tissue ablation, of the epidermis and a portion of the upper dermis across the treatment area. The CO₂ laser’s 10,600 nm wavelength is highly absorbed by water in the skin, allowing precise vaporisation of tissue layer by layer. This process is analogous to a controlled, precise “sanding” of the skin’s surface.
The thermal energy delivered also causes immediate collagen contraction and stimulates a long-term wound healing response, leading to extensive new collagen formation. This makes it an effective tool for addressing deep wrinkles and severe, widespread textural damage.
How Does Fractional CO₂ Laser Work?
Fractional CO₂ laser technology, or fractional photothermolysis, delivers laser energy in a pixelated pattern. This creates thousands of microscopic columns of thermal injury, called microthermal treatment zones (MTZs), that penetrate deep into the dermis.
The skin surrounding each MTZ is left intact. These “bridges” of healthy tissue serve as a reservoir for rapid healing, allowing for faster re-epithelialization (new skin formation) and reducing downtime and side effects compared to an ablative procedure.
Choosing the Right Intensity: Ablative vs. Fractional for Your Scars
The decision between a fully ablative or fractional approach is a clinical judgment based on scar type, scar depth, patient’s skin type (Fitzpatrick scale), and tolerance for downtime. A practitioner adjusts variables like laser intensity (energy per pulse) and treatment density (spacing of MTZs) to create a customised treatment.
When is Fully Ablative CO₂ Laser Indicated?
A fully ablative laser is typically reserved for severe photodamage and scarring. Its comprehensive tissue removal makes it effective for:
- Severe atrophic acne scars: Widespread, deep boxcar scars and significant textural irregularities covering a large surface area.
- Deep rhytides (wrinkles): Deep-set perioral (around the mouth) and periorbital (around the eyes) lines.
- Significant skin laxity: The intense thermal effect provides a notable degree of tissue tightening.
Patients considering this option must be prepared for a substantial recovery period and have a lighter skin phenotype (Fitzpatrick I-III) to minimise the risk of pigmentary changes.
Ideal Candidates for Fractional CO₂ Laser
Fractional CO₂ laser offers greater versatility and a more favourable safety profile, making it suitable for a broader range of patients and conditions. Ideal candidates have:
- Moderate to severe acne scars: Effective for ice-pick, boxcar, and rolling scars, often requiring a series of treatments.
- Sun damage and pigmentation: Can improve dyschromia, sun spots, and overall skin tone.
- Fine lines and textural concerns: Provides significant rejuvenation with less downtime than a fully ablative treatment.
Because of its reduced risk and quicker recovery, fractional resurfacing is often the preferred starting point and can be used on a wider range of skin tones with appropriate clinical protocols.
Downtime, Recovery, and Re-epithelialization: What to Expect
The recovery process is a critical factor in the fully ablative vs fractional CO₂ decision. The extent of tissue removal directly correlates to the length and intensity of the healing phase.
Fully Ablative Recovery: A Day-by-Day Overview
Recovery from a fully ablative procedure is intensive and involves managing an open wound. Patients can expect oozing, crusting, and significant swelling for the first 7-10 days. Meticulous post-procedure care with gentle cleansing and occlusive ointments is vital to support re-epithelialization and prevent infection. While the skin surface heals within about two weeks, redness (erythema) can persist for several months.
Fractional CO₂ Downtime: Faster Healing, Milder Side Effects
Fractional recovery is more manageable. The intact skin bridges accelerate healing. Patients typically experience redness and swelling similar to a severe sunburn for 3-5 days. The treated microscopic spots may appear as tiny dark dots that flake off, a process called “bronzing.” Most patients can return to social activities within 5-7 days, with residual pinkness that can be concealed with makeup.
| Recovery Milestone | Fully Ablative CO₂ | Fractional CO₂ |
|---|---|---|
| Initial Re-epithelialization | 10-14 days | 3-5 days |
| Typical Social Downtime | 14-28 days | 5-7 days |
| Resolution of Significant Redness | 8-16 weeks | 1-3 weeks |
| Return to Normal Skincare | 4-6 weeks | 1-2 weeks |
Expert Insights: Tailoring CO₂ Laser Treatment for Optimal Results
Superior outcomes with CO₂ laser technology hinge on practitioner expertise. The choice between fully ablative vs fractional CO₂ is a clinical decision that requires an understanding of skin physiology, laser physics, and aesthetic judgment.
The London Skin Clinic Approach: Precision & Patient Safety
At London Skin Clinic, every laser resurfacing procedure is performed by a GMC-registered consultant plastic surgeon or a laser specialist like Prof. Jonny Herron. This consultant-led model ensures patient selection is meticulous and treatment plans are bespoke. When treating acne scars, our specialists, including Mr. Onur Gilleard, assess the scar type, underlying skin quality, and pigmentary risk.
This expertise is critical when managing risks like post-inflammatory hyperpigmentation (PIH), especially in individuals with darker skin tones. By adjusting energy settings and treatment density, and implementing pre- and post-treatment skincare protocols, we can safely perform advanced CO₂ laser resurfacing while prioritising patient safety. This approach is detailed in clinical guidelines from sources like the Journal of Cutaneous and Aesthetic Surgery.
Can Multiple Fractional Sessions Match One Ablative Treatment?
A planned series of fractional CO₂ treatments can often achieve cumulative results comparable to a single, aggressive fully ablative session. This staged approach allows for significant collagen remodelling and textural improvement without the extensive downtime and heightened risk profile of a full-field ablative procedure.
Building on each session’s results gradually and safely resurfaces the skin, making it an effective strategy for patients who cannot accommodate a month-long recovery period. This methodical process allows for a powerful yet manageable transformation, as explored in our guide to CO₂ laser for acne scars.
Beyond the Laser: Comprehensive Scar Management Strategies
Effective scar revision plans often use a multimodal approach, combining lasers with other treatments for more comprehensive results, especially for complex scar morphologies.
Combining CO₂ Laser with Other Modalities
Certain atrophic scars, particularly tethered or anchored rolling scars, benefit from a combination approach. Subcision is a minor surgical technique used to release the fibrous bands that pull the scar down, allowing the surface to lift. Performing subcision before or during a laser session can enhance the final textural improvement.
For scars with significant volume loss, dermal fillers can restore the underlying support structure after laser treatment improves skin quality. This dual approach addresses both surface texture and the deeper volume deficit for a more complete correction. Comparing different laser intensities, as in a CoolPeel vs traditional CO₂ laser analysis, highlights how treatment can be tailored.
Post-Treatment Care and Long-Term Skin Health
The results of a CO₂ laser treatment are long-lasting, but their maintenance depends on post-treatment care. Strict sun avoidance and the daily application of a broad-spectrum, high-SPF sunscreen are essential. UV radiation can cause new damage and trigger post-inflammatory hyperpigmentation in healing skin, compromising the results.
A consistent skincare regimen with ingredients like antioxidants and retinoids (once the skin is fully healed) maintains the improved skin quality. Regular follow-up appointments are essential for monitoring progress and ensuring long-term success, a principle supported by bodies like the American Academy of Dermatology.
Ready to Transform Your Skin? Schedule Your Expert Consultation
Choosing the right laser treatment requires expert guidance. An in-person consultation with a specialist is necessary to assess your scars, discuss goals, and develop a safe, effective, and personalised treatment plan. Our team of consultant plastic surgeons and laser experts across Harley Street, St Albans, and Guildford provides the highest standard of medical care.
Schedule your Consultation today to determine which CO₂ laser approach is right for you.
Conclusion
The choice between fully ablative vs fractional CO₂ laser is about matching the right intensity and modality to the patient. Fully ablative resurfacing offers a powerful, single-session solution for severe textural issues but demands a significant recovery. Fractional resurfacing provides a versatile, lower-risk alternative that achieves results over a series of treatments with manageable downtime. The optimal choice depends on your anatomy, skin type, and lifestyle. To explore your options, contact us and Schedule your Consultation.
Frequently Asked Questions
What is the core difference in the fully ablative vs fractional co2 laser approach?
A fully ablative CO₂ laser vaporises the entire surface layer of the skin across the treatment zone, requiring a longer healing period. In contrast, a fractional CO₂ laser creates microscopic treatment channels while leaving surrounding skin tissue intact. This fractional method uses the untouched skin as a healing reservoir, significantly speeding up recovery and enhancing the safety profile.
For severe acne scars, is the choice of fully ablative vs fractional co2 always straightforward?
No, the decision is highly nuanced and depends on a specialist’s assessment. While a fully ablative laser can be effective, it carries higher risks and significant downtime. A planned series of high-intensity fractional CO₂ treatments can often achieve comparable or even superior results with a much greater margin of safety, making it the preferred modern approach for most deep scars.
Why does your clinic favour fractional CO₂ laser for most scar treatments?
Our consultant-led team prioritises fractional CO₂ technology because it offers the best possible balance between profound efficacy and patient safety. This approach allows for deep, powerful treatment of atrophic scars while the surrounding healthy tissue promotes rapid re-epithelialization. This minimises common risks like prolonged redness and post-inflammatory hyperpigmentation (PIH), particularly in diverse skin tones.
Can the results of several fractional sessions equal one fully ablative treatment?
Yes, a bespoke course of 2-3 advanced fractional CO₂ laser treatments can often match or exceed the results of a single, highly aggressive fully ablative session. This staged strategy is generally safer and allows for more precise, cumulative improvements with recovery periods that are far more manageable for the patient’s lifestyle.
How do I know if fully ablative vs fractional co2 is right for my scars?
This critical decision can only be made by a qualified specialist during a clinical evaluation. Our GMC-registered consultant plastic surgeons assess your specific scar type, skin tone, and treatment goals to determine the safest and most effective modality. The choice between fully ablative vs fractional co2 is tailored precisely to your individual needs to ensure optimal outcomes. Schedule your consultation to receive an expert medical opinion.
What determines the recovery time in the debate of fully ablative vs fractional co2?
Downtime is a primary differentiator when considering fully ablative vs fractional co2. Fully ablative resurfacing requires a longer, more intensive healing phase as the entire skin surface has been removed and must regenerate. Fractional laser recovery is much faster, typically 7-10 days, because the islands of untreated skin accelerate the natural healing process.
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