Schedule a Consultation
(310) 998-5533
CO2 Laser Skin Resurfacing

Featured in Elle Magazine. WebMD calls the Fractional CO2 laser the Number One Antiaging Breakthrough of the Decade!  Fractional CO2 is an major advancement in the CO2 laser, a true gold standard among plastic surgeons for non-surgical facial rejuvenation.  In the article, the authors explain that CO2 laser "delivers powerful results without the traditionally harsh side effects."  The benefits of Fractional CO2 are superb, without the risks associated with previous generations of CO2 laser. An article in Vogue magazine touts the benefits of fractional CO2 laser for skin resurfacing.

co2 laser beverly hills 

According to Dr. Raffy Karamanoukian, the outstanding benefits of the Fractional CO2 laser stems from the SmartPulse mode and the ability to calibrate depth control for such a powerful and potent laser.  This allows Dr. Karamanoukian to treat the thin areas around the eyes at the same time as the thicker and deeper wrinkles around the mouth in one session. 

Our office is pleased to introduce the Smartxide Fractional CO2 laser for acne scars, deep wrinkle resurfacing, and non-surgical facial rejuvenation. The SmartXide Fractional CO2 is one of the foremost ablative laser resurfacing systems available worldwide and is widely popular in North America, Europe, and Asia.  SmartXide fractional CO2 is an excellent treatment modality for patients who wish to rejuvenate their skin without the lengthy recovery periods inherent in more invasive surgical procedures.  Dr. Karamanoukian is an expert in fractional CO2 laser skin resurfacing and can provide you with the expertise to rejuvenate your skin without invasive surgery. 

Laser skin resurfacing using fractionated CO2 laser provides longterm improvement of premature aging caused by fine wrinkles, skin discoloration, pigmentation, seborrheic keratosis, scarring, and large pores.  Treatment parameters vary depending on whether patients require deep or superficial treatment. The entire face and neck areas can be treated with the fractional CO2 laser resurfacing technique.  Laser treatments are performed in our AAAHC accredited surgical center and Dr. Karamanoukian and staff will make sure that your fractional CO2 laser procedure is performed with the highest standards of patient safety and efficacy. 




Wrinkles on the hands can be a form of premature aging that can leave the back of the hand creepy, wrinkled, with loss of volume.  Hand rejuvenation has become more and more popular with the introduction of safe volume fillers using hyaluronic acid and laser peels that can resurface the top layers of the skin.  At the office of Dr. Raffy Karamanoukian, hand rejuvenation is a popular treatment option for those men and women who complain of premature aging of the hand.  Our office recommends a combination of laser peels to resurface wrinkles on the surface of the hand, IPL for the removal of sunspots and pigmentation, topical hand creams to rejuvenate and stimulate the skin, and volume fillers to fill up the hollowness and boniness of the skin.  If you have questions about hand rejuvenation and wish to undergo either a laser peel or volume enhancement of the back of the hand, please call our Los Angeles plastic surgery office to schedule an appointment.  Call 310-998-5533 and speak to one of our plastic surgery patient care coordinators.



With Fractional CO2, Dr. Raffy Karamanoukian will examine your face and calibrate the CO2 laser to meet your desired goals. Undereye wrinkles will require a less invasive penetration depth compared to the forehead because the skin is noticeably thinner under the eyes.  Once calibrated, the area will be numbed with topical creams and anesthetic blocks in order to minimize pain.  The CO2 laser procedure typically lasts one hour. Our office allocates about two hours for the fractional CO2 laser resurfacing treatment.  The first hour will consist of a brief review of the pre and post treatment expectations.  Once the patient is numbed with topical lidocaine and subcutaneous lidocaine, the laser treatment is begun, which usually takes one half hour to perform. 


During the fractional CO2 laser treatment, patients usually feel heat and discomfort that is minimized by the application of a cooling spray called the Zimmer Cryo.  This effectively reduces the discomfort associated with the procedure and is one of many mechanisms employed by Dr. Karamanoukian to improve your experience during the procedure.  Since the laser only takes 30 minutes to perform, we can easily stage the procedure with small breaks to maximize your comfort level.



Recovery after the fractional CO2 laser varies, depending on the depth of the laser resurfacing peel.  The SmartXide Fractional C02 laser offered at Kare Plastic Surgery minimizes recovery after treatment when compared to traditional carbon-dioxide laser resurfacing. Laser resurfacing with CO2 laser effectively ablates the skin, thereby shrinking the epidermis and dermis.  The skin resurfacing treatment stimulates neocollagenesis and thus improves the texture, tone, resiliency, and tightness of the skin.  Dr. Raffy Karamanoukian offers several depths of CO2 laser resurfacing and can tailor the CO2 laser to meet your specific requirements. 


After treatment with the Fractional CO2 laser, you will feel some slight swelling of the skin with mild tingling.  Once the topical numbing medication wears off, you will feel some tingling of the skin for approximately 12 to 24 hours.  It is recommended that patients take oral analgesic medications including Tylenol or ibuprofen post treatment to reduce the discomfort associated with the laser resurfacing. 


Most patients can drive home after the CO2 laser and Dr. Karamanoukian will provide a detailed post treatment regimen to improve results and maintain a high level of safety with the laser.  At home, patients are advised to dab the skin three times daily with a Domeboro soak and apply an ointment, as provided by Dr. Karamanoukian.  The ointment will maintain the moisture of the skin and allow for more rapid healing of the underlying epithelium.  Follow-up appointments will be made within two to five days of the fractional CO2 laser resurfacing treatment and our office practitioners are available 24 hours a day for questions related to the Fractional CO2.  During non-business hours you may call our Santa Monica plastic surgery office at 310-998-5533 and Dr. Karamanoukian or PA Kelly Cummings will be able to provide you with assistance regarding your laser resurfacing treatment. 


Kare Plastic Surgery is accredited by the AAAHC and maintains the highest standards of patient safety.  If you have questions about Fractional CO2 laser resurfacing in Santa Monica, Beverly Hills, or the Los Angeles area, please feel free to call our office to schedule an appointment with Dr. Raffy Karamanoukian.


Once the laser treatment is complete, an assistant will help you wash off any residual numbing medication and apply an ointment to reduce inflammation and help the skin heal.  This emollient base forms a protective environment for skin healing.  Once the discharge criteria are met, you will be able to drive home. Follow-up appointments are made within several days of the procedure. 


Fractional CO2 can be used for out-of-town patients and Dr. Karamanoukian regularly sees patients from Russia, Saudi Arabia, Kuwait, Bahrain, Qatar, and UAE, among other nations.  Our office requests that you contact us prior to your visit in order to pretreat your skin prior to the laser session.  All laser sessions will be performed after careful examination in order to assess whether you are a candidate for Fractional CO2 laser resurfacing.  Patients are seen in for CO2 laser in our Santa Monica or Beeverly Hills offices in order to treat acne scars, wrinkles, or undergo laser resurfacing.  Fractional CO2 is an alternative treatment for facial rejuvenation that provides options for non surgical facelift. Patients who wish to undergo neck rejuvenation and neck lift surgery in Santa Monica or Beverly Hills may also benefit from non-surgical rejuvenation using the CO2 laser. 


  1. An article by B. Katz titled the ‘Efficacy of a new Fractional CO2 laser in the Treatment of Photodamage and Acne Scarring’ studied the safety and efficacy of fractional CO2 laser in the treatment of facial wrinkles, hyperpigmentation, enlarged pores, skin laxity, and acne scarring.  The author noted significant improvement with the laser with 92% of patients noting good to excellent improvement in photodamage; 85% noting reduction in wrinkling; and 79% noting improvement in skin laxity and pore size.
  2. Drs. Stebbins and Hanke studied the effects of ablative Fractional CO2 laser for resurfacing of the hands and noted a high degree of improvement in the study population with no long term sequel.  Investigators noted mean improvement in wrinkles, pigment, and texture of the hands.  This study provides insight into the many advantages of fractional CO2 in hand rejuvenation. 
  3. A recent paper from the Department of Dermatology in Riyadh Saudi Arabia, from the King Saud University noted improvement and safety in the treatment of acne scars with a fractional CO2 laser.  Acne scars can be improved in ethnic skin using the fractional CO2 laser, noted the authors from the King Saud University College of Medicine in Saudi Arabia.  The authors noted that prophylactic skin preparation improved post-inflammatory hyperpigmentation.  Our office recommends the Melaquin AM and Melaquin PM Skin Brightening Complex prior to treatment with CO2 laser.
  4. Authors from the GB Bietti Eye Foundation in Rome Italy describe the benefits of non-surgical eyelid rejuvenation using the fractional CO2 skin resurfacing system.  The authors noted a short downtime and easy patient recuperation after CO2 fractional treatment with safe skin contraction of the lower eyelids.  Fractional CO2 offers several advantages for eyelid rejuvenation for those patients who would like a non-surgical alternative to blepharoplasty.   ‘Lower Eyelid Ablative Fractional Resurfacing: A New Technique to Treat Skin Laxity and Photoaging.’
  5. A Study from the Department of Dermatology and Cutaneous Biology Research Institute in Seoul Korea reviewed the efficacy of fractional CO2 laser in the treatment of burn scars. The authors noted improvement in scar atrophy, scar contracture, scar texture, and color of the burn scars.  This study provides insight into the use of fractional CO2 laser in the treatment of scars and the utility of laser scar revision that is non-surgical. 
  6. An article in The Journal of Cosmetic Laser Therapy evaluated the efficacy of fractional CO2 laser in the treatment of aging skin and as an adjunct to cosmetic treatments. Their study demonstrated an average improvement of 42% in wrinkles and about 40% improvement in pigment and color variegation. This study further solidifies our Los Angeles plastic surgery practices advocacy of fractional CO2 laser in the treatment of wrinkles, scars, and pigmentation on the face.
  7. If you are wondering how effective the fractional CO2 laser is as an alternative to Fraxel laser, new research has shown that the fractional CO2 laser provides significant improvement in photoaging of the face.  Dr. Raffy Karamanoukian also uses the fractional CO2 laser for scars, acne scars, and stretch marks.  A study in Dermatologic Surgery in 2011 demonstrated the effectiveness of the CO2 laser in skin texture, skin laxity, dyschromia, and cosmetic outcome.  Participants showed a mean improvement of 48.5% for skin texture, 50.3% for skin laxity, 53.9 % for dyschromia, and 52.4% for overall cosmetic outcome.



  1. What type of anesthesia is used for fractional CO2 DOT laser resurfacing? Fractional laser resurfacing is an ideal treatment for correction of mild-to-moderate wrinkle on the face as well as tightening of the skin.  Dr. Raffy Karamanoukian is a board certified plastic surgeon practicing in Santa Monica and Beverly Hills.  He performs laser resurfacing with the fractional CO2 DOT laser system.  Fractional CO2 is an ideal laser surfacing treatment for patients with fair skin and mild-to-moderate wrinkles.  The procedure is generally well tolerated by both men and women and there are several steps taken by our staff to minimize pain and discomfort during the procedure.  Dr. Karamanoukian performs typical fractional CO2 laser skin resurfacing under local anesthesia using topical cream and lidocaine injection.  Some patients may request general anesthesia or IV sedation with a board certified anesthesiologist during their fractional CO2 laser treatments.  If you have particular questions regarding laser skin resurfacing and the DOT laser, please call our cosmetic surgery patient care coordinator at 310-998-5533. Dr. Raffy Karamanoukian employs the fractional CO2 laser skin resurfacing in consort with facial volume fillers, Botox injections, and facial cosmetic surgery.  When combining these many different options, the facial skin and neck skin are tightened and recontoured.  Our office is pleased to offer the SmartXide system for fractional CO2.
  2. What is the fractional CO2 laser? Fractional CO2 laser surfacing has been touted as one of the biggest cosmetic innovations in the last decade.  Fractional CO2 laser uses an ablative energy source to resurface the skin in order to improve the overall texture, quality, tightness, and firmness of the skin.  Premature aging, skin laxity, large pores, scars, acne scars, fine wrinkles, and deep wrinkles can be effectively resurface in order to optimize the skin and improve the cosmetic appearance of the face.  Dr. Raffy Karamanoukian is a board certified plastic surgeon specializing in cosmetic surgery and can provide you with many options for fractional CO2 laser skin resurfacing in our Los Angeles area office.  Dr. Karamanoukian utilizes the fractional CO2 laser for patients who desire facial rejuvenation without invasive cosmetic surgery.  The CO2 laser resurfacing system can provide the safe alternative for skin tightening and laser face lift without significant downtime or surgical scars.  Our office also offers the fractional CO2 laser system for patients with acne scars or in those patients who needs scar revision from previous surgeries.  Fractional CO2 laser can reduce the cosmetic appearance of a scar and increase the tightness of the skin.  There is new clinical research documenting the safety and efficacy of fractional CO2 laser in the treatment of stretch marks on the body.

  3. How safe this fractional CO2 laser? The safety of fractional CO2 laser rest in proper patient selection and the utilization of proper safety protocols during your laser treatment.  Dr. Raffy Karamanoukian is a trusted expert in the plastic surgery and has double board certification.  He performs fractional CO2 laser skin resurfacing in an accredited operating room using local anesthesia, IV sedation, or general anesthesia.  The patients who have a low pain tolerance can elect to undergo fractional CO2 laser skin resurfacing with general anesthesia with a board certified anesthesiologist working alongside Dr. Karamanoukian. All elements of your care will be carefully performed in order to maximize safety and minimize risk.  Unlike traditional surgery, there is no cutting during a fractional CO2 laser treatment and this minimizes the risk of long term scarring.  Dr. Karamanoukian will identify your candidacy for fractional CO2 laser skin surfacing during your preop consultation as well as immediately prior to your treatment.

  4. How long does fractional CO2 laser take to perform? Fractional CO2 laser is an outpatient procedure that takes approximately one to two hours to perform depending on the surface area of treated skin.  Our Los Angeles plastic surgery office is dedicated to safety during treatment and will allocate approximately two hours for your fractional CO2 laser.  During this time, Dr. Karamanoukian and his physician assistant will administer a topical anesthetic on to the face which will take approximately 45 minutes to absorb into the skin surface.  Once activated, the topical medication will be enhanced with nerve blocks administered with a tiny needle.  Dr. Karamanoukian will administer the nerve blocks safely in order to minimize pain during the procedure.  The actual laser treatment will take approximately 30 minutes to 45 minutes to perform and the patients are able to drive home and perform normal functions after the procedure.  At the end of the procedure, Dr. Karamanoukian will review all aspects of your posttreatment regimen in order to facilitate your recovery.

  5. Can I have the fractional CO2 laser without anesthesia? The fractional CO2 laser is effective in surfacing the skin and has a particular depth of penetration within the skin surface.  This area of the skin and dermis is particularly sensitized because of the high density of nerve endings.  Although it is possible to undergo the fractional CO2 laser skin resurfacing treatment without anesthesia, Dr. Karamanoukian advises the patients to undergo the full course of local anesthetic in order to minimize discomfort during the procedure.  By maximizing your safety during the procedure, the risks are minimized and the overall patient experience is enhanced.

  6. Can I undergo the fractional CO2 laser treatment under general anesthesia? Some patients will have a low pain threshold and may request laser skin resurfacing treatment under IV sedation or general anesthesia.  These patients may benefit from anesthesia as opposed to local anesthetic.  Dr. Raffy Karamanoukian works alongside board certified anesthesiologists who are knowledgeable and experienced in the management of cosmetic surgery patients.  On request, Dr. Karamanoukian will use a board certified anesthesiologist during your procedure.  The anesthesiologist will administer a proper anesthetic based on patient selection and minimize your pain during the procedure.



Once your CO2 laser is performed and you have fully recovered, many patients ask whether they can enhance their results with monthly or bimonthly treatments.  Dr. Raffy Karamanoukian, a board certified plastic surgeon, recommends a topical skincare regimen that includes Melarase creams and regular visits for a new technique known as the Hydrafacial.

  1. Hydrafacial incorporates dermolipoinfusion treatments to rejuvenate and maintain your skin quality. Seen on Daily Candy and The Real Housewives of Beverly Hills, the Hydrafacial is the latest innovation in facials and cosmetic skincare.  The Hydrafacial system incorporates key elements of skin rejuvenation, including microdermabrasion, dermolipoinfusion, enzymatic cleansing of large and clogged pores, and chemical peeling all in one.  In essence, the Hydrafacial system exfoliates dead skin cells and extracts impurities and blackheads with a vacuum-based skin abrasion tip while stimulating the blood and ymphatic flow.  The healthy underlying skin is then infused with key nutrients, antioxidants, and active serums that are specifically tailored to your skin type. 
  2. Diamond Microdermabrasion treatments provide controlled exfoliation of the skin and can remove surface impurities that lead to premature aging, skin discoloration, and acne.  After a CO2 laser resurfacing procedure, diamond microdermabrasion sessions can effectively maintain the skin's glow by gently exfoliating the skin of the face and chest.  Ideal for sensitive skin and for skin that is prone to blemishes and breakouts. 
  3. The MelaPeel treatment provides little downtime and works well to even skin complexion and melasma before and after fractional CO2 laser.  Most patients who have premature wrinkling and pigmentary changes may benefit from the chemical peel and laser peel combined in order to decrease signs of aging.  The Melapeel contains proprietary wrinkle and pigment reducing agents and can be applied as a weekend rejuvenative procedure.


In Dr. Karamanoukian's office, we utilize a specialized protocol for medical facials that incorporates the hydrafacial system.  Our medical facials use the dermolipoinfusion system contained within the Hydrafacial armamentarium as well as a specialized protocol of microdermabrasion and chemical exfoliation. Your skin will look refreshed and exhilarating for a party or event.


© 2011 Skin Kare, Inc. All rights reserved.