Pico Laser vs Fractional CO₂: Do Dark Marks and Acne Scars Need the Same Treatment?

For flat brown acne marks or pigment spots, Pico laser is the more direct choice. For depressed acne scars with visible edges or tethering, fractional CO₂ is usually more appropriate. The two devices have different main jobs: Pico targets pigment, while fractional CO₂ remodels skin structure.

At STC, we first decide whether an ‘acne mark’ is colour or a true depression. The name alone is not enough to choose the laser.

What is Pico laser best for?

Pico uses very short pulses to break up pigment. It is well suited to brown post-acne marks, dark spots and selected uneven pigmentation, generally with less surface recovery than fractional CO₂ [1].

Some Pico platforms also have fractional optics for shallow texture, but that is not the same as Pico toning. Not every Pico treatment is an acne-scar treatment.

What is fractional CO₂ best for?

Fractional CO₂ creates microscopic injury columns to drive resurfacing. It is more direct for depressed scars and uneven texture, but usually causes more redness, flaking or crusting and carries a greater PIH concern.

Can fractional Pico replace fractional CO₂?

Selected shallow scars may respond to fractional Pico with easier recovery. Some comparative studies report similar improvement in mild-to-moderate scars, but this does not make the devices interchangeable for deep or tethered scars [2].

What if you have both dark marks and scars?

Control active acne first. If pigment dominates, STC often starts with Pico to address colour and reduce PIH concerns before stronger resurfacing. If depressions dominate, the plan focuses on fractional CO₂ or scar-specific techniques with pigment prevention.

Frequently Asked Questions

Does Pico toning treat acne scars?

It is mainly a pigment treatment and should not be expected to remodel depressions like a fractional optic or fractional CO₂.

Does fractional CO₂ remove dark marks?

Tone may look more even after recovery, but fractional CO₂ is not the first choice for every flat dark mark and may trigger PIH.

Which has less downtime?

Pigment-focused Pico generally has less recovery. Fractional CO₂ usually produces more redness, flaking and crusting, depending on density and settings.

Send STC photos taken in direct and side lighting. We can separate pigment from depression and recommend Pico, fractional CO₂ or another scar technique.

References

[1] DermNet — Picosecond laser — https://dermnetnz.org/topics/picosecond-laser

[2] Sirithanabadeekul et al. — Fractional picosecond vs fractional CO₂ for acne scars — https://pubmed.ncbi.nlm.nih.gov/32910030/

[3] DermNet — Carbon dioxide laser treatment — https://dermnetnz.org/topics/carbon-dioxide-laser-treatment