Fractional CO2 Laser
Korean: 프락셀 CO2 (Peuraksel CO2) · Medical name: Fractional ablative carbon dioxide laser resurfacing (10,600 nm) · Category: Energy-Based · Last reviewed: 2026-05-01
A fractional ablative laser that delivers carbon dioxide energy at 10,600 nm in a grid of microscopic columns. The fractional pattern removes damaged tissue while preserving surrounding skin, driving collagen remodeling and epidermal renewal. In Korea "프락셀" functions as a generic colloquial label for fractional lasers.
What it is
A medical procedure performed by licensed physicians using carbon dioxide laser systems at 10,600 nm, a wavelength strongly absorbed by tissue water. The fractional modality produces thousands of microscopic treatment zones (MTZs) per square centimeter. Each MTZ contains a central ablative column surrounded by a coagulation zone, with intervening untreated skin preserving keratinocyte and fibroblast reservoirs for re-epithelialization.
Documented indications include atrophic acne scarring, photodamage, rhytids, dyschromia, actinic keratosis, and surgical or burn scars.
How it works
The mechanism rests on three principles introduced by Manstein, Anderson, and colleagues in 2004: selective thermal injury, spatial fractionation, and preservation of adjacent uninjured tissue.
At 10,600 nm, fluence above 5 J/cm² delivered within approximately 1 ms produces explosive vaporization within ablative columns. Surrounding coagulation zones denature collagen above 66.8 °C, producing immediate fiber contraction. Wound healing proceeds through inflammatory, proliferative, and remodeling phases, with re-epithelialization within 24 hours and remodeling extending past 6 months.
Origin and development
Fractional photothermolysis was introduced at the Wellman Center for Photomedicine (Massachusetts General Hospital / Harvard) in 2004. Reliant Technologies commercialized the non-ablative Fraxel SR (1550 nm) in 2003 to 2004 and received FDA 510(k) clearance for the first fractional ablative CO2 device in May 2007. Solta Medical later acquired Reliant.
Lutronic Corporation (Goyang, Gyeonggi-do) received FDA 510(k) clearance for the Korean-developed Mosaic eCO2 in July 2008. Korean academic dermatology groups including Yonsei University and Seoul National University Hospital contributed clinical evidence on use in Fitzpatrick III to IV skin, where post-inflammatory hyperpigmentation risk is materially different from lighter skin types.
Regulatory status
| Jurisdiction | Status | Notes |
|---|---|---|
| Korea (MFDS) | Cleared (품목허가) | Korean Medical Device Act. Lutronic eCO2 manufactured in Korea. Multiple device registrations on the MFDS device registry |
| United States (FDA) | Multiple 510(k) clearances | UltraPulse K022060 (2002); Lutronic Mosaic eCO2 K080496 (2008); eCO2 3D K244060 (2025). Class II under 21 CFR 878.4810 |
| European Union (CE) | CE-marked | Class IIb under MDR Rule 9 |
Typical protocol
- Sessions: 1 high-setting session for Fitzpatrick I–II per expert consensus protocols. 2 to 4 sessions at 6 to 8 week intervals for Fitzpatrick III–IV. 2 to 3 sessions for acne scarring.
- Settings (Lutronic eCO2): mild-to-moderate at 120 mJ and 30 to 40 percent density. Aggressive at 200 mJ and 50 to 70 percent density.
- Re-epithelialization: typically 3 to 6 days
- Social downtime: 3 to 7 days at moderate settings
- Anesthesia: topical anesthetic used in approximately 95 percent of consensus-panel protocols
- Pre-treatment screening: recent isotretinoin history, keloid history, Fitzpatrick phototype
Commonly reported effects
Tissue-level responses include immediate vaporization within MTZs, collagen contraction, transient erythema and edema, re-epithelialization within 1 to 2 weeks, and progressive collagen remodeling over 3 to 6+ months.
Documented adverse events from clinical literature and MFDS guidance include acneiform eruptions, herpes simplex reactivation, post-inflammatory hyperpigmentation (higher risk in higher Fitzpatrick types), hypopigmentation, burns, infection, and rare scarring.
Korea vs US availability
Fractional CO2 is widely available in Korean dermatology and plastic surgery clinics, with the highest density in Seoul's Gangnam-gu and Seocho-gu. Per 모두닥 (Modoodoc) 2026 listings, 루비성형외과의원 in Gangnam offers sessions at ₩180,000 (event ₩140,000) and 디오디피부과의원 청담 at ₩220,000. 강남언니 (Gangnam Unni) 2026 event pricing ranges ₩108,900 to ₩590,000 per session.
The procedure is not covered by Korea's National Health Insurance for cosmetic indications. US per-session pricing typically ranges $1,000 to $4,500 for full-face treatment. Korean pricing is meaningfully lower, particularly at event rates, and Korean clinics have built routine procedural fluency in higher-Fitzpatrick protocols that US clinics see less often.
What to research before
- Confirm Fitzpatrick-appropriate settings. Higher Fitzpatrick types (III to VI) carry higher post-inflammatory hyperpigmentation risk and require specifically calibrated protocols. Ask about the operator's experience with your skin type.
- Pre-treatment isotretinoin history. Recent isotretinoin (Accutane) use is a published contraindication. Disclose any course within the past 6 to 12 months.
- Keloid history. Keloid-prone individuals carry elevated scarring risk.
- Verify the device. Multiple fractional CO2 platforms exist (Lutronic eCO2, Solta UltraPulse, others). Ask which device the clinic uses and at what settings.
- Verify the operator and clinic. Our credential verification guide covers KSPRS and dermatology specialty registries.
- See also: our Korean Surgery Safety Guide.
Related procedures
- Q-switched laser — pigmentation laser, complementary indication
- RF microneedling — alternative collagen-stimulation modality with a different mechanism
- Korean 피부관리 — common combined-protocol companion
- Chemical peels — non-laser resurfacing alternative
Sources
- Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers in Surgery and Medicine 2004;34(5):426–438. https://pubmed.ncbi.nlm.nih.gov/15216537/
- Ramsdell WM. Fractional Carbon Dioxide Laser Resurfacing. Seminars in Plastic Surgery 2012;26(3):125–130. https://pmc.ncbi.nlm.nih.gov/articles/PMC3580980/
- Levy T, Lerman I, Waibel J, et al. Expert Consensus on Clinical Recommendations for Fractional Ablative CO2 Laser Resurfacing. Lasers in Surgery and Medicine 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11776446/
- US FDA 510(k) K080496. Mosaic eCO2 Laser System, Lutronic Corporation. Cleared July 7, 2008. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K080496
- MFDS (식품의약품안전처). 의료용레이저 안전사용 안내서. https://www.mfds.go.kr/brd/m_465/view.do?seq=27162
- Lutronic Corporation (주식회사 루트로닉). 연혁 (regulatory milestones for eCO2 platform). https://kr.lutronic.com/about/sub03.html
- 모두닥 (Modoodoc). 프락셀 가격정보. 2026. https://www.modoodoc.com/blog/price-detail
- 강남언니 (Gangnam Unni). 프락셀 CO2 레이저 시술추천 및 가격비교. 2026. https://www.gangnamunni.com/search?q=%ED%94%84%EB%9D%BD%EC%85%80+CO2+%EB%A0%88%EC%9D%B4%EC%A0%80