The CO2 laser has great potential in plastic surgery, dermatology and many other surgical specialities. Vaporisation of the tissue is very effective, and almost no bleeding makes the field of operation very clear for the practitioner. Of utmost importance is the fact that the unwanted tissue destruction depth is very well controlled and penetrates only several microns into the tissue. As a result, the healing process is much faster and painless.


This was a monocentric retrospective study conducted over a period of 1 year. The inclusion criteria were: patients with benign cutaneous tumours; warts; benign skin marks; and all patients who benefited from a treatment with CO2 laser set in ‘normal’ or ‘fractional’ mode — those with enlarged pores, acne scars and ‘tired skin’ who needed rejuvenation.

The laser

The Fraxis CO2 laser (ILOODA, South Korea), emitting at 10600 nm and based on radiofrequency (RF)-excited laser tube technology, which was developed by a US company.

Fraxis uses fractional and normal (surgical) handpieces. The fractional handpiece is usually used for skin rejuvenation, and the normal handpiece is intended to treat dermal lesions. The normal handpiece can be used in different modes: pulse, pulse single, ultra pulse, and continuous.

In this study, over 500 patients were treated for 20 different indications.


Normal handpiece

The great advantage of Fraxis CO2 laser treatment is that vaporisation of the tissue is not followed by bleeding. This results in a much faster healing process and minimises the risk of infection. Over 500 patients were treated in this study and only three cases of infection were recorded, all of which occurred after treating resistant warts located on the plantar site of the foot. These lesions require more aggresive treatment and deeper vaporisation of tissue.

Fractional handpiece

(A) Facial wart before treatment; (B) immediately after treatment; (C) 2 months post-treatment

(A) Facial wart before treatment; (B) immediately after treatment; (C) 2 months post-treatment

The proper settings using fractional mode depend on other factors: indication for treatment, skin phototype, skin texture, skin elasticity, and age. In general, it is possible to say that the more evident the remodelling of skin collagen we want to achieve, the more energy needs to be delivered to a proper depth of the skin.

Patients asking just for skin rejuvenation were treated with the fractional handpiece with minimaly-aggresive settings, some of which do not even require anaesthetic cream to be applied before treatment. The healing process lasts for 2–3 days, until epithelisation is complete. To achieve long-lasting results, more than two sessions are recommended, with 6–8 weeks between each treatment.


It is quite easy to learn how to manage treatment with Fraxis. I find using the ‘ultra’ mode more helpful then the ‘pulse’ mode (surgical handpiece) for treating epidermal and dermal lesions. After treating many patients with both modes, I found that using the ‘ultra’ mode makes the operation field more transparent for the doctor as the treated tissue is not ‘carbonised’ as with the ‘pulse’ mode. The healing process is also faster. Using the ‘pulse’ mode requires a little more experience with Fraxis, but can bring nice results.


I find Fraxis to be a very helpful and reliable device. More patients can be treated in a shorter time compared with conventional surgery. The accurate laser beam allows me to treat lesions smaller than 0.5 mm in diameter. It is difficult to recognise treated lesions after 6–8 weeks. This means that the proper use of Fraxis gives good aesthetic results.