Smartskin+ laser skin resurfacing is a fractional CO2 treatment that removes damaged skin in thousands of microscopic columns while leaving the skin between them intact, so healing is faster than full-surface resurfacing. Coastal Dermatology + Aesthetics performs it at its San Luis Obispo office for deep lines, pitted acne scars and sun damage. Recovery takes about a week.
What Smartskin®+ does for your skin
Most treatments try to improve the skin you have. This one replaces part of it. The laser removes the damaged surface in thousands of microscopic columns and leaves untouched skin in between, and that untouched skin is what heals the rest. You get the result of taking a layer off without the recovery of taking the whole layer off at once.
That is why it reaches things nothing else on this page can. Lines that are visible when your face is completely still. Scars you can feel with your fingertips. The rough, mottled surface that Central Coast sun leaves behind. Those are structural, they live below the reach of any cream or facial, and they need the surface rebuilt rather than polished.
It is also the treatment that rewards careful matching the most. Depth and intensity are chosen for your skin at your consultation, which is what turns a powerful laser into the right one for your face.
What Smartskin®+ is good at
- Softening pitted acne scars you can feel in the texture of your skin
- Smoothing etched lines that stay put when your face is not moving, including the vertical ones above the lip
- Resurfacing the rough, uneven skin left by years of sun damage
- Evening out mottled tone and the brown patching that comes with it
- Firming skin that has lost its tone, gradually, over the months after you heal
- Doing all of it in one appointment for most people, rather than a course of visits
When the new surface has closed over, according to the manufacturer, with about five to seven days before you look like yourself again. Underneath, the rebuilding carries on for months. [1]
How treatment works
It works in columns, not sheets
The laser treats your skin in thousands of microscopic columns and leaves the skin around each one alone. That untouched skin is the reason a treatment this deep is something you recover from at home rather than in a clinic.
It takes the damaged surface away
Gentler devices heat your skin from underneath and leave the top layer where it is. This one takes that damaged layer away entirely, which is why it reaches things the gentler devices never will and why the change is so much bigger in a single session.
Your skin rebuilds
New skin closes over the treated columns within days. Underneath, collagen keeps forming for months. The surface improves first and the firmness arrives slowly, long after you have stopped thinking about the appointment.
Patients, across six studies pooled in a 2022 review of fractional CO2 laser for depressed acne scars. It came out ahead of the treatments it was measured against on skin smoothness, and scarring is one of the best supported things this laser does. [2]
Your week, day by day
Here is exactly what the week looks like, so you can book it against your calendar with confidence. Most pages give you “several days” and leave you guessing. This is the day by day.
| When | What is happening |
|---|---|
| The appointment | You are numbed beforehand. You feel heat and pressure rather than sharp pain. Most faces take 30 to 90 minutes. |
| That evening | Hot, tight and swollen, like a bad sunburn. Ointment goes on and stays on. Somebody else drives you home. |
| Days 1 to 2 | Swelling is at its most noticeable, usually on the second morning, and the skin stays damp as it heals. Both are exactly what should be happening. |
| Days 2 to 3 | The new surface closes over. The skin dries, turns a bronze color and feels tight. |
| Days 3 to 5 | Peeling and flaking, heaviest around the mouth and cheeks. You leave it alone and let it come off on its own. |
| Days 5 to 7 | New skin, pink and slightly shiny. Most people are comfortable in front of other people again around here. Makeup goes back on once we clear you. |
| Weeks 2 to 6 | The pink fades gradually. Sunscreen every day is not a suggestion during this stretch. |
| Months 2 to 6 | The quiet part. Collagen keeps forming and the firmness keeps improving long after you have stopped watching for it. |
Most people book it so the visible stretch lands over a weekend and a few days either side. Give it a quiet week and you will enjoy the whole thing a great deal more.
Areas we treat
Face
Full resurfacing for texture, etched lines, acne scarring and built-up sun damage in one pass.
Around the mouth
The vertical lines above the lip, which filler softens and rarely erases. This is one of the few treatments that genuinely changes them.
Around the eyes
Fine crepey lines, treated carefully and with the eye shielded throughout.
Cheeks
Where acne scarring usually concentrates, and where the improvement is easiest to see in a photo.
Individual scars
A single scar treated on its own, rather than resurfacing everything around it.
Real results
Before & after
These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice’s private gallery, and we are happy to show you cases similar to yours at your consultation.
Individual results vary. Photos shown are unretouched patients of Coastal Dermatology + Aesthetics, published with consent.
Treatments in a typical plan, which is the entire point of going this deep. Some skin does better with a second once the first has fully healed. You are told which one you are before you commit to anything.
Dr. Kilcline is the best dermatologist! Best experience ever! Love her new beautiful facility & location.
The Coastal difference
The settings are the treatment, and a dermatologist chooses them
A CO2 laser is only as good as the plan behind it. How deep it goes, how much energy it carries and how many passes your skin gets are all decisions, and they are made here inside a board-certified dermatology practice, for your skin specifically. The same team then looks after your week of healing, which is the part that turns a strong treatment into a great result.
It also means you get pointed at the right treatment rather than the nearest one. RF microneedling reaches a similar depth while leaving the surface in place and suits some skin better. Brown spots and broken veins are a different job with a different tool. If your face has lost volume rather than surface quality, filler is the answer and we will say so. Getting that call right is why people come here for this one.
Is it right for you?
Smartskin®+ is probably a good fit if:
- You have etched lines or pitted scarring that skincare and lighter treatments have not moved
- Years of sun have left your skin rough, uneven and mottled rather than just a little dull
- You can give up a week, and you would rather do that once than spread it over six visits
- You will follow wound care exactly and stay out of the sun while you heal
We will steer you somewhere else if:
- Your skin carries more pigment, where a surface-sparing treatment usually suits you better
- You have a tan, fresh or from a bottle, which has to fade first
- You have an active infection or a cold sore anywhere near the treatment area
- You heal slowly, form thick scars, or have finished a strong acne pill recently
- You are pregnant or nursing
- A week away from other people is not something your life has room for right now
Not sure which of these you are? That is exactly what the consultation is for, and it is why we look at your skin before booking this one.
What to expect afterward
Your skin does its healing out in the open for about a week, and every stage of it is a sign the treatment is working. Redness and swelling first, peaking around the second morning, then crusting and peeling as the new surface comes through. Most people look themselves again in about a week, with a fading pinkness for another two to six. The day-by-day walkthrough above covers it.
In the first week, do
- Follow the wound care instructions exactly, in the order you were given them
- Use only the ointment and cleanser we send you home with
- Sleep with your head raised for the first couple of nights to take the swelling down
- Start sunscreen the moment the new skin has closed over, and wear it daily from then on
- Call us early about anything that looks like an infection
In the first week, don’t
- Pick, scrub or help the peeling along
- Use retinoids, acids, vitamin C or anything active until we clear you
- Let healing skin see direct sun, including through a car window
- Wear makeup before we tell you that you can
- Assume a symptom will settle on its own because you read about it somewhere
Call us about anything severe, worsening, or simply not what we described: significant pain, spreading redness, signs of infection, blistering, or any reaction that does not fit what we went through before your treatment. We would far rather hear from you early.
Concerns treated
This laser works on the structure of your skin rather than its surface. Pick a concern to see how we approach it.
What treatment costs
Smartskin+ is priced by the area treated and by how intensively your skin needs to be worked, and a full face costs more than a single scar or the skin around the mouth. Because most people need one treatment rather than a course, you will usually get one number rather than a plan that grows.
You get that number at your consultation, after your skin has been looked at, and it holds. If a lighter treatment would serve you better, that is the one you will be offered.
Treatment time
30 to 90 minutes, depending on the area
Downtime
About a week. Redness and swelling, then crusting and peeling
Results appear
New surface in 1 to 2 weeks, firmness keeps building for months
Results last
Long-term, though aging and sun exposure carry on
Smartskin®+ laser skin resurfacing frequently asked questions
New skin burns easily and marks permanently, so sun protection matters more here than on any other page of this site. Broad spectrum, SPF 30 or higher, water resistant, every day. [6]
Offered at
Ready to start? Request your consultation
Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology in San Luis Obispo, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form. In Santa Maria, medical appointments are available without a referral for PPO patients, and for HMO patients we are in-network with Santa Maria Physician's Choice.
A consultation fee of $125 is due at the time of booking.
Sources and medical review
1. Cynosure Lutronic. “Smartskin+ micro-ablative skin resurfacing.” Manufacturer’s US product page. Supports the fractional CO2 mechanism, re-epithelialization at day 2 to 3, and five to seven days of downtime. https://www.cynosure.com/product/smartskin/ · Manufacturer
2. Lin L, Liao G, Chen J, Chen X. “A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars.” *Annals of Palliative Medicine.* 2022;11(2):743-755. Six studies, 467 patients; higher skin smoothness scores than comparators. PMID 35249351. https://pubmed.ncbi.nlm.nih.gov/35249351/ · Peer-Reviewed Meta-Analysis
3. American Academy of Dermatology Association. “Acne scars: Diagnosis and treatment.” Supports laser resurfacing as a dermatologist-performed treatment for acne scars, and that healing skin produces collagen and elastin that diminish scarring. https://www.aad.org/public/diseases/acne/derm-treat/scars/treatment · Medical Organization
4. American Academy of Dermatology Association. “Warts: Diagnosis and treatment.” “A laser can effectively treat stubborn warts and may clear them quickly,” recommended where other treatments have not worked. https://www.aad.org/public/diseases/a-z/warts-treatment · Medical Organization
5. American Academy of Dermatology Association. “Rosacea treatment: Thickening skin.” Lists laser surgery, which “uses light to remove excess tissue and sculpt the area,” among the procedures for thickened rosacea skin. https://www.aad.org/public/diseases/rosacea/treatment/thickening · Medical Organization
6. American Academy of Dermatology Association. “How to select a sunscreen.” Broad spectrum, SPF 30 or higher, water resistant. https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice. Smartskin®+ is a registered trademark of Cynosure Lutronic, Inc. Redness, swelling and crusting are expected during healing, and pinkness can last for weeks. Infection, prolonged redness, dark marks left behind, loss of skin color and scarring are uncommon but possible, and the risk rises on skin that carries more pigment and on skin that is tanned or sunburned at the time of treatment. Cold sores can be triggered and antiviral medication is started beforehand where needed. This treatment is not suitable during pregnancy, while taking or recently finishing a strong acne pill, or where healing is impaired. New skin marks easily and must be kept out of the sun. Individual results may vary. A consultation fee of $125 is due at the time of booking.