Since its introduction, no therapy has been as effective for rhytid effacement as the CO2 laser. Aggressive CO2 laser resurfacing remains the gold standard for facial-wrinkle treatment. In addition, the selective removal of epidermis and dermis allows for the simultaneous treatment of dyschromias and a variety of benign lesions. Regardless of the success and drawbacks of aggressive CO2 laser resurfacing, there remains a popular push for less aggressive therapies. It is somewhat amusing that the media and the industry are heralding a new claim that the public wants more conservative procedures and will not tolerate extended recoveries. In reality, the public has always wanted conservative procedures, and always will. The push for nonablative and minimally invasive procedures has led to some disappointing results for those who expected CO2-like outcomes. On the other hand, these less invasive procedures have provided patients with increased choices, tailored to their lifestyles and recovery windows. In my practice, laser skin resurfacing remains a popular option. The various choices of treatment include the following:

• CO2 heavy, characterized by aggressive CO2 resurfacing, two to four passes, high fluence, high density, reticular dermal injury, twelve to fourteen days' recovery

• CO2 medium, characterized by a single pass, nondebrided, high fluence, high density, upper dermal injury, eight to ten days' recovery

• CO2 light, characterized by a single pass, nondebrided, low fluence, high density, basilar and superficial dermal injury, six to eight days' recovery

• CO2 ultralight (fractional CO2), characterized by a single pass, nondebrided, low fluence, low density, epidermal injury, four to six days' recovery