The Expanding Role of CO ₂ Lasers in Plastic and Cosmetic Surgery: An Eight-year Single-centre Experience and Narrative Review

Background: Carbon dioxide (CO 2 ) lasers have transitioned from niche resurfacing tools to versatile mainstays in aesthetic and reconstructive surgery. Objectives: To present 8 years of single-centre clinical outcomes using fractional and surgical CO 2 platforms, together with a narrative review of emerging biologic adjuncts. Methods: Retrospective analysis of 1,098 patients (650 females, 448 males; aged 4-81 years) treated between August 2017 and May 2025. Indications included acne scars, pigmentary dyschromia, benign cutaneous lesions and post-traumatic/burn scars. Outcomes were measured using clearance rates and patient satisfaction. A narrative review synthesised recent evidence on adjunctive stromal vascular fraction (SVF), platelet-rich plasma (PRP) and exosomes. Results: Fractional CO 2 achieved 76%-85% mean improvement across texture and pigment indications, with ≥84% patient satisfaction. Surgical mode achieved 95% clearance of benign lesions and ≥50% keloid regression in 86% of cases. Adverse events were limited to transient erythema (47%), post-inflammatory hyperpigmentation (9%) and one delayed hypopigmentation. Literature review suggests biologic adjuncts enhance collagen remodelling, reduce downtime and improve pigmentary safety. Conclusions: CO 2 lasers remain the gold standard for resurfacing and lesion removal. Biologic adjuncts, particularly SVF, PRP and exosomes, represent promising synergistic strategies. Prospective controlled trials are warranted to define optimal combined protocols.