In a sentence: Tetra CO₂ with CoolPeel removes ultra‑thin columns of old skin so new, smoother skin can form—softening lines, sun damage and texture with customizable downtime from a “lunchtime peel” to deeper resurfacing.1 2
Who it’s best for
- 40s–60s: sun spots, uneven tone, etched lines around mouth/cheeks, crepey texture; great if you want more change than “light” lasers.
- 30s: photo‑damage and early texture; focal acne‑scar touch‑ups.
- 20s: selected acne‑scar cases (usually lighter settings).
- Skin tones: can help many complexions, but deeper tones (IV–VI) have a higher risk of temporary darkening (PIH)—choose experienced clinics and consider test spots/alternatives.3 4
What it can do
- Smooth wrinkles and etched lines—especially around the mouth/cheeks.3
- Fade sun spots and blend blotchy colour; improve overall “glow.”3
- Refine texture and help shallow acne scars (series may be advised).5
What it can’t do
It won’t lift a sagging jawline or neck like ultrasound/RF devices, and one session won’t erase very deep lines for everyone—some people need staged treatments or surgery depending on goals.
Treatment & sessions
- During: after numbing, the handpiece delivers fractional CO₂ pulses that ablate tiny columns while leaving surrounding skin to speed healing. Face takes ~20–45 minutes.1
- How many: many see change after 1 treatment; deeper lines or scars often need a series (spaced ~4–8 weeks).
- CoolPeel vs deeper Tetra: CoolPeel uses very short, low‑energy pulses for lighter downtime; standard Tetra settings allow deeper resurfacing when bigger changes are needed.6
Healing time & aftercare
- Downtime range: CoolPeel is often 1–3 days of redness/“sandpapery” feel; moderate passes are ~3–7 days; deeper resurfacing can be 7–10+ days with pinkness lasting a few weeks.6 7
- Comfort: warmth/tingle; deeper settings may feel sunburn‑like for hours.
- Aftercare basics: gentle cleanse, bland moisturiser/occlusive, strict SPF; avoid heat, scrubs, retinoids/acids until cleared; don’t pick flaking.3
Safety in deeper complexions (skin of colour)
Fractional CO₂ can be used cautiously in darker tones but PIH risk is higher. Experienced operators may use lighter densities, fewer passes and strict sun protocols; test spots are wise. Alternatives (e.g., 1927‑nm fractional, picosecond pigment lasers, RF microneedling) may be suggested first.3 4
Possible side effects & complications
- Common: redness, swelling, bronzing/crusting, tightness.3
- Less common: acne or eczema flares, cold‑sore reactivation (antivirals may be advised if you’re prone).3
- Rare: burns/blisters, infection, scarring, post‑inflammatory hyperpigmentation or prolonged redness—seek review if symptoms are severe or lasting.8
Who should avoid or delay (contra‑/precautions)
- Active infection/open wounds; recent heavy sun exposure or tanning.
- Pregnancy/breast‑feeding (often deferred); strong keloid tendency needs individual assessment.
- Recent isotretinoin/photosensitising medications—timing is individualized by your clinician.
- History of melasma or PIH—discuss risk/benefit and alternatives.
Regulatory & region notes
- U.S. FDA: SmartXide Tetra Pro is cleared as a Class II powered surgical laser (21 CFR 878.4810; product code GEX).2 9
- Platform family: Earlier SmartXide CO₂ systems also hold 510(k) clearances for soft‑tissue ablation/coagulation in dermatology/plastic surgery.10 11
- Availability: widely offered in US/Canada/UK/EU/Australia; branded CoolPeel protocol is marketed by Cartessa on DEKA platforms.1
How it compares
- Versus hybrid/non‑ablative (HALO/MOXI/LaseMD Ultra): CO₂ can deliver stronger smoothing of etched lines but with more downtime.3
- Versus RF microneedling (Morpheus8/Genius): RF boosts collagen and texture with shorter “social” downtime; CO₂ is chosen when you need greater resurfacing of lines and texture.
At‑a‑glance
- Best for: sun damage, uneven tone, texture, etched lines; focal acne scars.
- Sessions: often 1; deeper issues may need a series.
- Downtime: ~1–3 days (CoolPeel) to 7–10+ days (deeper resurfacing).
- Operator matters: outcomes/safety depend on energy, density and passes—choose experienced providers.
References (open in new tab)
- Cartessa — CoolPeel overview & features
- FDA 510(k) K240497 — SmartXide Tetra Pro (Class II; 21 CFR 878.4810; GEX)
- DermNet — CO₂ laser uses, healing and risks
- JAMA Dermatology — lasers & post‑inflammatory hyperpigmentation
- Dermatology Times — fractional CO₂ resurfacing overview
- Cartessa blog — CoolPeel downtime claims (short‑pulse, low energy)
- Clinic page — Tetra CO₂ typical healing timelines
- JAAD — complications after fractional ablative CO₂ (risk awareness)
- FDA GUDID — SmartXide Tetra device entry
- FDA 510(k) K113504 — DEKA SmartXide² (family clearance)
- FDA 510(k) K133895 — DEKA SmartXide² (additional models)
Region notes: SmartXide Tetra/“CoolPeel” is widely available in US/Canada/UK/EU/Australia; labeled indications and marketing claims vary by country—confirm locally.