CO2 Laser: DOT Therapy Photos – Patient Case Study

DOT Therapy Photos – Case Study: The DOT laser treatment (CO2 laser)

Before and After Photographs of DOT Therapy with the CO2 Skin Laser

What is it like to have DOT Therapy, the CO2 Laser Skin Treatment to rejuvenate the appearance of your skin? Find out by reading the first-hand experience with the first CO2 laser facial treatment. Also known as DOT Therapy or DOT Laser Treatments for skin refinement.


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During a DOT Therapy treatment you can see what it can do for  ageing skin and help others better understand:

  • what the treatment actually feels like
  • what it does for skin
  • whether I think it’s a ‘worth it’ treatment for refreshing the skin on the face’
  • the quick answer, after seeing the results over time, is YES. But do expect some downtime and a lot of redness and swelling as you recover from the treatment

My Experience

Other than my first-time injectables treatment at Coco Ruby Plastic Surgery a few months ago at the age of 53, the only other skin treatments I’d undertaken previously were relatively topical in nature. I was using topical methods and hadn’t really thought a lot about going very deeply into the dermis. But, I was well aware these treatments existed as I’d been trained in Aesthetics and work in the industry.

So other than laser hair removal, I had never tried a facial laser treatment before…but in your forties and fifties, topical skincare only goes so far.

Plus, after 50, facial skin does get lax and crepey-looking. Lasers are usually a viable option for giving skin a non-surgical “refresh.”

DOT Therapy Treatments: What to expect for DOT Therapy Skin Laser Treatments

  • Being a newbie in relation to skin-refining laser treatments such as DOT Therapy and Fraxel, I wasn’t quite sure what to expect.
  • Plus, no matter who you ask, there’s only one real way to know how a treatment feels and what the results will be for yourself. And, that’s to go through the experience yourself.
  • So if you’re considering having DOT Therapy to help reduce the signs of facial ageing or sun damage, or you’re wanting to improve your skin texture using a modernised CO2 laser option, this blog is for you.

Diary of the first few days

I hear everyone reacts differently to having DOT, and the settings of the laser have a lot to do with how much you feel or swell. They can go very deep or very intensive with the number of micro-channels, so there’s a lot of treatment variability. I had very little pain but a lot of post-treatment redness and swelling; this passed in 7-10 days.

  • I’m writing this blog after just having had a DOT Therapy treatment (plus two post-treatment Healite II treatments).
  • To help you gain an idea of what to expect from your own treatment, especially in relation to post-op redness and swelling and whether DOT Therapy feels “worth it” in terms of a week or two of ‘downtime’, I’ve detailed the first 10 days of the after-DOT therapy treatment, including some not-so-flattering photographs.

Therapy Details: Patient Diary of Face Laser Treatments with a CO2 laser technology

Here’s my Diary of the DOT Therapy experience in photographs and exactly what I was thinking as I went along.

Let’s start with a quick snapshot of the DOT Therapy Laser treatment (a modern CO2 Laser treatment).

DOT Therapy stands for “Dermal Optical Thermolysis” – but it literally covers your treated skin in tiny DOTS (initially, anyway – then the dots fade away as fresher, smoother skin reveals itself)

  • DOT Therapy is an ablative laser treatment as contrasted with Fraxel which is a non-ablative treatment
  • Fraxel lasers and DOT Therapy are both good for rejuvenation but they do have differences in treatment modalities and downtime (too complex for a blog but you can ask your Dermal Therapist about the differences and which one might be best for your skin).
  • DOT Therapy can help treat deep wrinkles and fine lines, crepey-looking skin or lax skin, acne or acne scars, other skin scars including surgical or traumatic scars
  • Most treatments are readily tolerated by patients. However, more intensive treatments such as for reducing deep acne scarring might be more painful to undertake.
  • For stronger treatments, a topical anaesthetic (prescription strength numbing cream) and cool packs can go a long way to make the treatment endurable

Next, let’s look at how it helps rejuvenates and tighten the skin through improved collagen levels.

  • DOT Therapy is a process whereby microscopic dots (somewhat like mini-channels) are created in the skin using CO2 laser energy (fractional laser).
  • The pin-point channels resemble columns.
  • These are essentially ‘scanned” onto your skin with a ‘scanner handpiece’ that creates super-fine channels through different layers of your skin.
  • What creating these micro-channels actually does is to help stimulate skin tightening and collagen strengthening (increased collagen production and stronger, firmer collagen networks) as your skin heals itself from the micro-columns or pin-point channels.  And skin tightening is something that most of us over the age of 40 can relate to very well.

DOT Therapy treatment – photos


Does creating micro-channels in the skin make sense? Scientifically it does.

  • The essence of DOT Therapy is ‘controlled micro-trauma’ to the skin layers to stimulate the skin’s innate repair and renewal processes.
  • It might sound daunting, but DOT Therapy leaves a lot of healthy, untouched skin tissue between the micro-channels created by the handpiece.
  • With healthy skin surrounding the micro-channels, the skin tends to heal much faster after treatment than if the entire surface were treated with ablative laser energy.
  • If you’re a bit reluctant to try lasers, you could try skin needling instead (e.g. a DermaPen method). The concept is somewhat similar and with skin needling, there’s less risk of future pigmentation concerns; and it can also help with evening out the skin.
  • But for a more intensive and effective method, the DOT therapy may be just the solution you’ve been looking for. It’s not too much in terms of downtime (But you’ll want to avoid special events for about 2 weeks), and with 3 treatments, your skin will look more glowing, fresher – and typically younger too because it’s been re-stimulated in terms of collagen structures – about 3 months after your 3rd treatment (but you’ll see results in just a few weeks after each consecutive treatment).

What’s is the recovery/downtime?

This means that your downtime after having DOT laser therapy is roughly only 7 to 14 days for most people (meaning that at 7 days most of the signs you’ve had treatment will have resolved or can be readily hidden with makeup).

And that’s excellent for an effective wrinkle reduction and texture refinement solution that can visibly rejuvenate your skin after just 3 sessions spaced about 4 to 5 weeks apart (up to 6 weeks if necessary).

Image below of DOT Therapy treatment. All image rights reserved.


Initial reactions to facial DOT Therapy include redness, warmth, discomfort and swelling of the face or other treated areas. At first, you can also clearly see the DOTS, which can even redden over the next few days before the redness and swelling subsides.

Skin Redness and Red Dots immediately after DOT Therapy (CO2 Laser)

  • You will need to use cool compresses about every 30 to 90 minutes for the first few days
  • You’ll need to frequently apply a gentle, non-active moisturiser several times a day to keep the skin moist whilst healing
  • The skin will feel very dry and rough, somewhat like course sandpaper
  • This is followed by eventual peeling or flaking of the outer skin layer and revealing fresher looking skin.


Recovery after DOT Therapy Laser Treatment

Within about 7 days, most of your swelling will be gone, but you still may have some redness and residual swelling for another week or so.  This varies from person to person and also relates partially to the strength of the DOT treatment (there are numerous settings that are changed to treat particular skin conditions or skin types).

For best results from DOT Therapy using a CO2 Laser (by DEKA), you’ll need three treatments.

What you might not know about DOT Therapy (DEKA laser).

The DOT Therapy laser involves the same DEKA laser equipment and general technology that is also used to rejuvenate and tighten vaginal skin during a Mona Lisa Vaginal Touch Treatment. However, the laser settings and handpiece (delivery modes) are uniquely adapted to different tissues for different treatments.

My Treatment

So here’s the journey of my DOT Therapy treatment in Pictures (Photographs) with how I was feeling as I healed from the treatment.

Day of the treatment:  topical prescription Numbing Cream – leave on for about 45 minutes to one hour (glad wrap helps)


This topical numbing cream PHOTO opportunity was good preparation for NOT caring how I was going to look for 7 to 10 days after DOT Therapy.

Treatment with DOT Therapy by a Dermal Clinician is Less than one hour, potentially a bit longer including numbing time.

Discomfort (Pain) level of DOT Therapy (CO2 Laser Treatments) during actual treatment after using numbing cream:

  • Discomfort was only a 3.0 to a 3.5 out of 10.
  • However, at the top of the forehead near the hairline, where the numbing cream hadn’t quite reached, the DOT scan felt like a temporary curling iron burn.
  • This showed me that the numbing cream was actually helping a LOT.  But I also had a relatively low-level intensity treatment because I didn’t know what to expect and because I wanted shorter downtime.


If I had elected a more intensive treatment, there is a chance it might have hurt a bit more than it did. Again, the pain was surprisingly minimal.  I was actually a bit shocked that it wasn’t more uncomfortable to get the treatment. It wasn’t entirely pain-free, but it felt hardly noticeable.

Overall, the DOT Therapy treatment I had felt far less painful than typical laser hair removal on the face or legs.  It wasn’t unpleasant at all and it’s easy to relax on the reclining table during treatment.  TIP: You could probably bring music and listen with your earplugs if that would help relax you even more.  So here’s what the immediate HEALING and REJUVENATION process looked like in Photographs.

How to minimise pain during a CO2 skin laser or DOT Therapy Facial Treatment Session

Again, I credit the prescription-strength numbing cream for making it essentially an easy, because the only area that hurt was near the forehead where the numbing cream hadn’t gone up to the hairline

Photo below as taken immediately after skin treatment with DOT Therapy.


  • You can see the dots and redness, just after my treatment finished.
  • But the face hadn’t started to swell yet.
  • It did feel very warm, though (even hot) – be sure you avoid touching your skin for several days after treatment, other than to apply any recommended products (you’ll avoid nearly all products for several days, but ask your Dermal Clinician for details).


The photo below was taken about 1 hour after DOT Therapy and just after a skin calming Healite II low-level light therapy treatment.



  • You can see the micro-channels (dots) quite clearly.
  • I used cool packs for the first half-hour after treatment as instructed, then had a Healite II session 1 hour later, then used the cool packs every 20 to 30 minutes for the rest of the day, to up to an hour between cool packs.

All photos copyright protected by Coco Ruby Skin & Anti-Ageing.

12 Hours and 24 Hours After DOT Therapy Skin Treatment with a CO2 Laser

  • About 10 to 12 hours after DOT Therapy, the redness and swelling started setting in on my face.
  • The worst of the swelling and redness actually showed up 24 hours after the treatment (DAY 2) and continued for about 4 to 5 full days before starting to noticeably subside.
  • I wore a hat to draw attention away from the face. But, it was obviously quite red and very swollen for about a week, or slightly longer.
  • Working in an industry that helps people better understand cosmetic procedures, I did go to work. I did this even though my facial appearance frightened my colleagues when I passed them in the hallway.
  • In the long run, it was well worth the downtime and swelling.
  • My skin looked really smooth and refreshed just a few weeks later.


A few days after my facial treatment:

  • The day after treatment (DAY 2) was interesting to me, however, because I woke up with less swelling than when I went to sleep.
  • I thought my diligent cool pack regime was helping. I think cool packs are crucial for most types of healing including sporting injuries as well as laser treatments.
  • Yet by mid-morning, the swelling had returned with a vengeance.
  • It didn’t frighten me as I knew it was a normal response to the treatment and that it would pass
  • well okay, it frightened me a little, but not as much as it did my colleagues.

What I did to get good sleep the night of my skin treatment

Trying to sleep was uncomfortable, and slept with my cool pack near my face.  I decided to take a Panadol to help me sleep, which worked a treat.  I woke up in the morning and from that point forward, had zero discomforts relating to the DOT treatment, the redness or the swelling.  Upon waking, my face wasn’t initially very swollen and seemed to have gone down a bit from the night before.  But within about 3 hours, or precisely 24 hours after the DOT Laser treatment, my face swelled up..a lot!  It didn’t hurt at all (it just looked like it did). So I wasn’t uncomfortable, but I was aware my eyes were really puffy as if I’d eaten something I was allergic to.

The swelling would continue for several days, and at day 13 has nearly fully resided.

It was crucial to avoid all sun exposure, however, for several weeks following the treatment. Fortunately, it was raining and I could work entirely indoors.


I didn’t need ANY time at all away from my work. But if I had a very visible role dealing with clients, I would likely have wanted at least 5- 7 days o of not needing to be seen in public.  So my suggestion is to get it on a Thursday as by Monday/Tuesday you’ll likely be less puffy. But, this can vary from what I experienced. Before a major event, I’d definitely make sure it was at least 3 weeks in advance. Ask your Clinician as every person and DOT treatment settings are unique.

Here’s a few happy snaps of the days between the DOT Therapy treatment and the skin results as of day 13. My Dermal Clinician tells me that the collagen will continue to improve over the next several weeks to a few months. I’ve also been instructed that an additional 1 to ideally 2 treatments – scheduled 4 weeks apart. These will give me the best rejuvenation effects.

Here are a few glamour shots (NOT) of the days following the DOT laser treatment.

Photos of what I looked like the first few days and the first week after DOT Therapy

DAY 2 AFTER-TREATMENT (wearing a moisturiser with minor zinc content).  Day 3 and Day 4 were about the same as the 2nd day, although perhaps a bit less each day. As you can see in the images below, the worst of the facial swelling was under my eyes, on the cheeks. The eye area, in general, stayed puffy for about 8 to 9 days. That said, I am in need of an Upper Blepharoplasty.

Swelling after DOT THERAPY as you heal. Yes, pretty swollen!

Dot therapy: swollen-face-after-DOT-therapy-co2-laser  dot-therapy-co2-laser-swelling-day-3-

Days 4 to 8 Photos After DOT Therapy CO2 Laser Skin Treatment

  • The swelling started going down only a tiny bit each day.  However, it lessened significantly after Days 6 and 7.
  • Some days it seemed better than others (salt intake may have played a role).
  • Swelling was still generally noticeable, however, for up to 10 to 12 days after the DOT Therapy laser treatment.
  • The photo taken on 25th September was on Day 4, and the 26th September photo was taken Day 5.
  • The hat and glasses photo was how I dressed to go to the cafe to pick up a coffee on a busy Saturday morning.

Dot therapy - treatment - redness and swelling - photo diary day-5-after-dot    day-7-swelling-Dot therapy - treatment - redness and swelling -

Days 9 to 13 Photos After DOT Therapy – Getting Back to Normal but much smoother, tighter skin

  1. The cheeks and eyes were the last facial areas where the swelling went down.
  2. Even at Day 13,  when this blog was written, the eyes and cheeks were just a bit puffier than normal.
  3. In this photo (apologies for the backlighting), you can really see the difference in the skin.
  4. I was also able to wear mineral makeup again after about the 5th day after treatment. It glided on much more smoothly and looked a lot better than before the treatment.


Day 13 after DOT Therapy: Swelling is nearly completely gone. Skin looks radiant even without makeup.



  • The result after nearly 2 weeks. Radiant skin with a smoother texture. More firmness and fewer visible fine lines.
  • My Summary of how the skin feels after DOT Therapy
  • My skin feels amazing now at nearly 2 weeks after DOT Therapy Treatment.
  • It feels moister. It’s less dry than before the DOT therapy. It also feels more smooth. The lack of dryness may be due to the fact that I’ve been moisturising more since the treatment.


I’m quite happy that my skin pores look visibly reduced. Especially the visible one I had on my forehead before I started. My skin also feels a lot firmer.

Would I choose to get DOT Therapy again?

  • YES, I would…and will.
  • I want to see just how much better my skin can look with the 2nd and possibly 3rd treatment.
  • My clinician has recommended follow up treatments.
  • But even after 1 treatment, I have noticeable results in how my skin looks and feels to touch.
  • My skin feels great and looks ‘clearer’. It is more even in tone and seems more radiant.
  • The results to me were great and well worth it. It’s not an inexpensive treatment. But, it will likely keep me from needing to get a facelift for a few more years. So, I consider it a great investment in my skin.

I’m also now convinced that the downtime – whilst not a great look for the photo books – is quite manageable.

Another plus to me was that the treatment didn’t hurt hardly at all. I was expecting it to be painful, but it wasn’t. At least, not on the settings my Dermal Clinician used for my particular DOT treatment. And, not with adequate topical numbing cream.

DAY 1 to DAY 13 Contrast in Swelling and Colour after Therapy (actual colours)

Some skin treatments leave you a bit on the pink side. DOT Therapy, however, will leave you a shade of red (or many shades of red) during the initial post-treatment period.  Healite II can help a lot. Ask your Clinician if you can schedule in a few Healite II sessions as part of your recovery period.

I did 2 brief Healite II treatments during the week following the treatment. I also had another low-level light therapy session 2 days before the DAY 13 photo was taken. But look how RED I was just after the DOT Treatment.

Before and After photos DOT Therapy CO2 laser

Swelling and redness after DEKA DOT Therapy Skin Treatments

  • The swelling and redness can be quite disconcerting at first, and were a bit confronting to my colleagues.
  • But if you follow the post-treatment instructions carefully, including;
      • avoid the sun
      • nor wearing any makeup
      • avoiding strenuous exercise for a few days whilst you heal
      • eating right
      • drink plenty of water
  • By following the above steps you’ll end up with smoother, clearer and tighter skin that should heal well.
  • You’ll also need to avoid any alcohol for about 5 days after treatment and of course, not smoke at all. If you don’t follow this advice, your healing might be delayed. Your DOT Therapy results might also not be as great as they would be, otherwise.

Want to learn more about whether DOT Therapy and Healite II treatments are suitable for YOUR skin?  Schedule a skin consultation with one of our leading Dermal Clinicians by phoning (03) 8849 1400 or sending in an enquiry form.


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