[Finexel] Periorbital Tightening with CO2 Laser and Best Post-Care Tips to Reduce PIH

Date: 12 JULY 2025 (SAT)

Webinar: Periorbital Tightening with CO2 Laser and Best Post-Care Tips to Reduce PIH

Speaker: Dr. Indu Ballani (Dermatalogist)

Q1. What is the energy setting for the treatment?

The energy setting varies depending on the treatment type:

Full-face resurfacing: Typically 10–30 mJ.
Acne scar treatment (requires deeper, more ablative effect): Usually 30–50 mJ.

However, when using higher energy levels (e.g., 30–32 mJ) on Fitzpatrick skin types IV–V, the risk of PIH increases.
To mitigate this:

Adjust density accordingly: Use a lower density such as 0.8 mm instead of 0.5 mm, to increase spacing between the thermal coagulation zones.

Example recommendation: 32 mJ with 0.8 mm density is safer for darker skin types than 32 mJ with 0.5 mm.

Clinical caution: While practitioners may be tempted to use tighter spacing (e.g., 0.4–0.5 mm) for small acne scars, this increases PIH risk in darker skin.

Recommended approach: Start with high energy + low density (wider spacing) in initial sessions. Once the patient’s skin reaction is confirmed, you can gradually decrease spacing (increase density) in subsequent sessions.

Q2. What is the maximum energy that can be used without protective devices such as eye shields during eyelid procedures?

No amount of energy is safe without proper eye protection. Even at the lowest energy levels, procedures on the eyelids must never be performed without eye shields. The skin in this area is extremely thin, and patients may present with additional skin laxity, increasing the risk of penetrating into unintended layers. Without adequate protection the orbital area may be inadvertently exposed. There is a serious risk of ocular injury, including potential damage to the eyeball.

Q3. Can we apply heavy functional creams such as eye cream right after the periorbital procedure? As heavy creams can clog pores and cause acne, what is the right time to start using them?

No, heavy functional creams (including eye cream or active ingredients) should not be used immediately after the procedure. It is recommended to avoid such products for 5 to 7 days, allowing the skin to heal. During this period, patients should use a gentle moisturizer, post-laser soothing cream, and sunscreen only. Once the scabs fall off and the skin stabilizes, functional or active products can be gradually reintroduced.

Q4. What are the effective protocols for treating stretch marks on the body? Is body preparation recommended? What is the course of procedures?

Stretch marks are difficult to treat, and 100% improvement is rarely achievable. Stretch mark treatment typically involves high-energy fractional CO2 laser (30–50 mJ) due to their scar-like nature. Treatment begins with low density, gradually increasing over multiple sessions. Priming the skin beforehand improves outcomes. Combining RF energy or post-laser application of exosomes can further enhance results. As aesthetic medicine advances, multimodal protocols are increasingly favored for more effective stretch mark management.

Q5. When can laser treatment begins after surgery for scars?

Laser treatment should not begin earlier than 6 weeks post-surgery. After the scar has fully healed, low energy settings can be used initially. In some cases, waiting up to 3 months is recommended before beginning treatment. It’s essential to consult the surgeon, assess the patient’s skin type and scar type, and proceed cautiously.

Q6. What are some tips to reduce the gauze effect after fractional CO2 laser treatment?

The gauze effect refers to the visible grid-like pattern that can appear due to scab formation in the thermal coagulation zones after fractional CO2 treatment.

To minimize this, it’s important to use lower energy and lower density settings, especially in sensitive areas like the cheeks. Applying lower energy and density around the treated area helps create a feathering effect, which blends the treatment zone with surrounding skin and prevents a stark, dark grid pattern from forming.

Always treat the entire area uniformly, and tailor energy levels based on skin type. Proper patient counseling is also crucial, as some visible gauze effect is expected. It usually subsides within 5–7 days, but may last up to 10 days if higher energies are used. After a week, remaining marks can typically be concealed with tinted sunscreen or makeup.

Q7. For patients who have a significantly higher risk of developing PIH, what special post-treatment care should be recommended? Please include oral medication, topical ointments, and any additional supportive care.

To minimize the risk of PIH, it is essential to use topical corticosteroids and other appropriate topical agents after treatment. In addition, oral antioxidants such as vitamin C, glutathione, or oral sunscreens can be added to support healing and further reduce the risk of PIH. These measures collectively help accelerate skin recovery and minimize pigmentation-related side effects.

Q8. Would it be advisable to recommend wearing sunglasses for about a week after treatment?

Yes. Wearing sunglasses is a highly recommended form of physical sun protection, especially after treatments around the periorbital area. In addition to topical sun protection, sunglasses provide an effective barrier against UV exposure during the healing phase.

Q9. What post-treatment care do you use for dark skin types?

For darker skin types, topical corticosteroids are typically prescribed for the first 3–5 days to reduce inflammation. After this period, patients can resume pre-treatment brightening agents such as hydroquinone or vitamin C. Additional therapies like PDRN or PRP are also beneficial in minimizing downtime and preventing PIH

Q10. What makes the findings special for the treatment of darker skin type patients?

Finexel is a super-pulsed CO2 laser with precise targeting and low pulse width, which significantly reduces the risk of PIH in darker skin types. After years of use, they’ve seen very few cases of PIH. Proper energy settings and using a reliable, well-specified CO2 laser like Finexel are essential for minimizing side effects in patients with darker skin.

Q11. What makes Finexel unique compared to other carbon dioxide laser brands?

Finexel offers clinical efficacy comparable to leading CO2 laser brands but at a more affordable price. Its advanced specifications help minimize PIH, even in darker skin types. Unlike unbranded or lower-end lasers that lack precision and may carry a higher risk of pigmentation issues, Finexel delivers high-quality results with greater safety, making it a strong value option in the CO2 laser market.

Q12. What’s your opinion about using exosomes combined with CO2 in the same session?

Yes, combining exosomes with fractional procedures such as CO2 laser, microneedling, or MNRF is beneficial. It enhances skin penetration, reduces healing time and PIH risk, and improves results. They are usually applied in the same session. More clinical data may be needed, but this combination represents a promising future in rejuvenation therapies.

Q13. Should we use a corneal shield when treating the periorbital area?

If available, corneal shields are preferred over wet gauze or standard eye shields, as they offer better safety. However, if the practitioner lacks experience with corneal shields, wet cotton or traditional eye shields may be used as alternatives.

Q14. What are the general settings used in the video demonstration?

The settings shown include 12mJ energy with 0.8mm density, using a rectangular pattern tailored to the width and length of the under-eye area. The procedure covered the target zone in 3–4 passes. PDRN was injected in a separate session, while PRP was both injected and topically applied during the same session for better penetration. However, combining microneedling with CO2 in one session may not offer additional benefit, as both are ablative procedures.

Q15. What’s your opinion about using exosomes combined with CO2 in the same session?

Combining exosomes with CO2 laser is highly beneficial—it enhances treatment outcomes, reduces PIH, and shortens healing time. While more clinical studies may be needed, this approach is considered a promising direction in skin rejuvenation. Regarding overlap, excessive overlapping can increase the risk of PIH, especially with high energy settings. However, a 1/3 overlap is generally safe and effective, as it ensures complete coverage and allows better energy delivery across the treatment area, ultimately improving results.

Q16. What is the difference in settings between metal tube and glass tube CO2 lasers?

The Finexel laser used in the session featured a metal tube. When using a glass tube model, which is more powerful, it is recommended to reduce the energy setting by approximately 20%. For example, if 12mJ is used with a metal tube, 10mJ may be appropriate for a glass tube. Always consider reducing the energy based on the Fitzpatrick skin type, starting from 10–12mJ and increasing gradually in later sessions. Always remember to decrease the settings a bit when you are using the glass.

Q17. Is using 30–50mJ energy for acne scars risky due to the depth of laser penetration (e.g., up to 600µm)?

No, it is not considered risky when properly used. The 30–50mJ range is specifically recommended for treating acne scars that require deeper ablation. For rejuvenation or periorbital areas, the typical energy range is 10–30mJ, with initial settings around 10mJ, gradually increasing in later sessions. When using higher energies for scars, it is essential to start with lower densities (e.g., 0.8–1.0 mm) to minimize the risk of PIH. If the patient responds well, the density can be decreased (to 0.7 or 0.6 mm) in follow-up sessions, especially in darker skin types.

Q18. What are the recommended laser parameters for treating the periorbital (under-eye) area, as shown in the video? Please explain the settings and variables such as energy (mJ), density, and any other relevant factors.

For the periorbital area, low energy and low density are key to minimizing the risk of PIH (post-inflammatory hyperpigmentation). The energy (mJ) setting typically starts at 10mJ, and may be increased to 12 or 14mJ depending on the patient’s skin type — lighter skin (e.g., Fitzpatrick II) may tolerate slightly higher energy. The density is intentionally kept low, meaning the distance between coagulation zones is wider to allow sufficient healing tissue.

Recommended densities range from 1.0mm to 0.8mm or 0.7mm, but never as low as 0.5mm unless PIH risk is ruled out. A rectangular scan pattern is used to match the contour of the under-eye area, and overlap is kept minimal, generally 1 pass, to avoid over-treatment in this delicate zone.

Q19. Is it safe to use 12mJ on the face?

Using 12mJ on the face—especially on Fitzpatrick type IV or V skin—can cause PIH if the density is too high (e.g., 0.5mm). However, by increasing the density spacing (e.g., 0.8mm or 1.0mm), the risk of PIH is reduced because more untreated skin is left between the thermal zones. This untreated skin supports healing and minimizes post-inflammatory pigmentation. Therefore, both energy and density must be adjusted based on the skin type to optimize safety and efficacy.

Q20. How can you prevent acne or rosacea flare-ups after fractional CO2 treatment?

Post-procedure acne or rosacea flare-ups can be managed by reviewing the patient’s skin profile and medical history. Oral antibiotics may be prescribed after treatment alongside topical post-care products to reduce the risk. It’s essential to ensure patients avoid prematurely restarting active skincare products or combining too many procedures.

Q21. We could catch isn’t these parameters burn the skin like India’s weather condition?

No, 10–12mJ is considered a low energy setting, especially when paired with appropriate density (e.g., 0.8mm to 1.0mm). When used correctly, these parameters do not typically cause PIH. Has routinely used them with good outcomes and no hyperpigmentation. However, many patients are now experiencing delayed post-procedure reactions, typically around two weeks after treatment.

This is often due to improper post-care, such as early resumption of active skincare products or undergoing additional procedures too soon. Proper sun protection and use of antioxidants can help reduce erythema and flare-ups. Reviewing the patient’s overall treatment plan and skincare routine is critical. Additionally, LED therapy can help calm redness, but medical management remains essential for prevention and control of complications.

Q22. Tube of devices removed, is it safe for patients and doctors from residue of smoke?

Basically, I always use a Smoke Evacuator when I’m doing a procedure. It is not safe. When you’re doing specially treating wards and removing skin tags and all doing the ablative mode, you should always have some protection, some Smoke Evacuator or good ventilation in the room.

Q23. How has your experience been using Finexel in Ultra mode for removing lumps and bumps?

My experience has been excellent. Even in the ablative mode, the risk of PIH has been minimal. I’ve rarely encountered PIH, which makes Ultra mode a reliable option for treating lumps and bumps with precision and safety.

Q24. Have you used Finexel’s fractional mode on off-face areas as well?

I’ve used it for stretch marks and for rejuvenation. In other areas, the parameters are similar. So when I’m using the stretch marks, I treat them as scars.
When I’m doing a rejuvenation, For general rejuvenation, I opt for lower energy settings, just as I would on facial areas.

Q25. What is your experience with Freshpeel mode on dark skin, and what are its best applications?

I don’t have the Freshpeel mode because my laser is very old, but still, I have done a very light resurfacing in many patients, use it like a peel instead of the TCA peels. My visions are very happy with this peeling mode of the Finexel. And they have taken it very well, and actually, many of them really like it, and take it about once in 6 months they want to take this rejuvenation or this peeling effect of the laser, to get this freshness on the face.

Q26. What parameters are recommended for managing the shouldering effect in fractional treatments?

To reduce the shouldering effect caused by the grid pattern, start with higher energy and density settings in the center—for example, when treating acne scars. And on the sides, you can use fine like a lesser energy of rejuvenation and a lesser density to make it more even.

Q27. What settings do you use for treating hypertrophic scars and keloid?

For hypertrophic scars and keloids, I typically use an ablative mode followed by intralesional steroid injection. I apply high energy with a very low density (approximately 0.2–0.3 mm) to effectively target the fibrotic tissue and enhance steroid absorption for better therapeutic outcomes.

[Finexel] Advanced Lower Eyelid Transconjunctival Blepharoplasty

Date: 21 JULY 2024 (SUN)
Webinar: Advanced Lower Eyelid Transconjunctival Blepharoplaty
Speaker: Dr. Ho-Joon Yoon (Korea)

Q28. How long does it take to recover from the blepharoplasty procedure?
Swelling typically reduces by about 70% after 4 days and by 80-90% after a week. Complete recovery usually occurs in about 2 weeks.
Bruising can happen, but it generally resolves within a week. There are no special precautions to take after the procedure, and the downtime is shorter compared to surgical incisional procedures.

Q29. What are the parameters for the blepharoplasty procedure?
Ultrapulse / 200 Hz / 200 microseconds

Q30. How is the amount of fat removal determined?
This is one of the most challenging aspects and requires a lot of experience. After removal, if the patient appears to have a sunken area when lying down, it indicates too much fat was removed.
The goal is to achieve a flat appearance while lying down. If there is still a slightly sunken area, a fat transplant may be necessary.

Q31. Is suturing performed after the procedure?
Typically, suturing is not required because the wound adheres well without it.

Q32. How is bleeding controlled during the procedure?
Bleeding is controlled using bipolar forceps. While some doctors use monopolar devices, they can damage the surrounding tissue, so bipolar devices are preferred.

Q33. Post-care instructions for patients
– Contact lens usage can resume after 2 weeks.
– Exercise can be resumed after 1 week.
– Showering and normal daily activities can be resumed the day after the procedure.
– If skin sagging occurs, additional fractional CO2 treatments may be recommended.

Q34. How is fat repositioning performed?
Fat repositioning is carried out using the standard method in typical fat transplantation procedures.
Fat is harvested using a syringe and then transplanted to the targeted area as usual, with no difference from the usual procedure.

[Finexel] CO2 Laser Uses in Dermatology and Aesthetics

Date: 2 JUNE 2024 (SUN)
Webinar: CO2 Laser essentials Major Indications in Dermatology and Aesthetics
Speaker: Dr. Fares Salameh (Israel)

Q35. Removing Large Mole
Usually, when I start with a large mole, I begin by using a 300 Hz setting with a 200-microsecond pulse duration.
As I get closer to the surface of the skin, I decrease the pulse duration and use less energy to minimize harm to the surrounding tissue.

Q36. Xanthelasma
I typically use local anesthesia with lidocaine and remove the tissue layer by layer, taking off small layers each time.
I use an ultrapulse CO2 laser set to 300 Hz with a 120-microsecond pulse duration.

Q37. Using CO2 Laser with Oral Isotretinoin
There are two review articles from 2017 suggesting that CO2 fractional laser can be used with isotretinoin, although full resurfacing is not advised.
A split-face study conducted six months after treatment showed that using a CO2 laser with isotretinoin yielded better results. Combining CO2 laser treatment with isotretinoin is feasible.

Q38. High Chance of Hypopigmentation
There is a 30% chance of hypopigmentation. However, by reducing the laser density, you can decrease the likelihood of post-inflammatory hyperpigmentation (PIH).
Using topical steroids can reduce the possibility of PIH by more than 50%. Clobetasol or Fusidic ointment are recommended for this purpose.

Q39. Er:YAG vs CO2 Laser
The main problem with the Erbium laser is that it is difficult to control bleeding.

Q40. How to Handle Treatment in Summer?
After treatment, patients should stay indoors for 4-5 days and use steroids for a while.
They should avoid sunny areas, such as the beach, for one month. If they cannot avoid sun exposure, it is advisable to delay the treatment.

Q41. Reducing Hyperpigmentation (HIP)
A modified Kligman regimen, including hydroquinone, kojic acid, and niacinamide, should be used.
And in the morning should apply sunscreen application.

[Finexel] Skin Rejuvenation and Resurfacing

Date: 3 FEB 2024 (SAT)
Webinar: Skin Rejuvenation and Resurfacing
Speaker: Dr. Mohammad Reza Mashhouri (Iran)

Q42. How does it compare with an RF needle device? Or are you using them together?
Combination therapy is the best approach. These are all tools—CO2 lasers, needles, any system can work, and the choice of system depends on the specific case.
I recommend combination therapy, which includes two sessions of microneedling, followed by CO2 laser and mesotherapy. This combination is effective and also works for pigmentation issues.

Q43. Drug Delivery?
We can use fractional CO2 laser at under 5 mJ with a large spot size to remove the stratum corneum in the skin. This allows the drug to penetrate better.

[Finexel] Combined Therapies for Scar Treatment

Date: 23 SEP 2023 (SAT)
Webinar: Combined Therapies for Scar Treatment
Speaker: Dr. Agnieszka Katarzyna Surowiecka (Poland)

Q44. Is a subcision needle necessary for deep scars?
Yes, a subcision needle is necessary for deep scars.
A laser has a superficial effect and finds it difficult to reach deeper areas, so a needle is needed to handle the deeper areas.

Q45. What is the best timeline for post-operative scars?
Most of the time, it is best to wait 3 months. During the initial 3 months, there are healthy inflammatory reactions.
However, in some cases, treatment can start earlier, around one month after surgery. This early treatment should not be very invasive; it aims to stimulate the healing process rather than evaporate the scar.
So, mostly wait 3 months, but sometimes treatment can begin at 1 month, focusing on promoting healing with weak fluence.

Q46. How can we prevent PIH (Post-Inflammatory Hyperpigmentation)?
The most important factor is good technique, ensuring not to burn tissue, which reduces the possibility of PIH.
Additionally, the topical use of steroids and tranexamic acid can help prevent PIH.

Q47. What are the clinical outcomes for fine wrinkles and stretch marks?
For fine wrinkles, resurfacing is often sufficient. If the wrinkles are deep, they should be treated like scars, with a more aggressive approach.
Stretch marks are treated similarly to post-acne scars, using CO2 laser combined with PRP (Platelet-Rich Plasma).

Q48. What is the timeline for fat transplant with CO2 laser?
The interval is around 1 month. If performing a CO2 laser first, a fat transplant can follow.
However, it should not be done the other way around to avoid damaging the fat.