DOT Therapy is the fractional CO2 laser resurfacing we offer at our New Braunfels and Spring Branch clinics. It treats rough texture, sun damage, fine lines, crepey skin, and some acne scars. It is a deeper treatment than a facial or a light laser, so plan for real downtime: redness and peeling for a while, then collagen improvement that keeps building over several months. If you live in Bulverde, Spring Branch is a short drive.
People ask us whether they need "the strong laser" or something gentler. The answer depends on your skin, your goals, and how much recovery time you can give it. Your nurse practitioner sorts that out at a consult.
What is CO2 laser resurfacing?
A CO2 laser is an ablative laser. Mayo Clinic describes ablative resurfacing as removing the outer layer of skin, called the epidermis, while heating the dermis underneath. That heat prompts the skin to make new collagen, and the skin that grows back is smoother and firmer.
A fractional laser treats tiny columns of skin and leaves the skin between them untouched. Those untouched areas help the skin heal faster than when the whole surface is treated at once. Mayo Clinic notes that fractional devices are now the preferred approach for that reason.
What does DOT stand for?
DOT stands for Dermal Optical Thermolysis. It is the name of the fractional CO2 treatment on our DOT Therapy page.
What can DOT Therapy treat?
We use DOT for people who want more change than a lighter treatment can give. Common goals include:
- Rough or uneven texture
- Sun damage and uneven tone
- Fine lines and wrinkles
- Acne scars, depending on their depth and age
- Crepey or lax skin
- Some stretch marks, when your provider thinks they are a good fit
The American Academy of Dermatology (AAD) is clear that a laser can make a scar less noticeable but cannot erase it. We set expectations around softer, flatter scars, not perfect skin. If you still have active breakouts, our acne treatment post covers what we do first. Resurfacing works best once the skin has calmed down.
How is DOT different from CoolPeel, microneedling and Morpheus8?
We offer several treatments for texture and tone. They differ mostly in depth and downtime.
CoolPeel
CoolPeel also uses CO2 laser energy, but it targets the surface layer of skin. Most people go back to their day right away, and results build over a series. It suits people who want brighter, smoother skin without a week at home.
Microneedling and Morpheus8
Microneedling and Morpheus8 build collagen without a laser. Morpheus8 adds radiofrequency heat through the needles. Both usually take a series and have shorter recovery than DOT. Mayo Clinic notes that radiofrequency microneedling can be a lower-risk option for people with brown or Black skin who worry about color changes after a laser. Our microneedling vs. Morpheus8 comparison goes deeper on those two.
Peels and IPL
Chemical peels help with tone and mild texture. IPL photofacials target brown spots and redness. Neither resurfaces as deeply as DOT.
How do you prepare for DOT?
Preparation is part of the treatment. Before your appointment, your provider may:
- Prescribe an antiviral medicine to lower the risk of a cold sore flare, which Mayo Clinic lists as the most common infection after resurfacing
- Ask you to avoid tanning and unprotected sun in the weeks before treatment
- Review your medicines, including any isotretinoin (Accutane) in the past year
- Ask you to stop smoking for a couple of weeks before and after, since smoking slows healing
- Give you written pre-care and aftercare steps
The AAD notes that a laser can't safely be used on tanned or sunburned skin, so a beach trip right before your visit may mean rescheduling.
What happens on treatment day?
Comfort comes first. That usually means a topical numbing cream, and sometimes oral medicine. If you get medicine that makes you drowsy, you will need someone to drive you home. Mayo Clinic notes that ablative resurfacing can take from 30 minutes to two hours, depending on the area treated.
Afterward, your skin will feel warm and look red. We cover it with a protective ointment and go over your aftercare plan before you leave.
What is recovery like after CO2 laser resurfacing?
Expect redness, swelling and peeling. Mayo Clinic says new skin usually covers the treated area in 7 to 10 days after ablative resurfacing, and full recovery takes at least a month. Pinkness can linger longer. How long it lasts for you depends on how deep and dense the treatment is, and your provider will tell you what to expect for your settings.
During healing:
- Keep the skin clean and moisturized the way your aftercare sheet says
- Skip makeup and harsh products until your provider clears them
- Avoid hot tubs, pools and heavy sweating early on
- Wear a broad-spectrum sunscreen of SPF 30 or higher every day once the skin has healed
Small white bumps called milia, or a few breakouts, can show up from the thick ointments. Darker or lighter patches are a risk too, especially for people with brown or Black skin. Call us if anything looks off instead of waiting it out.
When will you see results?
Your skin will look smoother as it heals, but most of the change comes from new collagen, and that takes months. We judge results over several months, not the first week. Many people get a meaningful result from one DOT treatment. Deeper scars, lines or laxity may need more planning.
Results can last for years. New sun exposure and normal aging still add lines over time, so daily sunscreen helps your results last longer.
Who should wait or choose something else?
Resurfacing isn't right for everyone. Mayo Clinic lists reasons a provider may advise against it, including:
- Taking isotretinoin in the past year
- A recent cold sore outbreak
- A history of keloid scars
- Radiation to the face
- Pregnancy or breastfeeding
- A fresh tan
- Some autoimmune or immune conditions
If DOT isn't a fit, we will tell you and suggest a gentler option such as CoolPeel, microneedling or Morpheus8.
What does DOT cost?
DOT is priced per treatment area, and our pricing page lists our CO2 laser options. If you'd like to spread out the cost, we offer payment plans through Affirm and Cherry.
Frequently asked questions
Is CO2 laser resurfacing painful?
Most people describe heat and prickling. Numbing cream helps, and your provider may add oral medicine for comfort. The first few days after can feel like a sunburn.
How much downtime does DOT need?
Plan on about a week or more before new skin covers the area, and longer for pinkness to fade. Deeper settings mean longer recovery. We'll give you a timeline at your consult.
Is DOT the same as CoolPeel?
No. Both use CO2 laser energy, but CoolPeel treats the surface with little downtime, and DOT treats deeper for bigger changes in texture, lines and scars.
Can DOT help acne scars?
It can soften some acne scars. Results depend on the type, depth and age of the scars. Lasers make scars less noticeable but don't remove them completely.
How many DOT treatments will I need?
Many people see meaningful results from one treatment. Deep scars, lines or laxity may need more than one, spaced out after you have fully healed.
Do you offer DOT in New Braunfels and Spring Branch?
Yes. We offer DOT for patients at both our New Braunfels and Spring Branch clinics.
Book a DOT consult
A consult is the first step. We look at your skin, talk through your goals and your schedule, and tell you honestly whether DOT is the right depth or whether something gentler would serve you better. Book online or call us at (830) 608-9989.