Background and Objective The purpose of this clinical paper is to explore the therapeutic effects, healing times, adverse effects, and maintenance periods of using a CO2 fractional laser in the treatment of photoaging in Asian skin. Study Design/Materials and Methods One fractional CO2 laser procedure was performed on the full face in 56 patients with photoaging. Based on the Dover scoring system, we evaluated the degree of skin aging before treatment and at one-month post laser and at five years post laser therapy in 30 of the patients. Statistical analysis was performed by the Wilcoxon's method. Results Thirty of the treated patients have had follow-up for 5 years at this time. The photoaging scores in these thirty patients were significantly changed (P < 0.01) at one month, one year, and five years after the fractional laser treatment, as compared with their baseline. Adverse events seen during this analysis were found to be minimal and not of clinical significance. Conclusions Fractional CO2 laser resurfacing in the treatment of photoaging in Asians is a useful modality with results, for the first time, being shown to have continued efficacy for up to 5 years. Lasers Surg. Med. 46:750–756, 2014. ? 2014 Wiley Periodicals, Inc.