Dear Chai
Let me take the opposite position of Dr. Groff. The CO2 laser is a crude instrument compared to the flexibility of the chemical peel.
It is important to understand that there is no free lunch in skin resurfacing with lasers or chemical peels. To improve the issues you are concerned with you need either an intense CO2 laser resufacing or a properly executed chemical peel that combines a combination of peeling agents. CO2 laser resufacing became popular because it provides a reproducible means of improving the aging changes of the facial skin with a very short learning curve. A surgeon can be taught to perform laser resufacing in a two day course. In contrast, it can take 2 years of intense fellowship training to learn to perform an artful chemical peel. Human nature being what it is, once a doctor has plunked down $150,000 for a laser, it is very hard to hold the thought in the mind that $2.00 worth of chemicals could produce a better result.
The truth is that we are still in the midst of an epidemic of bad outcomes from over aggressive CO2 laser resurfacing. The depth of treatment needed to improve deep facial lines caused permanent depigmentation of the skin and textural changes from scar tissue. I call this effect the "aliens have suck my face off" look.
Now, it is also possible to cause scaring with chemical agents. The key is finding a surgeon who knows what they are doing. All things being equal, it is my belief that chemical peels are more effective and less likely to cause unwanted skin color and texture damage. There is no free lunch so that very deep peel and very deep laser resufacing will cause scaring. The art is finding the right balance so that the punishment fits the crime.
