Chemical Peel Vs Laser Resurfacing for Various Facial Folds?

Question

Chemical peel or Laser resurfacing for severe perioral lines, nasolabial folds and folds under mouth corners? Which technology is best? The surgeon said Facelift won't help, suggested Chemical peel, he doesn't use laser. I’m willing to do both. Research has confused me. I am 60, have 15 facial age spots, and years of sun exposure. Don't tend to scar, but recently hyperpigmented after using Efudex on 2 pre-cancer cheek spots, VERY slowly fading. On my nose it healed quickly.

Kenneth D. Steinsapir, MD · Answer

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.

William Groff, DO · Answer

Laser resurfacing can be done with much greater precision that a chemical peel. Chemical peels that are done for deep perioral lines either don't work or they go too deep and leave the patient with scarring and severe hypopigmentation. I have seen many patients damaged from chemical peels. Nasolabial folds are best addressed with fillers. I have posted photos under my profile with examples of patients with perioral lines that I have resurfaced. Take care.

Steven Wallach, MD · Answer

If you have deep facial lines and nasolabial folds, a combination of alot of different things in moderation can do the trick. You may be a candidate for a facelift. You may also want to use fillers to camouflage the nasolabial folds. you m ay also want to use lasers to soften the fine wrinkles and "clean up" the sun spots.

Theodore Katz, MD, FACS (retired) · Answer

I agree completely with Dr. Groff.  The fractional CO2 lasers in the proper hands are much safer and more predictable than either a completely ablative CO2 laser or deeper chemical peels. In fact, I have abandoned deeper chemical peels in favor of the Fraxel RePair laser. This laser allows customizable treatment levels for various types of skin as well as the physiologic damage to skin (age and sun spots, finer wrinkles, deeper wrinkles and furrows, etc.). 
The Fraxel RePair laser also gives a samll amount of skin tightening and can softer nasolabial folds and jowls and decrease the need for or the amount of fillers necessar for any residual.

Brooke R. Seckel, MD, FACS (retired) · Answer

Correction of lip lines, loose skin, and folds around the mouth and facial sun damage require new collagen production to plump the skin, restore elasticity, tighten skin and remove the superficial pigment and sun damage.
Unequivocally the new combined fractional laser resurfacing provides the best results with the least risk of scarring and hypopigmentation (white skin in treated areas).
Deep chemical peels do work, but the risk of scarring is significant, but even with an excellent result from a Chemical peel, the skin will be left very white in the treated areas creating demarcation lines that will require make up to conceal.
The new combined fractional laser resurfacing combines a non-ablative lux1440 treatment with an ablative lux2940 ablative laser treatment at the same procedure. I have been doing laser resurfacing for the past 15 years and the results of this new technique far surpass previous resurfacing techniques.
The most impressive thing about this new technique is that healing and down time are reduced by half and we have not had scarring or hypopigmentation. This is due to the fact that the lux1440 and lux 2940 are Erbium lasers and create less thermal damage.
Becuase of this we are now able to treat darker skin types without the worry of demarcation lines. 
See before and after photos of fractional laser resurfacing.

Chemical Peel Vs Laser Resurfacing for Various Facial Folds?

Answers (5)