Chemical Peel Vs. Laser Peel - Which is Better for Fine Lines, Sun Damage?

Chemical peels have been a reliable mainstays of the cosmetic physician's toolbox for well over a century. Trichloroacetic acid (TCA), Jessner's solution, salicyclic acid, glycolic acid and phenol have all been used in varying concentrations and protocols for treating acne scarring, pigmentary problems, wrinkles and other unwanted manifestations of photoaging for many decades before lasers came on the scene.

Although quite a number lasers and light treatments have come and gone in the past fifteen years, chemical peels have not only remained an important treatment tool, but have actually been experiencing a kind of renaissance. In experienced hands, they offer reliable and reproducible results.

Chemical peels are typically divided into three categories: light, medium and deep peels. Light peeling agents include low concentrations (10-25%) TCA, glycolic acid, salicylic acid and Jessner's solution. Light peels are good for skin maintenance, and for fading mild hyperpigmentation and softening very fine wrinkles. Light peels are accompanied by little downtime and make great lunchtime beauty fixes.

Medium peeling agents include TCA 50%, and Jessner's solution or  glycolic acid 70% followed by 35% TCA. Medium peels can help with more stubborn pigmentation and more pronounced photoaging.  They typically are associated with more prolonged healing times and downtimes of seven or more days.

Deep peeling often meant the use of a combination product known as Baker's Phenol. Deep peels were quite useful for more severe wrinkling and skin laxity, but entailed, much like surgery, nearly two weeks of downtime, required strong sedation to perform and possessed signicant risks for the developing permanent loss of skin pigmentation and even scarring.For this reason, despite its efficacy, deep peeling fell in considerable disfavor in the last twenty years.

Enter the "Punctuated Phenol Peel"--the most recent advance in chemical peeling technique, and one that is sure to put chemical peeling squarely back on the map and in competition with the more expensive, more heavily hyped laser and light-based therapies currently intensively marketed to consumers.

The procedure is simple, requires no sedation, and has little or no downtime. Using 88% plain phenol, fine lines and crinkles are treated in punctuated (i.e. fractionated or pixelated)  fashion. Using a very finely pointed applicator, the chemical is applied in a serial spot fashion with each spot separated from surrounding treatment spots by approximately one-quarter inch. The use of serial spot coverage, rather than coverage of whole areas, allows for rapid recovery as healing takes place from the intervening non-treated areas. It is precisely the same rational for the use of fractional lasers.

The "Punctuated Phenol Peel" technique is a novel approach to rejuvenation that limits the overall potential for toxicity and downtime of traditional deep peels while constituting focal spots of more intense peeling. Wrinkle lines and crepeyness can be traced in this punctuated fashion, and treatment sessions can be repeated at monthly intervals if necessary until the desired result is obtained. When appropriate, hyperpigmentation and acne scarred areas may likewise be treated in a punctuated fashion.

Consultation with and treatment by an esthetic physician experienced in chemical peeling is an absolute must for determining  the appropriateness of this novel approach for any particular situation.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Some patients will want a light chemical peel to prep their skin a month prior to a laser. The mild peel can help with sun damage, pore size, and fine lines, but does not produce new collagen. This is a great way to work on "fresh skin" and already have some of the older, damaged skin peeled off. The Cutera Pearl Resurfacing Laser is a great treatment to take care of all of your skin concerns.

Medium depth chemical peels create peeling for 5 to 7 days. They do help with photodamage but are less helpful with fine lines than some laser treatments which can also take one week to heal.

As a general rule, the deeper the skin is peeled:
1. The more dramatic the improvement in wrinkling
2. The longer the healing period
3. The greater the risk of scarring or irregular pigmentation after the peel.
For pigment and fine wrinkling, a superficial papillary dermal peel should be appropriate. Experienced physicians can accomplish a such a peel predictably with either chemicals such as TCA or perhaps Hetter's very light solution, or with an Erbium:YAG laser. The tool that does the peeling isn't what matters - it's predicably peeling the skin to the appropriate layer that determines risks, recovery, and results.

Many doctors will argue the relative merits of chemical peel vs laser peel. They both work, the question really is safety, reliability, and uniformity of results.
 
Chemical peel involves guess work. The doctor applies a chemical solution and has to guess how deep it goes. If it does not go deep enough, then the result will not be what you want. If the peel goes too deep, you may be scarred.
 
Laser peels are predictable. The laser can be accurately set to go a certain depth to achieve the result that you want. Of course the most important point is to find a very experienced doctor who knows how to use the laser.
 
In my opinion, a combined non-ablative 1540 Erbium and ablative 2940 Erbium laser resurfacing is the most effective and safest peel for your skin type and goals (see link below.)