Chemical Peel Vs. Fraxel Laser for Facial Rejuvenation?

Question

I'm 45 years old and want to do some facial rejuvenation, especially around the eyes. I was considering Fraxel but have been reading some negative reviews online. They say it could take years for the negative results to show up, and that it causes DNA changes to the undamaged skin. Is Chemical Peel a safer approach? Do you have any other suggestions? Thank you.

William Groff, DO · Answer

I haven’t encountered any studies that have demonstrated long-term negative effects with Fraxel. I have been using Fraxel Re:Pair, which is a CO2 ablative laser, plus the gentler Fraxel Re:Pair and Fraxel Dual for many years and have had terrific results. Re:Pair needs only one treatment, but you will have a reddened face for a couple of weeks. Re:Store and Dual have no significant downtime, but you will probably need more than one treatment; three is the norm.Chemical peels are also great to resurface the skin, but at 45 you probably would benefit from additional collagen and elastin. While chemical peels will stimulate the production of some new collagen, it’s not to the same degree that occurs with Fraxel. Fraxel creates microwounds in the skin that trigge the body’s healing response, including the production of new collagen and elastin that plump up your skin and strengthen it. These effects can last up to 7 years. Be sure to consult a board-certified dermatologist who has experience with both Fraxel and chemical peels so that you can learn about the benefits of both and choose the one you’re most comfortable with and that will give you the results you want.

Raffy Karamanoukian, MD, FACS · Answer

I believe the SmartXide Fractional CO2 laser is the best option for those patients who have lighter skin types. I prep patients with Melarase creams prior to laser, if indicated. Raffy Karamanoukian, Los Angeles

William Ting, MD · Answer

Both TCA chemical peel and Fractional CO2 laser resurfacing are excellent options for reversal of prior sun damage, i.e. diminishing future risk of skin cancer. However, Fractional CO2 laser resurfacing will afford more stimulation of collagen and tightening vs. TCA chemical peel. Both treatments may result in transient post-inflammatory redness or pigmentation, particularly for ethnic skin. If reversal of sun damage is the priority, TCA chemical peel offers the best value. If facial rejuvenation is the priority, Fractional CO2 laser resurfacing may be preferable.

Michele S. Green, MD · Answer

I was quoted in Vogue Magazine that "I wish I had invented the Fraxel laser" and it is true. I am not sure what negative reviews you have read but it is an entirely elegant and effective may to rejuvenate the skin. It is my favorite procedure because everyone is happy and looks great! Please find an experienced board certified dermatologist with extensive cosmetic dermatology background in lasers, especially Fraxel.

Martie Gidon, MD, FRCPC, FAAD · Answer

I prefer the fractional CO2 laser called SmartXide DOT. The settings can be individualized for each patient and the area being treated. Please consult a board certified dermatologist or plastic surgeon for assessment and treatment.

Sam Goldberger, MD · Answer

I am a fan of fractionated CO2 laser resurfacing for the face and especially around the eyes.  It gives excellent results.

Henry Daniel Sandel IV, MD · Answer

Gale,
Fraxel is a non-ablative method of skin rejuvenation.  It tries to create "damage" to the deeper layer of the skin in order to have the collagen tighten-up and remodel itself. Usually, patients require at least 5-6 treatments over a period of time before they see results.
A medium or deep chemical peel, as performed by physicians, is an ablative method of skin rejuvenation. It "damages" the outer surface of the skin down to the collagen layer allowing new skin to replace the old.  
Chemical peels have been around for a long time and have shown excellent results in just one treatment.  Because it is more intense than the nonablative methods, there are more risks associated with it. This includes lightening the skin too much and prolonged redness (1-3 months). Both of which are somewhat expected and can be controlled if the right techniques are used.
In conclusion, the results with Fraxel are minimal... but the risks are low.  The results with physician strength chemical peels are excellent with one treatment, but the risks are higher.  
Be sure you consult with a surgeon who has a lot of experience in all forms of skin resurfacing.  Thanks for your question.

Chemical Peel Vs. Fraxel Laser for Facial Rejuvenation?

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