Alternatives to Deep Chemical Peels?

Question

Mydermatologist said some of my acne scars are deep, and I will need a deep peel for them. Are there other successful, more cost-effective alternatives to a deep chemical peel?

Gregory Turowski, MD, PhD, FACS · Answer

Preparingthe skin with Obagi Newderm system with Tretinoin prior to Fraxel laser procedure and in between treatments with proper spacing produces great results for acne scarring. It is safer than deep chemical peels as well as more predictible, healing is quick too.

Raffy Karamanoukian, MD, FACS · Answer

The fractional co2 laser is the most effective alternative to a deep chemical peel in my practice.  I would recommend a skin evaluation to see if the fractional co2 is appropriate with your skin type.

Jon E. Mendelsohn, MD, FACS · Answer

We have been very pleased to offer the DOT laser to patients for the treatment of acne scars.  We always let patients know that they will never have perfect skin and scars will always exist. But, the fact that this treatment has less downtime and can be performed with a topical anesthetic agent is fantastic.  It also has several feature such as "stacking" which are helpful particularly for acne scars. Other modalities that we use include subcision with sephly.

David Shafer, MD, FACS · Answer

Shaina,
Chemical peels are often very effective for mild to moderate skin resurfacing.  However, if you have deep scars, you may want to consider fractionated laser.  The laser technology has grown considerably in the last few years.  Fractionated laser may be able to give you significant results with less down time than previous treatments.  It is important that you go to a surgeon with laser experience and not just a weekend course.  Ask to see their before and after pictures and talk to some of their patients.
David Shafer, MD

Brent Moelleken, MD · Answer

Resurfacing techniques are, in some respect, all the same.  They injure the dermis, causing collagen formation when the dermis repairs, and leveling off of scars by microtightening and reduction in topographic irregularities such as the edges of acne scars.  Of course this is a slight oversimplification, and minor differences exist between the techniques.  The degree of control and precision is higher with lasers, lower with peels and dermabrasion.  Lasers have an additional effect of heating the tissue, increasing the formation of collagen over peeling techniques.  There may be some theoretic benefit in repeat very light resurfacing over time as well.
All resurfacing techniques also all have inherent drawbacks.  The deeper the TCA peel / CO2 / factionated laser / dermabrasion treatments, the higher the chance for whiteness, scarring, atrophic "shiny" appearance of the skin, hyperpigmentation  complications etc.  Period.  There is no magic bullet.
Since there is a limit in what resurfacing can accomplish, doctors and patients must be realistic in their goals.  You simply cannot turn the laser high enough to eradicate most severe acne scarring.  Doing so would cause a third degree burn with severe scarring, along with all the other undesirable changes mentioned above.
In some acne patients, tightening of the skin via facelifts helps immensely, in combination with resurfacing.  Some patients with pitted acne scarring or "ice pick" marks can benefit from direct removal of the scars and closure, obviously not performed at the same setting as resurfacing or facelifting.

William Groff, DO · Answer

The best treatment for most acne scars is laser resurfacing, specifically with the new fractionated CO2 lasers.  You may need one treatment or you may need a few.  This will be more expensive than a chemical peel, but the safety and results are much better.
Deep chemical peels have a higher risk of infection, scarring, and permanent loss of skin color.  Seek out a well established dermatology or plastic surgery office where the physician performs the treatment and takes care of you afterward.
Some acne scars are best treated surgically (punch excision), followed a few weeks later with laser resurfacing, but your dermatologist can determine this during your consultation.
Take care,
Dr. Groff

Sirish Maddali, MD · Answer

For many patients with deep acne scars, laser skin resurfacing has provided an effective method to treat the scars. Some deeper, "ice-pick" type scars will need to be cut out surgically. However, for the majority of the other types of acne scars, laser skin resurfacing is a great option. It may be more expensive than peels but the results are also much better.
Fraxel restore and Fraxel repair are two lasers I recommend. The "repair" laser will only need 1 or 2 treatments but will have a longer "downtime" in terms of redness and swelling. The "restore" laser will need 4-6 treatments but will have a substantially reduced "downtime." 
Hope this helps you in your hunt for a better treatment plan. Good luck Shaina.