(Chemical or Laser)
Having been involved with both medical lasers and chemical skin peels for nearly 30 years, I can give you a qualified opinion. My initial training in chemical peeling began in 1969 under Dr. Richard Ariagno at Northwestern University Medical School. In 1971, while at the University of Illinois College of Medicine, our department received one of the nation's first generation medical lasers. At that time we used it primarily for tumor surgery.
In the early 1990s, I employed lasers in nasal surgery and major facelifting. When laser technology was adapted for use in skin resurfacing/wrinkle removal, I joined my colleagues in evaluating that "latest technique."
Lasers have intriguing potential for many uses, but questions remain, particularly concerning skin resurfacing. Do lasers measure up to the 40-year gold standard for wrinkle removal the phenol deep chemical skin peel? And which lasers are best? In 1991, I wrote the medical text Chemical Rejuvenation of the Face.
Purchased primarily by cosmetic surgeons and dermatologists wanting to learn the process or improve their skills, this single-procedure textbook was well received and a medical best seller.
I was quite proud when prominent dermatologic surgeon, James Fulton, MD, PhD, one of the co-formulators of Retin-A®, publicly pronounced the textbook "The Bible of Chemical Skin Peeling." In preparation, I reviewed nearly every book and medical journal article written on the subject. My research further enhanced my understanding of how skin ages and what we doctors can and cannot do about reversing that aging.
Wrinkles are the worst thing to get rid of practically impossible. You cannot get rid of them even with a facelift. It's a peel or nothing.-Joan Rivers
In 1998, Lawrence Moy, MD (a fellow UCLA faculty member in the Dermatology Division), and I conducted joint research comparing the newer laser technology with traditional chemical skin peeling. An independent pathologist examined both techniques side by side using microscopic skin samples from volunteer patients. This landmark study was published in a major medical journal.* It presents very strong evidence of the relative virtues and expectations for each of these treatment techniques.
So, which is "better" laser or chemical? The answer on the surface is: "It depends."Ayoung person in his or her 30s or early 40s, with early signs of skin aging, will probably be satisfied with a less powerful laser or mild chemical peeling agent. A 60-year-old with "crocodile skin" would require a more aggressive technique, such as deep phenol peel or high-intensity laser.
Here are some important caveats to remember. The more intensive the skin resurfacing by either process the greater the potential for prolonged healing, color irregularities, and even complications such as scarring. Skin tone, thickness, dryness or oiliness, depth and location of wrinkles and prior treatments are all factors that must be considered when choosing the type and strength of resurfacing. The "best" procedure is the one tailored to the individual by a highly specialized doctor who understands both the benefits and risks of laser and chemical treatments.
Surgical techniques of facial rejuvenation have become quite sophisticated in the past several years…. and among the many methods and techniques now offered are alpha hydroxy acids, tretinoin (Retin-A), dermabrasion, phenol peel, trichloroacetic acid peel, and resurfacing with CO2 and Erbium lasers. Facial skin has undergone a multiplicity of changes and continues to improve. New techniques and procedures continue to evolve rapidly and there is no doubt that what is presented in this issue will be improved upon, changed, or even discarded. The specialty of aesthetic surgery and specifically facial skin resurfacing is not static, but forever advancing. We continue to strive for perfection.-Thomas J. Baker, MD, FACS Guest Editor, Clinics in Plastic Surgery, Skin Resurfacing, January 1998
The aim of both processes is to destroy the outermost skin layers and thereby induce nature to replace the older, wrinkled, sun-damaged skin with new, smooth, unwrinkled skin, free of age spots and other precancerous areas that are the hallmark of aged skin. The ability of man to create "new skin from old skin" has been a desire since antiquity. Records show, for example, that ancient Egyptian women rubbed their facial skin with alabaster stone in an attempt to restore their youthfulness; the crude forerunner of dermabrasion or skin sanding.
We all remember the scraped knees of childhood. Several days after the fall, the scab came off to reveal fresh, pink and smooth skin. Living skin will always regenerate itself when its outer layers are shorn, either deliberately or accidentally. The technical difference between laser and chemical peel treatments is how the outer layers of skin are destroyed.
It's not quite a month since I had my chemical peel done, and already I am used to my remarkably younger face. People who know me either just stare at me or ask me straight out, ‘What have you had done? You look great!'…People are astonished that a peel can do so much. Actually I was too. Although I've been in the medical field for twenty years, I did not realize that a face peel, under circumstances such as mine, could have far more effective results than a facelift. You were right. I would have been unhappy had I opted for a face lift, which would have left me with a tighter face but old skin. Thanks for doing a great job on my face, which now more closely resembles the young woman inside of me.-Paula, marketing consultant, California
Lasers use a high-intensity, invisible beam of light energy that destroys superficial skin cells by boiling the water inside the cells. The treatment's strength is a function of intensity and length of time the beam is allowed to strike the skin. Lower power and shorter exposure time translates to less skin destruction and a shorter healing time, but a less profound result. Conversely, the deeper the damage to the skin, the more exuberant the healing process which generates the smoothest, tightest, most wrinkle free new skin.
Some people show the signs of aging worse than others. Genetics plays a part. "Darker skinned people don't wrinkle as much as fair-skinned people, for example,"according to Susan E. Downey, MD, Associate Professor of Clinical Surgery. -USC Medical Journal
Chemical peels achieve their result by a controlled chemical burn instigating the repair process. The spectrum of peeling agents or acids includes salicylic acid (a cousin of aspirin) at the weak end, and trichloroacetic acid (TCA) or phenol (carbolic acid) at the strong end. Phenol is considered by most sophisticated practitioners the most consistent, predictable and effective peeling agent. It is the agent preferred for deep peeling and creates the most impressive rejuvenation result.
The ideal candidates for facial rejuvenation either chemical or laser are fair-complected with red or blond hair, green or blue eyes. Commonly, those of central or northern European ancestry. Because the process can cause some lightening or darkening of the skin, most skilled practitioners prefer to treat the entire face to assure uniformity of color. The area of facial treatment should "end" obscurely at the hairline and jawline to hide any potential minor color contrast with the adjacent untreated area.
The attention media gives to new procedures exerts a tacit but very real pressure on plastic surgeons to "conform," and this pressure may affect clinical judgment.-National Plastic Surgery Survey journal Plastic and Reconstructive Surgery, October 2000
Therefore, a proposed treatment of only isolated areas or regions must be fully discussed during the consultation; there is the possibility of permanent, differential facial pigmentation. I consider laser and chemical facial resurfacing rarely appropriate for acne scarring. Scar excisions and filling injections are generally better.
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