Comparison of the laser and phenol chemical peel in facial skin resurfacing

Objective: To determine differences in postoperative outcomes, complication s, and adverse effects between phenol chemical peel (CP) and the carbon dio xide laser peel, when used for facial skill resurfacing. Design: Nonrandomized prospective comparison of 2 facial skin resurfacing t echniques using a split-face paradigm. In this initial study, 18 months of follow-up data are available, including the patients' subjective evaluation s, the surgeons' objective assessments, and a histological analysis of 1 pa tient by a blinded pathologist. Setting: A facial plastic surgery clinic associated with a university medic al center. Patients: Four female patients with actinic-damaged facial skin and facial rhytids, aged 61 to 73 years. Interventions: The left side of each face was treated with a phenol-based C P formula according to standard procedure. The right side was resurfaced us ing the Sharplan Silktouch Flashscanner carbon dioxide laser. Patients were photographed before treatment and at regular intervals postoperatively. On e patient underwent rhytidectomy at 2 months posttreatment, and specimens w ere obtained for histological analysis. Main Outcome Measures: Evaluation of observable clinical improvement in ski n quality, postoperative swelling, erythema, pigmentary alterations, healin g time, and complications. Results: All 4 patients experienced transient initial discomfort on the CP side that subsided within 24 hours after treatment. The laser side was note d to have slightly more prolonged stinging, erythema, and edema. Erythema w as noted to be more uniform in the laser-treated areas. Final clinical impr ovement in rhytids was evaluated by 4 surgeons who reviewed color slide pre sentations of each patient 1 year or. more postoperatively. Uniform wrinkle improvement was noted around the eyelid and lateral cheek areas on both th e CP and laser-treated sides. A moderate advantage in the degree of wrinkle improvement was noted on the laser-treated sides of the upper lip and fore head. Thick-skinned, glandular skin areas, such as the nasolabial fold and chin, were found to be substantially smoother in the laser-treated areas. H istological studies indicate that the CP side was noted to have a deeper in jury, extending into the reticular dermis. The skin treated with the laser was injured more superficially, down to-the papillary dermis. Conclusions: Phenol CP is as effective as the laser in diminishing rhytids in the thin-skinned areas of the face. The laser produces improved results in the thick, glandular areas of the face, but also produces more intense h ypopigmentation, longer periods of patient discomfort, and longer periods o f postoperative erythema. Both phenol CP and laser resurfacing remain usefu l clinical tools.