Some lighter peels' result equal to laser

Philadelphia - For reasons not fully understood, some of the lighter resurfacing peels are achieving results nearly equivalent to CO2 resurfacing, without the long list of complications.

This was among the points made by Jason N. Pozner, M.D., while discussing advances in cosmetic laser surgery at the American Society of Plastic Surgeons (ASPS), here.

Laser resurfacing

"The problem with earlier laser resurfacing was that results came at a price. The CO2 laser not only required long healing time, but it was also associated with complications such as scarring, pigmentary issues and persistent redness. Deep erbium resurfacing had fewer complications but long healing times limited use," Dr. Pozner explains.

Then along came Sciton's Profile high-power erbium:YAG laser with a computer scanner.

"This laser allowed very confluent resurfacing from very deep to very light," Dr. Pozner says, who became one of the first physicians in the country to use it to perform microlaserpeels, a one-pass erbium, short-recovery resurfacing.

"Now, even with the lighter erbium peels, we're finding that the patients can achieve a very nice correction of superficial lines, pigmentary changes, rough skin and enlarged pores without significant downtime or discomfort."

While Dr. Pozner says there is a depth-dependent relationship between the peel and healing time with these erbium lasers, he notes that deeper peels don't always necessarily translate into a greater effectiveness.

In the very lightest laser peel - what he calls the "arctic peel" - only 10 microns of skin are removed and there's no downtime at all, but the procedure must be repeated four to five times to achieve significant results. He does add, though, that after one treatment, patients notice their skin is smoother and makeup applies more evenly.

Deeper resurfacing

With deeper resurfacing there is more downtime as the depth of resurfacing increases, i.e., a 20 micron peel requires two days, a 30 micron peel requires three days and 60 microns requires four days.

However, Dr. Pozner points out, "It's not necessarily the case that a 60 micron peel gives three times the results of a 20 micron peel. For some reason, our current data is showing that you don't really need to go that deep with some patients who get excellent results with the lighter peels. With some of the lighter peels, we're getting almost equivalent results to the medium peels."

As for the deep erbium resurfacing, he says, "We're getting results that are almost equivalent to those with the CO2 with fewer complications.

As part of the discussion on the comparison of the different nonablative systems Dr. Pozner and colleague Lawrence Bass, M.D., discussed how and why many of the nonablative systems are similar as well as the modes of action of different systems.

"We compared different wavelengths and studies of their efficacy as well and compared complications with different systems. Complications either were from too much heat with not enough cooling or wrong wavelength on tanned or dark patients causing burns," Dr. Pozner explains.