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

[OBJECTIVE] To determine differences in postoperative outcomes, complications, and adverse effects between phenol chemical peel (CP) and the carbon dioxide laser peel, when used for facial skin resurfacing.

[DESIGN] Nonrandomized prospective comparison of 2 facial skin resurfacing techniques using a split-face paradigm. In this initial study, 18 months of follow-up data are available, including the patients' subjective evaluations, the surgeons' objective assessments, and a histological analysis of 1 patient by a blinded pathologist.

[SETTING] A facial plastic surgery clinic associated with a university medical 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 CP formula according to standard procedure. The right side was resurfaced using the Sharplan Silktouch Flashscanner carbon dioxide laser. Patients were photographed before treatment and at regular intervals postoperatively. One patient underwent rhytidectomy at 2 months posttreatment, and specimens were obtained for histological analysis.

[MAIN OUTCOME MEASURES] Evaluation of observable clinical improvement in skin quality, postoperative swelling, erythema, pigmentary alterations, healing 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 noted to have slightly more prolonged stinging, erythema, and edema. Erythema was noted to be more uniform in the laser-treated areas. Final clinical improvement in rhytids was evaluated by 4 surgeons who reviewed color slide presentations of each patient 1 year or more postoperatively. Uniform wrinkle improvement was noted around the eyelid and lateral cheek areas on both the 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 forehead. Thick-skinned, glandular skin areas, such as the nasolabial fold and chin, were found to be substantially smoother in the laser-treated areas. Histological studies indicate that the CP side was noted to have a deeper injury, 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 hypopigmentation, longer periods of patient discomfort, and longer periods of postoperative erythema. Both phenol CP and laser resurfacing remain useful clinical tools.