Many patients come to my office this time of year for help with their sun damage, discoloration, and fine lines. While skin creams can help, sometimes it takes a laser or chemical peel to get significant results. When I started performing these treatments 18 years ago, there were only a few options. Now there are dozens, so which one is best? The answer: no single procedure is ideal for everyone, and I spend a great deal of time examining my patients before I can make a specific recommendation. Here are some FAQs:
How do lasers and chemical peels work? Lasers use beams of light to target a particular problem. Wrinkles, dark spots, broken blood vessels, large pores, tattoos, and excess hair are treated with different lasers. Chemical peels use different strengths of acid solutions to remove layers of skin (to treat wrinkles, discoloration, and sun damage) and unclog pores (to treat acne and oily skin). Many patients ask for laser because it’s a newer technology and the idea of using “acid” scares them. But I explain that new devices aren’t necessarily better or safer. Peels range from mild lactic acid (like you find in sour cream) to deep TCA (trichloroacetic acid). Likewise, there are different types of laser, and the result depends on what setting the doctor uses.
What are the risks? With both laser and peels, risks include skin discoloration, scabs, and scarring if the treatment is too strong or the skin is not properly cared-for before and after the procedure. Lasers may also cause blistering and bruising. Certain lasers are not safe for those with a deeper complexion or tan skin. Instead, I often recommend chemical peels because, in my experience, peels are safer and give more reliable results in these individuals. I’m a stickler on prepping patients before their treatments, and recommend specific products to use (such as retinoids). Some lasers can cause prolonged redness in those with fair skin, and both lasers and peels can make skin more sun sensitive, so sun protection is crucial before and after procedures. Be sure to discuss proper skincare with your doctor prior to your treatment.
How does it feel & what’s the recovery? Ablative lasers (such as CO2 resurfacing lasers) are used to treat acne scars and deeper wrinkles. Skin can ooze and scab for a week or more, followed by redness that may last for months. Sometimes these lasers need to go very deep to reach the bottom of the wrinkles – that’s when it produces a pale, “waxy” appearance. Many patients choose to be sedated for these treatments. Fractional lasers (like Fraxel, Affirm, and Pixel) treat pinpoints of skin while leaving normal skin in between, so healing time is faster, typically several days of redness, swelling and superficial crusts. Nonablative lasers (such as intense pulsed light, or IPL) target freckles, redness, and pores, and stimulate collagen. Each pulse feels like a hot pinprick. Skin is red for a few days and may develop peppery dark spots for a week or two, but most of my patients go back to work right away. IPL is the most popular laser in my office. Chemical peels may feel warm or sting while they’re being applied. Depending on the strength, there may be slight redness for a few days, following by flaky patches. Deep chemical peels can produce dark crusts and scabs that may take up to 10 days to peel off, revealing new skin underneath.