NEW ORLEANS – When deciding whether to laser or peel, safety is enhanced and postoperative results are more favorable when five factors are considered, according to Dr. Suzan Obagi of the Cosmetic Surgery and Skin Health Center at University of Pittsburgh Medical Center.
“When I look at a patient and I am deciding on a skin resurfacing modality, I go through a checklist in my head to evaluate their skin color, thickness, and anatomy; the depth of their skin problem; and the number of treatments the patient will be willing to go through,” she noted in a presentation at the annual meeting of the American Academy of Cosmetic Surgery.
Courtesy Dr. Suzan Obagi
A woman receives a TCA Blue Peel of the face, ears, and feathering onto the neck.
Consider every factor and to inform patients of the risks and benefits associated with each skin resurfacing modality, she said.
“Peels and lasers don’t work the same way, and comparing them is like comparing apples and oranges,” she noted.
In general, lighter skin responds well to a wide variety of peels and laser treatments, and fares particularly well when treated with lasers, said Dr. Obagi. However, patients with darker skin present a special challenge because they are more likely to present with a number of skin problems such as melasma, lentigines, ephelides, post-inflammatory hyperpigmentation (PIH), post-inflammatory erythema (PIE), acne scars, and dermatosis papulosa nigra (DPN). These patients often require a combination of modalities to address their concerns.
The depth of the skin problem should be carefully considered, as different modalities to treat specific indications are targeted to various depths, Dr. Obagi noted. Photodamage is a superficial condition that she typically treats with peels, while superficial scars and rhytids, can be treated with a combination of lasers and peels. Deep scars and rhytids that reside deeper in the skin should be treated with lasers.
“You can try to reach some of these deeper problems with peels and superficial laser peels, but you may end up in trouble from pushing a modality deeper than you can control it,” stressed Dr. Obagi. “When I see deep acne scars, I immediately know to use a laser; no chemical peel is going to address that,” she added.