PHOENIX — Fractional CO2 lasers provide greater accuracy, control, and predictability for skin resurfacing than do chemical peels, according to Dr. Kimberly Butterwick. However, Dr. Gary Monheit countered that peels are more efficient, safe, and reliable than lasers.
"We know in today's economy [dermatologists are asking] is a laser really worth it?" Dr. Butterwick said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery.
She estimated that an ablative fractional CO2 laser costs about $1,500 per patient in the first year, but said the device pays off in the long run. "You can make more money treating more patients. You end up working less hard [compared with chemical peels] and making good money," she said.
Patients are willing to pay more for the results provided by laser resurfacing, according to Dr. Butterwick, who is in private practice in San Diego. "Patients will pay $1,000 more if you say they will have a better experience, and you will get rid of more lines."
"The big thing about lasers versus chemical peels is how deep you can go and still be safe," Dr. Butterwick said. A patient concerned with rhytids along his or her upper lip, for example, can be treated safely with a laser.
"If the lines are not too deep, one treatment tends to get rid of the lion's share of the lines above the mouth," she said. Peels can be used, but there is a risk of adverse outcomes. "Scarring and a decreased oral aperture can result with a deeper peel around the mouth," she said.
Laser resurfacing is also less painful, Dr. Butterwick said. "Patients do not require meds, so they can drive there and back, and they don't have to rely on a friend or tell their husband."
A quicker, easier recovery is another benefit of fractional CO2 lasers. "No longer is there the 2-week redness and healing we saw with older CO2 lasers. Patients can be functional while they are recovering and can get back to work sooner," she said. "Everyone is healed and in makeup within 6 days in our practice."
The opportunities for instruction are another distinction between the fractional CO2 laser and chemical peel resurfacing. "You can get education and training in lasers, and you can hardly get any training in peels any more," Dr. Butterwick said.
However, in a subsequent presentation at the meeting, Dr. Monheit argued that chemical peels have a longer track record. "Peels remain the most popular, reliable, and efficacious method of skin resurfacing after more than 75 plus years," said Dr. Monheit, who is in private practice in Birmingham, Ala.
"Chemical peels yield predictable results with safety and efficacy," he said. "You can really [predict] what the patient will have in a reliable period of time."
There is no laser "that can produce results as efficiently and safely as chemical peeling," Dr. Monheit said. "I'm seeing a resurgence back to chemical peels because the laser hype has not delivered all it said it would."
Also, chemical peels "can be tailored to patients' needs and downtime, for example, a lunchtime superficial peel," he said.
Dr. Butterwick and Dr. Monheit reported no relevant disclosures.
'I'm seeing a resurgence back to chemical peels because the laser hype has not delivered all it said it would.'
Source Dr. Monheit
With the laser, 'you end up working less hard [compared with chemical peels] and making good money.'
Source Dr. Butterwick