The best treatments for severe sun damage and wrinkles

2 Questions - What are your thoughts on Phenol peel vs. Dot CO2 Fractional laser for lot of sun damage wrinkles, possibly acne scars & sun spots (age 65) & why would either effect heart or liver, etc Thank you!

My apologies, it took me awhile to get to this one, but it’s a great question. I think I’ll just go through these one by one. But first, to understand the below, we gotta understand that aging happens at all levels of the face, and for repair of serious sun damage plus aging, we need all 3 layers repaired. Think deep layer; as in bone changes and muscle. Think middle layer; as in fat and deeper dermis (skin where all the collegen, elastic fibers, blood vessels are). And then think top layer; as in the upper dermis and epidermis, which is the thinner barrier layer of skin.

Bottom Line:

If you have more severe wrinkles and sun damage, you have to add support to the deeper layers AND also make the upper layers healthier and reduce sun damage. One without the other won’t give you a great result.

Phenol peels:

Honestly no one uses them anymore that I’m aware of, perhaps except older plastic surgeons. Really recommend AGAINST them. They leave that weird porcelain white skin that has no pigment to it all. Your skin will never have a normal texture again. And it won’t match your neck and chest.

Fractionated CO2 laser (like the DOT)

These are the current gold standard for resurfacing. They are quite safe in the hands of an experienced dermatologist or plastic surgeon. Don’t allow non MDs to do this.  They can be customized easily for each individual patient. Light for a preventive collagen building approach. A little deeper for mild/moderate sun damage. Very deep for scars and deeper wrinkles. Deeper wrinkles generally need about a week of down time. You should be seen at about post laser 3 or 4 for your doctor/nurse to see how your healing is going. Downsides are the downtime, and that it won’t correct red blood vessels or deeper brown spots.  You’ll need a different laser to do that. Most patients need volume correction FIRST before the laser to get the best results. See above about deep support, if you’re over 45-50.

Non-fractionated (traditional) CO2

These are not used much anymore, although I’m still surprised at how many surgeons seem to have them. Much more prone to scarring, pain, infection, post procedure color problems like red and brown, and prolonged healing issues. The only advantage is a little more tightening, which in my opinion, is not worth the increased risks. When these were all we had, our clinic used one for a number of years, until the fractionated lasers were developed.

Side effects

You mentioned the heart and liver. Please consult your doctors, especially if you have heart issues. Most complications are related to the anesthesia used, and not the procedure itself.

Phenol itself though is fairly toxic, and heart monitoring should be done during the procedure, in my opinion.

Hope this helps,
Dr. Brandith Irwin
Founder, SkinTour
Director, Madison Skin & Laser Center
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Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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