A clinical and histologic comparison of electrosurgical and carbon dioxide laser peels.

Abstract

A radiofrequency-controlled electrosurgical device (ESD) has been adapted for skin peeling. A high-voltage, low-amperage current converts an irrigant into an ionized vapor, causing molecular dissociation and superficial damage in adjacent tissue. We compared the clinical and histologic effects of a scanning carbon dioxide (CO(2)) laser (ESC/Sharplan 40C) and the ESD (Visage Cosmetic Surgery System, Arthrocare). This study was a matched clinical trial involving 9 subjects. Two strips (2 x 1 cm) of skin on the temple were alternately assigned to receive 2 passes with either the CO(2) laser (Silktouch mode, 260 handpiece, fluence 15 J/cm(2), 10 mm(2)) or the ESD (125 V = setting 4, 5 mm handpiece). Strips were wiped with moist gauze after the first pass, and 4-mm punch biopsy specimens were taken immediately and after 3 months. Clinical assessment of re-epithelialization, erythema, and hyperpigmentation was made at 1, 2, 4, and 12 weeks. Median erythema scores were significantly greater in skin treated with the CO(2) laser. Histologic examination showed greater epidermal loss and a significantly thicker zone of underlying thermal damage (average difference, 63 microm; 95% confidence interval, 40-87; P =.0002) in skin treated with the CO(2) laser compared with skin treated with the ESD. After 3 months, a band of superficial dermal fibrosis was thicker in skin treated with the CO(2) laser (average difference, 170 microm; 95% confidence interval, 69-271; P =.0075). Two passes with the ESD elicited a more superficial skin peel than the CO(2) laser. Despite minimal thermal damage, superficial dermal fibrosis was seen at 3 months in skin treated with the ESD.