The women also evaluated the procedures and "confirmed our impressions," Kitzmiller says. "From their perspective, there was a slight advantage for the laser as far as wrinkle removal. But they were evenly divided as far as what they would recommend to their friends. Some women felt the extra wrinkle removal was not worth the extra healing time and discomfort of the laser treatment."
Because both procedures involve removing the top layers of the skin, "there is a significant period when it's weepy, uncomfortable and sore, and looks strange to the public," Kitzmiller tells WebMD. "It's seven to 10 days before you can wear makeup. Some women have a harder time dealing with that, especially if they ... have go back to work with the public. And when being away from a job or social responsibilities for a week is a big deal, that's a hardship."
The study is "well-performed," James M. Stuzin, MD, a plastic surgeon in private practice in Miami, Fla., writes in an accompanying essay. However, his treatment-of-choice for regional resurfacing around the mouth is another technology -- long-pulsed erbium laser. Healing occurs within five to seven days and redness disappears in four to six weeks, he says.
"The long-pulsed erbium laser is not quite as deep or efficacious as the CO2 laser;" writes Stuzin, who also is a clinical assistant professor of plastic surgery at the University of Miami School of Medicine. "However, we feel that the rapid healing and minimal [pigment lightening] associated with this treatment outweigh the slightly increased tendency toward residual [wrinkles] after treatment. ... We simply return them to the operating room and retreat only the wrinkles that remain and not resurface the entire area a second time.
"Although we agree with [Kitzmiller's findings], our strong feeling remains that when performing regional resurfacing, less is often more," he says.
"Excellent study," says Seth A. Yellin, MD, chief of facial plastic surgery at Emory Health Care and director of the Emory Facial Center in Atlanta. "As the authors point out, with a properly skilled surgeon, either technique works well. I personally think CO2 lasers are the workhorse of resurfacing. ... The CO2 laser generates some heat, which tightens the skin ... you want that in an aging face."