摘要

Objectives: To evaluate the clinical efficacy and safety of combined 20% trichloroacetic acid (TCA)–based Blue Peel and fractional carbon dioxide (CO₂) laser resurfacing in patients with moderate to severe facial photoaging. Introduction: Combination therapies for facial rejuvenation, such as trichloroacetic acid (TCA) chemical peels and fractional carbon dioxide (CO₂) laser resurfacing, have demonstrated synergistic effects in photoaged skin. TCA provides controlled epidermal exfoliation and contributes to dermal remodeling, while fractional CO₂ laser induces deep dermal stimulation promoting neocollagenesis and improving texture, laxity, and pigmentation. Their complementary mechanisms of action support the combined use as a strategy to enhance overall clinical outcomes in facial rejuvenation. Materials / method: Ten female patients with a mean age of 67 years (range 58–74), all diagnosed with Glogau grade III–IV facial photoaging, were treated with a single session of uniform medium-depth peel using 20% TCA, immediately followed by fractional CO₂ laser resurfacing over the entire facial area. Clinical follow-up with standardized photographic documentation was carried out over eight weeks. Outcomes included improvement in skin texture, rhytides, pigmentation, patient satisfaction, and adverse event profiles. Results: All patients demonstrated objective improvement in skin texture, pigmentation, and overall skin quality. Visible attenuation of fine perioral and periorbital wrinkles was also observed. No infectious complications or major adverse events were reported. One patient developed persistent thick crusts in the mental region, and three patients presented localized signs of subclinical dermal fibrosis, which did not affect the overall aesthetic outcome and required no additional treatment. Patient satisfaction rates were high, with over 80% reporting good to excellent outcomes. Conclusion: The sequential combination of medium-depth TCA peel and fractional CO₂ laser resurfacing appears to be a safe and effective approach for the treatment of moderate to severe facial photoaging, providing synergistic clinical benefits with a favorable safety profile and acceptable recovery time.