Deep treatments involved the use of carbon dioxide laser's (CO2) and higher percentages of TCA chemoexfoliation. These procedures provide the optimal skin rejuvenation possible. They remove the top layer of the skin and stimulate increased collagen formation in the deeper layers of the skin over the following nine to 12 months. Frequently patients see not only a refreshening of the skin by regeneration of a new "top layer" of the skin, but also find approximately a 20% tightening effect to the skin over 9 to 12 months. Again, results will vary from individual to individual and no one can guarantee results. However, most patients find that carbon dioxide laser or deep TCA chemical peels provide dramatic results in illuminating facial wrinkling, pigmentation changes, and improving the skin’s elasticity. However, these treatments can be associated with some pigmentation changes. Deep TCA based chemical peels are used to "lighten" areas of increased pigmentation such as and patients with melasma (the so called “mask of pregnancy”). Patients who undergo a deep TCA based chemical peel or the CO2 laser need to accept the fact that their skin may become lightened to the extent that they need to use make up and cover treated areas. Despite this the deep peel and the CO2 laser are very popular because it provides most dramatic reduction in facial wrinkling and the most improvement in skin elasticity of any of the facial rejuvenation procedures. Results can approach an 80% improvement.

CO2 laser resurfacing, as well as deep chemical peels, requires some sedation. Procedures are done on an outpatient basis, and patients are able to return home immediately following the procedure. Similar to the medium peel, there is very little discomfort associated with either of these procedures. As with the medium chemical peel, a moist dressing technique is used following treatment. Vaseline is applied to all treated areas four to six times a day for seven to ten days. While these procedures can be repeated, we find that most individuals respond very favorably to a single carbon dioxide laser resurfacing or deep chemical peel treatment. These procedures are indicated for severe acne scarring, patients with recurrent skin cancers, deep facial wrinkling such as "smoker’s lines" and more advanced pigmentation and skin textural changes.

Laser resurfacing is a relatively new technique, in which light energy is used to remove the most superficial layer of skin (epidermis), and actually stimulates increased collagen in the deeper layers of the skin (dermis). High-energy carbon dioxide and erbium lasers are the primary lasers used for skin resurfacing. The wound-healing mechanism and recovery time is very similar whether laser resurfacing or traditional deep chemical peeling is performed. In one case, light energy is used; in the other case, various chemicals are utilized to achieve rejuvenation of the skin.

Laser resurfacing is usually done on individuals who are concerned with deep wrinkling around the mouth or eyelid area as well as general photoaging and degenerative skin changes over the entire face. While not all wrinkles can be removed, significant and dramatic improvement can be obtained in selected individuals. The advantage of the laser over the deep chemical peel is that there is less chance of pigmentation changes to the skin, and the degree of redness following surgery may be significantly less.

Laser resurfacing is also frequently used to treat scars. Laser resurfacing performed at 4-8 weeks after a facial laceration can stimulate wound healing and, in many cases, dramatically improve the aesthetic appearance of the area. Laser resurfacing may provide significant improvements in older, depressed scars in selected patients.