Background: 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. Objective: We compared the clinical and histologic effects of a scanning carbon dioxide (CO₂) laser (ESC/Sharplan 40C) and the ESD (Visage Cosmetic Surgery System, Arthrocare). Methods: This study was a matched clinical trial involving 9 subjects. Two strips (2 × 1 cm) of skin on the temple were alternately assigned to receive 2 passes with either the CO₂ laser (Silktouch mode, 260 handpiece, fluence 15 J/cm², 10 mm²) 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. Results: Median erythema scores were significantly greater in skin treated with the CO₂ laser. Histologic examination showed greater epidermal loss and a significantly thicker zone of underlying thermal damage (average difference, 63 μm; 95% confidence interval, 40-87; P = .0002) in skin treated with the CO₂ laser compared with skin treated with the ESD. After 3 months, a band of superficial dermal fibrosis was thicker in skin treated with the CO₂ laser (average difference, 170 μm; 95% confidence interval, 69-271; P = .0075). Conclusion: Two passes with the ESD elicited a more superficial skin peel than the CO₂ laser. Despite minimal thermal damage, superficial dermal fibrosis was seen at 3 months in skin treated with the ESD. (J Am Acad Dermatol 2001;44:492-6.)