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Background

Facial wrinkles, uneven pigmentation and certain scars such as those caused by acne can be improved by a variety of skin resurfacing techniques. Chemical peels, dermabrasion and laser skin resurfacing are possible methods. Aging, sun exposure, heredity and lifestyle factors including alcohol consumption and smoking all may contribute to facial wrinkling. Prior acne may have made the surface of the skin uneven. Pigmentary changes of the skin, such as blotchiness or brown spots, may also occur with age or as a result of birth control pills, pregnancy or genetic factors. Patients may have their skin resurfaced at almost any age.

Technique

Chemical peels, dermabrasion and laser skin resurfacing remove layers of skin; as the healing process progresses, a new, healthier-looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin’s layers are removed. Chemical peels involve the application of a caustic solution, dermabrasion utilizes a high-speed rotary wheel, and laser resurfacing uses a laser beam. Chemical peels vary according to their specific ingredients and their strength. The depth of the peeling action may be determined by factors such as how long they remain on the skin and whether they are applied lightly or rubbed more vigorously onto the skin. Generally, the most superficial peels are those using alpha hydroxy acids (AHAs) such as glycolic acid. AHA peels can reduce the effects of aging and sun damage, including fine wrinkling and brown spots. No anesthesia or sedation is needed, and the patient will feel only a tingling or mild stinging sensation when the solution is applied. A trichloroacetic acid (TCA) peel is often used for the treatment of wrinkles, pigmentary changes and skin blemishes. TCA can be used to achieve a medium or even a deep peel, depending on the acid concentration and manner of application. A phenol peel is sometimes recommended for treating particularly rough and sun-damaged facial skin. It can correct pigmentary problems including blotchiness or age-related brown spots and may be used in the treatment of precancerous skin conditions. Dermabrasion uses a small, rapidly spinning wheel with a roughened surface similar to fine-grade sandpaper to abrade the skin, removing its upper layers. This procedure is sometimes selected for the treatment of facial scars such as acne. Skin resurfacing using a carbon dioxide (CO2) laser removes skin layers by vaporization.

Benefits

• High level of patient satisfaction.
• In the case of deeper treatments, benefits are relatively long lasting.
• Many patients can benefit from having TCA applied also on the neck and other parts of the body that have been exposed to the sun.
• Sometimes a single treatment with an AHA peel will give skin a fresher, healthier appearance.
• Phenol is particularly useful for minimizing the vertical lines around the mouth.
• Some patients may benefit from the carbon dioxide laser’s mild "tightening" effect on the skin, particularly in the lower eyelid area.

Other Considerations

• Infection or abnormal healing are infrequent but may occur with any of the treatments. Deeper chemical peels, dermabrasion or laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the posttreatment regimen selected by the plastic surgeon, a scab may or may not form over the treated area. About 7-10 days after the resurfacing procedure, a new skin will begin to form. After the initial redness subsides, the skin may be pink for several weeks to months.
• Superficial resurfacing procedures, such as light chemical peels, will need to be repeated periodically in order to maintain benefits.
• As the skin continues to age, wrinkles caused by movement of the facial muscles will eventually reappear.
• Patients prone to skin disorders, including allergic reactions or herpes, may find that skin resurfacing can cause eruptions of these conditions.
• Tiny whiteheads may develop on the skin following some procedures.
• The appearance of raised or thickened scars is possible and unpredictable.
• Chemical peels, dermabrasion and laser skin resurfacing sometimes produce unanticipated color changes or skin blotchiness.
• Following all resurfacing treatments, it is important that the patient avoid direct or indirect exposure to the sun until all the redness or pinkness of the skin has subsided. Even after that, it is advisable to protect the skin by regular use of a sun block.
• Superficial treatments require less healing time, but the patient may need to have them repeated to achieve the same results as a deeper treatment.
• Phenol used for spot peeling often has a significant bleaching effect. The patient may need to use make-up to match the treated portions with the skin color of the surrounding areas. Unlike TCA peels, phenol cannot be used on the neck or other parts of the body.