No matter what specific technique is used to resurface the skin, the procedure, in essence it is a matter of controlled injury with the intention of forming ‘good’ scar tissue. There is a risk of ‘bad’ scar tissue forming instead.
If you are considering skin resurfacing, the first step is to consult with a dermatologist or plastic surgeon (or for business owners looking to offer skin resurfacing, click here). During the consultation appointment, you may be asked to point out in a mirror the areas of your face that you would like to have worked on. This will give your doctor an idea of what you expect to achieve and whether your expectations are realistic.
Skin resurfacing may be able to help if you have any of a number of problems, including:
You can have the procedure at nearly any age. The specific technique will be determined by your unique situation and the experience of your doctor. Different techniques require different recovery times, and all can be used at varying depths. Superficial treatments heal faster than deeper treatments, but may need to be repeated to give the same results. Skin resurfacing can be done at the same time as other procedures. The surgeon will examine your skin to evaluate the extent of damage and determine what specific technique will offer the desired results.
Your doctor will take a thorough medical history and ask about such things as allergies, prior medical treatments and surgeries, and any medications you are using, including medicated creams used topically. To prevent a negative outcome, it is vital that you be open and honest.
There are three main techniques for skin resurfacing; chemical peels, dermabrasion, and laser resurfacing. All three techniques work on the same basic principle. The skin of the treated area is injured and as the area heals, new skin emerges. The difference is in the exact nature of the injury. The treatment is generally not covered by insurance except when precancerous lesions or certain types of scars are being treated. Your surgeon can work with your insurance company to find out whether your treatment can be covered.
Peels involve applying a chemical solution to the area to be treated, whether that’s a small area or the entire face. The surgeon will watch the skin for changes in its appearance. There are different types of chemical peels of differing strengths and specific techniques of use.
Alpha Hydroxy Acid (AHA): These peels, including glycolic acid, generally work on the top layers of the skin. A single treatment can be enough to give you a younger, healthier glow, while repeated treatments can further improve your skin. These peels are good for reducing brown spots and fine lines.
These peels are typically done in a plastic surgeon’s office without anesthesia or sedation. You may feel a mild tingling or stinging as the chemical is applied. Because there is no need for anesthesia, you will be able to drive yourself home. In most cases, you will be able to wear makeup after the procedure. Your surgeon will recommend an AHA product for you to use at home for maintenance.
Trichloracetic Acid (TCA): TCA peels are most often used to reduce wrinkles and blemishes, and can also be used on the neck or other areas that may be sun damaged. TCA is generally preferred for treating smaller areas because it lightens the skin less than some other peels, particularly those containing phenol. It is also the preferred peel for darker skinned patients for the same reason. Depending on the concentration and method of application, TCA can be used superficially or for a medium peel or even deeper, as needed.
Phenol: Phenol is generally used for treating facial skin that is more seriously sun damaged and deeper wrinkles, especially those around the mouth. Phenol can also be used to even out blotches and brown spots, and can also be used to treat precancerous skin lesions.
The drawback of phenol is that it tends to bleach the skin. After treatment with phenol, you may need to wear makeup to even out your skin color. Phenol cannot generally be used on other parts of the body, though some less concentrated products can be used more flexibly.
Think of using a small sander with fine-grain sandpaper to remove the top few layers of skin and this is essentially what dermabrasion involves. The injury is similar to skinning your knee and is most often used for treating facial scars. It can be used on any part of the face. Dermabrasion can be used on patients with darker complexions and in most cases the treated area blends into surrounding skin so that any changes in pigment are not noticeable.
Dermabrasion requires some degree of anesthesia. Small areas will typically be done under local anesthetic, but larger areas may require sedation. The injury is treated similar to a burn. Your surgeon will recommend follow-up care based on the depth of the treatment and your particular skin type.
There are two different types of laser skin resurfacing. The first type is similar to dermabrasion or a chemical peel and causes consistent injury across the treated area. Many surgeons like this type of laser resurfacing to chemical peels or dermabrasion because it is easier to control the depth of treatment.
The second type is known as fractional resurfacing and involves using the laser to drill tiny holes into the skin. The collagen under the skin then tightens between the holes, kind of like connecting the dots. The benefit to this type of resurfacing is that there is less surface injury, but because the injury goes deeper, there is an increased risk of undesirable scarring.
Laser resurfacing, like other techniques, is good for reducing wrinkles, evening out blotches and age spots, and reducing the appearance of scarring from acne or injury. Laser resurfacing can be used on small areas or the entire face. The thickness and texture of your skin will determine whether laser resurfacing is right for you. Laser resurfacing can be especially helpful in tightening the area below the eyes that can begin to sag as we age.
Depending on the area to be treated and the depth of treatment, laser resurfacing can be done under local anesthesia or may require sedation or general anesthesia. Recovery depends on depth of treatment and technique.
Risk
Thousands of patients have had skin resurfacing with no serious problems and are happy with the results, but it is important to consider the risks inherent in these procedures in order to make an informed decision. You should discuss the risks and possible complications of any procedure with your doctor, but having a little information ahead of time means you can have some questions prepared ahead of time.
Skin resurfacing done by a board-certified plastic surgeon is generally safe, though there are risks of complications with any procedure. Infection or scarring are rare, but can happen with any of these treatments.
Skin resurfacing can trigger outbreaks of certain skin conditions, including skin allergies and cold sores. Even the most mild of chemical peels can result in minor skin irritation. Small whiteheads can also develop. In most cases, these will disappear with a mildly abrasive skin cleanser, but in some cases, they may require a follow up visit to the surgeon’s office.
Some patients experience raised or thickened scars that can be unpredictable. Medication can treat this outcome in most patients, but in some cases the scarring can be permanent. Phenol peels can bleach the skin, while other treatments can occasionally cause pigment changes or blotchiness.
After a resurfacing treatment, it is important to avoid sun exposure, at least until redness subsides. After the skin has fully healed, it is a good idea to use sunscreen and a wide-brimmed hat to protect the skin. If your eyes have been treated, quality sunglasses are a must. You may also need to be careful about chlorinated water after certain resurfacing treatments. In any case, it is vital that you follow all of the instructions given to you by your surgeon.
Before your resurfacing procedure, your surgeon may give you a special cream, lotion, or gel to use on your skin for a few weeks. Your surgeon may also give you a prescription for oral medication and give you other instructions. The treatment will likely be done in your surgeon’s office, or may take place in a clinic or hospital. Depending on the need for anesthesia, you may need someone to drive you home and help you for a day or two.
Before the treatment
In most cases, you will be given medication to keep you comfortable. Depending on the method and depth of treatment, local anesthesia will be used either alone or with sedation. In some cases, especially with deep treatments or those covering large areas, general anesthesia may be used.
After the treatment
After the procedure, petroleum jelly or ointment will be applied to the treated area and a bandage may be used. Superficial peels may cause some mild irritation and redness. Deeper peels, dermabrasion and laser treatments may also cause some degree of swelling. Depending on the treatment and follow up care, a scab may form over the treated area. Your surgeon will provide you with instruction on caring for and cleansing your skin. If you are a man undergoing skin resurfacing, you will have to delay shaving for a time. It is important to follow all instructions so that the skin will heal properly.
In the week to ten days after the procedure, new skin will begin to form and redness will subside, but your skin may still be pink for weeks or months. Your surgeon will advise you as to when you can use makeup to disguise the still healing skin.
Because it can often take so long for the pinkness of new skin to subside, it may be months before you really like your new appearance. Most individuals find the results worth the wait and, especially with deeper treatments, the results are fairly long-lasting. Milder treatments may need to be repeated from time to time to maintain the results.
Your skin will continue aging, and wrinkles caused by certain facial muscle movements will reappear. Avoiding sun exposure and taking special care of your skin can help to slow the process. Some wrinkles may show up sooner than others, depending on the location and extent of treatment. Still, improvements in the quality and texture of the skin that are obtained by resurfacing will keep you looking younger and healthier for years.
Resuming daily activities
Depending on the technique and extent of the resurfacing, and the type of anesthesia used, you should avoid straining or heavy lifting in the days following the procedure. For superficial peels like glycolic acid or other AHAs, you can return to work the next day. For procedures that penetrate more deeply, you will likely be off work for a week or two.
Following up with your plastic surgeon
You will need to go back to your plastic surgeon a few times for follow up care. At these visits, the surgeon will evaluate your healing. You will be advised to schedule other evaluations, including mammography, as needed for your age group.
Your relationship with your plastic surgeon continues beyond the procedure and follow up visits. If you have any concerns about your recovery or need any other information later, don’t hesitate to contact your surgeon.
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