Skin Resurfacing is a procedure which targets coarse and fine wrinkles (rhytids) of the face. Laser devices and chemical peels are typically chosen for this task. There are significant differences between lasers and chemical peels. The relative advantages and disadvantages of each must be reviewed with each patient so that appropriate choices can be made. In general, lasers are a more aggressive treatment alternative and require a rather prolonged recovery and more significant risks. Chemical peels require a shorter recovery for the patient and typically possess less short term and long term risk factors. Laser peels and chemical peels are both similar in that they both involve the creation of a wound to the facial skin surface which should heal in a predictable fashion and produce the desired effect.
The CO2 ultrapulse laser is specifically used to reduce or eliminate wrinkles and textural abnormalities of the facial skin. This laser may also be used for blepharoplasty to improve the appearance of the eyelids. During treatment, the epidermis (outer layer of the skin) and the dermis (inner layer of the skin) are targeted. The depth of wounding is to some extent controlled by the parameters of laser device.
Patients with very severe skin damage and relatively fair skin complexions tend to respond favorably. The recovery is quite extensive and patients experience burning, itching, tightness, and redness for several weeks. Frequent visits to the office are required for wound care during the first 3 to 4 weeks. The treatment goals are reduction of wrinkles, improvement in skin texture and tone, and preservation of pigmentation.
Chemical peels are another option for patients who wish to improve the quality of their skin. A number of different substances are used for chemical peels; the most appropriate choice is determined by the patient’s goals, background pigmentation and time for recovery. Trichloroacetic Acid (TCA) is a very commonly used chemical peeling agent and allows for variable penetration and wound creation by adjusting the percent of the solution. TCA is frequently combined with a colored reagent (eg., The Obagi Blue Peel) to provide a more precise and predictable treatment. The flexibility of this type of peel provides the patient with a less extensive recovery as compared to laser treatments. Less wound care is needed and patients can return to work and enjoy outdoor activities earlier. Patients can choose this option regardless of their background skin pigmentation. Pretreatment with a skin care program may, however, be necessary depending on skin type. Multiple peels spaced over time may be needed for a given patient to reach the desired endpoint.
Individuals who choose skin resurfacing by lasers or chemical peels should understand the importance of continued care of their skin following treatment. Regular daily use of sunscreens with adequate UVA and UVB blockade is essential. A maintenance skin care program is often helpful in preserving the outcome and minimizing further damage over time. The differences between skin resurfacing and surgical options for treatment of aging of the face and neck should be discussed during a consultation with a board-certified plastic surgeon.
A thorough consultation is essential for individuals considering skin resurfacing. The following topics are typically covered during the office consultation:
- Medical and Surgical history
- History of Cigarette Smoking and Sun Exposure
- History of Previous Skin Care and Treatments
- Occupation and Job Requirements
- Participation in Sports and Hobbies
- Examination of Skin Surface of the Face and Neck
- Recommendations regarding skin resurfacing options
- Discussion of alternatives for skin care
- Discussion regarding anticipated recovery and limitation of post-treatment activities
- Follow-up Care in the Office
- Financial Requirements/Considerations Scheduling Treatments
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