Fine facial wrinkles, uneven pigmentation and scars (such as those caused by acne) can be improved by a number of resurfacing techniques. These include Chemical peels, Dermabrasion and Laser resurfacing. In essence, the principle of these techniques is the same, i.e. they address the problem by removing the defective superficial layers of the skin, encouraging the body to form new layers that are younger and free of blemish. The difference lies in the method by which the upper layers of the skin are removed.
Chemical peels involve the application of a caustic solution to the face, causing coagulation of the upper layers of skin which then ‘peel’ off. There are a number of solutions which are used, the most common of which are alpha hydroxyl acids (AHA’s). Glycolic acid is a widely used AHA found in most of your off-the-counter night creams but in low concentrations. Higher concentrations of AHA are to be used only by physicians or certified aestheticians. No anesthesia is generally needed and the patient only feels a tingling sensation. Other chemicals may also be used such as TCA. The depth of peel depends on the initial concentration of the solution, deeper the peel, longer the recovery period but more dramatic the effect.
Dermabrasion involves the use of a small rough spinning wheel studded with diamonds and attached to a hand piece. This mechanically removes the upper layers of the skin; the depth of peel is controlled by the surgeon. It is particularly suited for acne scarring in young skins.
Laser resurfacing has come into vogue in the last few years and is the most modern of the techniques used for resurfacing. Due to media hype most people feel that laser is “cure all” for skin problems which is really not the case. Lasers have their rightful place in cosmetic surgery and are the preferred method in some cases like wrinkles around the mouth and eyes.
Lasers are different in their wavelengths, and the targets which they best address, and each laser has its optimum use. No one laser system is able to do everything. The carbon dioxide or CO2 laser was widely used initially, but due to problems of prolonged redness, its use has declined especially for colored skin. It is making a come-back with fractional techniques.
The Erbium:YAG laser is far less invasive, and gives the surgeon more control over ablation of the upper layers of the skin but it does not heat the deeper layers, thereby skin tightening and collagen production is less. Er-Yag laser is useful to treat fine wrinkles, acne scarring, age spots, areas of varied pigmentation, and superficial skin lesions around the eyes especially. The procedure may be done under local anesthetic, however full resurfacing procedures may require some additional sedation. The skin is usually fully healed in five to seven days. Redness of the skin with this laser generally lasts no longer than three weeks. Laser techniques and machines are continually evolving; newer ones such as fractional Erbium and other wavelengths are entering the market.
The resurfacing techniques listed above are generally safe procedures when carried out by properly trained surgeons. In Middle Eastern or Asian skin types, we usually prepare the patient’s skin for with certain creams used for two to three weeks before doing the actual procedure; this is to reduce the risk of increased pigmentation. Anti-viral medications are started before procedure in persons prone to ‘cold-sores’.