Skin resurfacing employs a variety of techniques to change the surface texture and appearance of the skin. Common skin resurfacing techniques include chemical peels, dermabrasion, and laser resurfacing.
Skin resurfacing procedures may be performed for cosmetic reasons, such as diminishing the appearance of wrinkles around the mouth or eyes. They may also be used as a medical treatment, such as removing large numbers of certain precancerous lesions called actinic keratoses. Physicians sometimes combine techniques, using dermabrasion or laser resurfacing on some areas of the face, while performing a chemical peel on other areas.
Laser resurfacing is the most recently developed technique for skin resurfacing. Specially designed, pulsed CO2 lasers can vaporize skin layer-by-layer, causing minimal damage to other skin tissue. Special scanning devices move the laser light across the skin in predetermined patterns, ensuring proper exposure. Wrinkling around the eyes, mouth, and cheeks are the primary uses for laser resurfacing. Smile lines or those associated with other facial muscles tend to reappear after laser resurfacing. Laser resurfacing appears to achieve its best results as a spot treatment; patients expecting complete elimination of their wrinkles will not be satisfied.
Antiviral medications should be started several days before the procedure. Laser resurfacing is performed under local anesthesia. An oral sedative may also be taken. The patient's eyes must be shielded, and the area surrounding the face should be shielded with wet drapes or crumpled foil to catch stray beams of laser light. The physician will mark the areas to be treated before beginning the procedure.
The skin should be kept moist following laser resurfacing. This promotes more rapid healing and reduces the risk of infection. Some physicians favor application of ointments only to the skin; others prefer the use of dressings. In either case, care of the skin is similar to that given following a chemical peel. The face is washed with plain water to remove ooze, and an ointment is reapplied. Healing will take approximately two weeks. Pain medications and a steroid to reduce swelling may also be taken.
Chemical peels employ a variety of caustic chemicals to selectively destroy several layers of skin. The peeling solutions are "painted on," area-by-area, to ensure that the entire face is treated. After the skin heals, discoloration, wrinkles, and other surface irregularities are often eliminated. Chemical peels are divided into three types: superficial, medium-depth, and deep. The type of peel depends on the strength of the chemical used, and on how deeply it penetrates. Superficial peels are used for fine wrinkles, sun damage, acne, and rosacea. The medium-depth peel is used for more obvious wrinkles and sun damage, as well as for precancerous lesions like actinic keratoses. Deep peels are used for the most severe wrinkling and sun damage.
Preparation for the chemical peel begins several weeks before the actual procedure. To promote turnover of skin cells, patients use a mild glycolic acid lotion or cream in the morning, and the acne cream tretinoin in the evening. They also use hydroquinone cream, a bleaching product that helps prevent later discoloration. To prevent reappearance of a herpes simplex virus infection, antiviral medicine is started a few days before the procedure and continues until the skin has healed.
Patients arrive for the procedure wearing no makeup. The physician "degreases" the patient's face using alcohol or another cleanser. Some degree of pain accompanies all types of peels. For a superficial peel, use of a hand held fan to cool the face during the procedure is often sufficient. For medium-depth peels, the patient may take a sedative or aspirin. During the procedure, cold compresses and a hand-held fan can also reduce pain. Deep peels can be extremely painful. Some physicians prefer general anesthesia, but local anesthetics combined with intravenous sedatives are frequently sufficient to control pain. Within a day or so following a superficial peel, the skin will turn faint pink or brown. Over the next few days, dead skin will peel away. Patients will be instructed to wash their skin frequently with a mild cleanser and cool water, then apply an ointment to the skin to keep it moist. After a medium-depth peel, the skin turns deep red or brown, and crusts may form. Care is similar to that following a superficial peel. Redness may persist for a week or more. Deep-peeled skin will turn brown and crusty. There may also be swelling and some oozing of fluid. Frequent washing and ointments are favored over dressings. The skin typically heals in about two weeks, but redness may persist.
Dermabrasion uses an abrasive tool to selectively remove layers of skin. Some physicians use a hand-held motorized tool with a small wire brush or diamond-impregnated grinding wheel at the end. Other physicians prefer to abrade the skin by hand with an abrasive pad or other instrument. Acne scarring is one of the prime uses for dermabrasion. It also can be used to treat wrinkling, remove surgical scars, and obliterate tattoos.
Dermabrasion does not require much preparation. It is usually performed under local anesthesia, although some physicians use intravenous sedation or general anesthesia. The physician begins by marking the areas to be treated and then chilling them with ice packs. In order to stiffen the skin, a spray refrigerant is applied to the area, which also helps control pain. Some physicians prefer to inject the area with a solution of saline and local anesthetic, which also leaves the skin's surface more solid. Since dermabrasion can cause quite a bit of bleeding, physicians and their assistants will wear gloves, gowns, and masks to protect themselves from possible blood-transmitted infection.
Following the procedure, an ointment may be applied, and the wound will be covered with a dressing and mask. Patients with a history of herpesvirus infections will begin taking an antiviral medication to prevent a recurrence. After 24 hours, the dressing is removed, and ointment is reapplied to keep the wound moist. Patients are encouraged to wash their face with plain water and reapply ointment every few hours. This relieves itching and pain and helps remove oozing fluid and other matter. Patients may require a pain medication. A steroid medication may be taken during the first few days to reduce swelling. The skin will take a week or more to heal, but may remain very red.