Skin resurfacing

Skin resurfacing includes 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 may be used for cosmetic reasons, such as erasing wrinkles around the mouth or eyes. It also may be done as a medical treatment, such asremoving precancerous lesions. Doctors sometimes combine techniques, using dermabrasion or laser resurfacing on some areas of the face, while performing achemical peel on other areas.

In a chemical peel, the doctor paints on a variety of caustic chemicals to destroy several layers of skin, allowing new, fresh skin to grow. After the skin heals, discoloration, wrinkles, and other surface irregularities are ofteneliminated. 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 and acne. The medium-depth peel is used for more obvious wrinkles and sun damage, as well as forprecancerous lesions. Deep peels are used for the most severe wrinkling and sun damage.

For dermabrasion, the doctor uses a sharp tool to selectively remove layers of skin. Some doctors use a hand-held motorized device with a small wire brushor grinding wheel. Others prefer to remove the skin by hand with an abrasivepad. Dermabrasion is often used to remove acne scars; it also can be used totreat wrinkling, surgical scars, and tattoos.

Laser resurfacing is the most recently developed technique for skin resurfacing. Specially designed, pulsing lasers can vaporize skin layer by layer without damaging nearby skin tissue. Special scanning devices move the laser lightacross the skin in predetermined patterns. Laser resurfacing can be used toremove wrinkles around the eyes, mouth, and cheeks, but smile lines tend to reappear after laser resurfacing. Laser resurfacing works best as a spot treatment; patients expecting complete removal of their wrinkles will not be satisfied.

Patients need to get ready for a chemical peel several weeks before the actual procedure. To promote turnover of skin cells, patients use a mild fruit acid lotion or cream in the morning, and an acne cream in the evening, togetherwith a bleaching product that helps prevent later discoloration. To prevent reappearance of any 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. All peels cause some pain; for a superficial peel, a hand-held fan to cool the face during the procedure is often enough to ease discomfort. For medium-depth peels, the patient may take aspirin or a sedative. During the procedure, cold compresses and a hand-held fan reduce pain. Because deep peels can be extremely painful, some doctors prefer to use general anesthesia; however, local anesthetics with intravenous sedatives are often enough to control pain.

Dermabrasion doesn't require much preparation. It is usually performed underlocal anesthesia, although some doctors use intravenous sedation or general anesthesia. The doctor begins by marking the areas to be treated and then chilling them with ice packs. In order to stiffen the skin, a cold spray is applied, which also helps control pain. Some doctors prefer to inject the area with a saline solution and local anesthetic, which also leaves the skin's surface more solid.

Antiviral drugs are given several days before the procedure. Laser resurfacing is sometimes performed under local anesthesia or with an oral sedative. Thepatient's eyes must be shielded, and the area surrounding the face should beshielded with wet drapes or crumpled foil to catch stray beams of laser light. The doctor marks the areas to be treated before beginning the procedure.

Within a day or so following a superficial peel, the skin turns faint pink orbrown. Over the next few days, dead skin will peel away. Patients should wash their skin often with a mild cleanser and cool water, and then apply an ointment to keep skin moist. After a medium-depth peel, the skin turns deep redor brown and crusts may form. Care is similar to that following a superficialpeel. Redness may persist for a week or more. Deep-peeled skin will turn brown and crusty, and there may be swelling and some oozing. Frequent washing and ointments are better than bandages. The skin typically heals in about two weeks, but redness may persist.

Following dermabrasion, an ointment may be applied and the wound covered witha dressing and mask. Patients with a history of herpes infections will begintaking an antiviral medication to prevent a recurrence. After 24 hours, thedressing 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 fluidand other matter. Patients may need pain medication, and steroids may be taken during the first few days to reduce swelling. The skin will take a week ormore to heal, but may remain very red.

The skin should be kept moist after laser resurfacing to promote more rapid healing and reduce the risk of infection. Some doctors favor applying ointments only to the skin, but others prefer using 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 be taken.

All resurfacing procedures can lead to infection and scarring. It's also possible that skin color will be changed, or that redness will last for months. In addition, some of the peeling agents used in deep chemical peels can affectthe function of the heart.

Depending on the resurfacing techniques selected, it's possible to improve the appearance of skin damaged by sun, age, or disease. Skin resurfacing techniques deal only the surface of the skin, however; procedures such as face-liftsurgery or eyelid surgery may be needed to repair other age-related skin changes. All resurfacing procedures are accompanied by some pain, redness, and skin color changes which may last for several months following the procedure.Eventually, these problems usually fade away.

Complications of skin resurfacing techniques can be serious, including infection and scarring. Moreover, there are some people who don't make good candidates for the procedure. Patients who tend to scar easily may get poor results.Resurfacing procedures can reactivate herpes infections or lead to new, sometimes serious infections. All resurfacing techniques intentionally create skin wounds, which means that scarring is possible. These problems can be minimized by using antiviral drugs before the procedures and good wound care afterward. Selection of an experienced, reputable provider also is key.

As the popularity of skin resurfacing techniques has increased, unqualified or inexperienced providers have entered the field. Patients should choose their provider with the same degree of care they take for any other medical procedure.

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