PEELS, LASER RESURFACING, AND DERMABRASION
Fine wrinkles, brown age spots, roughened sunspots, pigmentary abnormalities and many sun-related conditions can all be improved with peels and laser resurfacing. This is essentially done by stripping away the dead outer layer of skin (epidermis) and stimulating re-growth within the deeper layer of skin (dermis).
As we age, the skin becomes dryer, rougher and thinner with the appearance of blotchy pigmentation particularly in areas exposed to the sun. Every day, thousands of cells die, fall off and are replaced by new cells from below. Unfortunately as we age, this becomes a slower and more haphazard process. The cells of the epidermis (top layers of skin) become large and irregular. Activity of the cells in the dermis which produces collagen and elastin decreases with age. The content of actual dermal collagen, which is the most important component of the dermis decreases by 1% per year after the age of 20. The collagen fibers become thicker and more brittle and the elastin fibers also decrease and break up with age. THE END RESULT: the skin is thinner and more susceptible to environmental conditions such as dryness, infection and skin cancer. The goal of all skin therapy including creams, peels and lasers is to remove the dead skin and stimulate cell regeneration and increased collagen production. The peel or laser creates an even controlled shedding of several layers of damaged cells. This exposes a new fresh layer of skin (at the dermal level) and a regrowth of skin with more even color and smoother texture. New cells are stimulated to grow in a more uniform direction, thereby tightening the skin, and thus decrease wrinkling.
There are many different types of peels and laser therapies that vary from being extremely superficial to deep peels. All peels, lasers and dermabrasion remove the epidermis and portion of the upper level of dermis (the papillary layer). The real difference is the actual depth or amount of skin removal that occurs and not necessarily the method or modality. The deeper the peel or laser, more wrinkles and deeper wrinkles can be removed and the smoother the skin – but at a cost. The greater the depth, the longer recuperative time. There is a higher chance for hypo or hyperpigmentation with lines of demarcation that may occur between the face that is being treated and the neck skin that is not treated. Additionally, deeper peels cannot be done on darker skin. Superficial peels or laser treatments such as the “photo-facial” and aesthetician “lunch time” peels have little down time and can improve the quality and texture of the skin in multiple treatment sessions over time. They are in no way as effective for rejuvenation or removal of facial lines and wrinkles as the deeper peels and laser resurfacing techniques.
The Secret to Success
An understanding of the procedure and what it accomplishes is essential for a successful outcome. One must understand, that neither chemical peel, laser resurfacing, nor dermabrasion will correct or “lift” sagging skin which only a face lift will accomplish. However, fine imprinted lines around the eyes or mouth can only be remedied by skin resurfacing techniques. This is why the road to facial rejuvenation is a “multi-modality” treatment. Your surgeon should have ALL of the tools available, so that he can recommend the best one suited to your needs and specific problems.
A Chemical Peel is a time-tested technique that provides significant rejuvenation with minimal healing time. The main benefit of chemical peeling is a rapid turnover of the skin cells which causes the formation of new collagen. This causes a tightening of the skin and eliminates much of the superficial pigmentation such as sun spots, age spots, liver spots, freckles and blotchiness. There are known types of chemical peels that are proven in plastic surgery and dermatology. I do not recommend that any patient undergo peels or purchase products from any clinic that have “special formulas” where the ingredients are not disclosed.
This is the mildest of the group of peels.
TCA (TRICHLOACETIC ACID) PEELS
TCA peels can be used in varying strengths. TCA peels have stood the test of time as the most common and popular type of peels given over the years. They improve fine wrinkling and pigmentation problems. Unlike the deeper, phenol peels or lasers, the TCA peel (at or below 35%) will create a fresh natural appearing complexion, while preserving the normal skin color. This type of peel is done with IV sedation. Postoperatively, the patient feels as if they had a bad sun burn. A very superficial scab develops and then peels off in about 5 – 6 days leaving new, smoother skin behind
The deeper peels, using 88% phenol or with the use of Croton Oil (Baker’s Formula) can effectively reduce deeper wrinkling. The potential problems with deep peels is the high chance of hypo and hyperpigmentation (light and dark spots) that might occur following the peel. These peels are not advocated in darker skin. Similar types of aging and sun damage changes occur on the neck, chest and hands. TCA peels (in lighter concentrations) can improve these areas as well.
There are many different types of lasers currently being used for skin resurfacing. The one that is most commonly used is the carbon dioxide (CO2) laser. The high energy, amplified light waves of the CO2 laser vaporizes the top layer of skin as well as re-organizing the collagen fibers within the dermis. The risks of the laser such as scarring, persistent redness or permanent hyperpigmentation and hypopigmentation can be reduced to a very low percentage if properly performed. This involves full knowledge of the laser settings and the procedure must be performed on the appropriate candidate.
The IPL laser, is a more superficial laser currently used in younger patients, patients with photo damaged skin, rosacea, spider veins and lighter skin pigmentary changes. These treatments usually require multiple sessions until improvement can be achieved. Spider veins are also effectively treated by using a simple hyphercater or cautery instrument.
Originally, full face laser treatments were advocated as standard therapy. However, treating the surface of the skin has evolved into a more sophisticated art. For example, if a patient has deep lines around the eyes or mouth, we have the opportunity to use the laser for these areas combined with a lighter 35% TCA peel for the rest of the face. This area does not necessarily need a deeper treatment where there are no wrinkles but possibly more pigmentary changes. This combined therapy avoids the problems of the deeper treatments while solving the problems of wrinkle removal.
Dermabrasion is a surgical technique whereby some deeper scars and wrinkles can be smoothed. After local anesthetic is applied to the area, a high speed rotating brush or diamond phrase burr is used to remove the top layer of skin to the appropriate level for best results.
Swelling and “crusting” of the skin are normal occurrences after peels, lasers and dermabrasion. Different regimens of postoperative care are provided for peels and lasers. The moderately deep peels and laser resurfacing procedures require at least a week of recuperation. In one to two weeks after surgery, new skin will emerge that is pink, finer and with less wrinkles. Redness of the skin will persist for usually up to 4 weeks or longer (usually with a laser procedure).