Facial Rejuvenation

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Long before advanced skin care products became available, plastic surgeons and dermatologists used resurfacing procedures to help freshen the skin. Resurfacing is a deeper removal of the outer layers of skin than exfoliation, accomplished by chemical peel, dermabrasion or laser. New cells are made by the remaining dermis (under surface of the skin) resulting in a newly healed surface (“resurfacing”). This results in fresher, healthier, and more radiant skin and is suitable for wrinkles, sun damage, pre-cancerous actinic keratoses, and acne scarring. There is a period of healing during which time the skin is moist and weeps fluid; or, if an Obagi Blue Peel is done, the skin is dry and flakes off. Light resurfacing allows the skin to heal in 3-5 days and deep resurfacing may take 9-12 days or more. Initially, the healed skin is red. After a few weeks to months (depending on the depth of resurfacing), the skin turns pink and then later a more normal color.

There are a number of advantages and some disadvantages to resurfacing. In patients with facial aging and sun damage, microscopic analysis of the skin shows disarray of the pink stained collagen fibers. After resurfacing, the collagen fibers are arranged in a more parallel formation as would appear in younger, healthy skin. By removing the upper layer of keratin and dead cells, the skin can be penetrated more easily by skin care products. Additionally, pre-cancerous actinic keratoses (scaling lesions of sun damaged skin) are improved and often eliminated. Wrinkles are smoothed, and acne scarring can be improved. Disadvantages of resurfacing procedures include the need for some form of anesthetic, recovery time, and the potential loss of pigment due to the destruction of underlying melanocytes. In recent years, physicians experienced with resurfacing are treating areas more lightly and repeating the procedure as needed to avoid the complication of pigment loss (depigmentation) or hyperpigmentation when deeper treatments are done. In addition, the skin is usually pre-conditioned with an Obagi Nu-Derm program to allow for more rapid healing, and to avoid post-inflammatory hyperpigmentation. Patients are routinely treated with antiviral agents to prevent herpes during the recovery phase.

In my own practice, I use a variety of procedures. For sun-damaged skin, wrinkles and pre-cancerous conditions, such as actinic keratosis (scaling lesion), I tend to use chemical peels. I find this method to be helpful with skin rejuvenation. I follow this with the use of advanced skin care products. For acne scarring, I favor dermabrasion and excision of deep scars though good results can be achieved with laser. For pigmentary problems, wrinkles and laxity, I have had excellent results with the Obagi Nu-Derm System conditioning and the Obagi Blue Peel.

Chemical Peel

Chemical peels may use a variety of chemicals including TCA (trichloroacetic acid), phenol and croton oil. The chemicals create a light burn of the outer layers of skin in a controlled fashion. Different concentrations will cause varying depths of skin removal.

Dermabrasion

Dermabrasion is the mechanical removal of the outer skin layers achieved by a rapidly rotating cylinder or dome covered with diamond chips or wires.

Obagi Blue Peel

Includes 8-12 weeks of conditioning with the Obagi Nu-Derm System followed by the Obagi Blue Peel (an application of TCA mixed with a special blue base).

Glycolic Peel

Also known as the "Beverly Hills Lunch Time Peel" because people can resume their normal life immediately after the treatment. Removes a micro-thin top layer of skin, smoothing and softening skin and diminishing fine lines. It is similar in its effect to microdermabrasion except that chemical products are used rather than mechanical abrasion.

Microdermabrasion

Exfoliates the skin with a jet of micro crystals sprayed and vacuumed across the skin's surface, removing dead cell tissue as it improves age spots, fine lines and wrinkles. This is a mechanical exfoliation, and allows immediate return to activities.

Overview of Facial Rejuvenation Procedures

Light Resurfacing ­ Healing Time: 3-5 days. Redness and Residual Pinkness for 1-2 months

1. Superficial Dermabrasion
2. Light Chemical Peels, such as Glycolic, TCA, Jessners   

Medium Resurfacing ­ Healing Time: 5-8 days. Redness and Residual Pinkness for 2-6 months

1. Medium depth Dermabrasion  
2. Stronger concentrations of Chemical Peels  

Deep Resurfacing ­ Healing Time: 9-12 days. Redness and Residual Pinkness for 4-12 months

1. Deep Dermabrasion  
2. Croton Oil-Phenol Peel

Conditions that can be treated with Facial Rejuvenation

Men and women of all ages may benefit from skin-revitalizing treatments or resurfacing procedures. Your skin type or characteristics may make you a better candidate for one method rather than another. If you have any of these conditions, you may be a good candidate for a facial rejuvenation procedure: 

• Wrinkled or sun damaged skin  
• Vertical wrinkles around the mouth that may cause "lipstick bleed" 
• Brown spots or blotches 
• Superficial blemishes 
• Facial scars caused by chicken pox or acne 
• Uneven pigmentation  
• Skin growths 
• Enlarged or oily pores 

When to be cautious with Facial Rejuvenation

You should be extra cautious in selecting a skin treatment if any of the following applies to you:

• You are prone to abnormal scarring.
• You frequently develop allergic rashes or other skin reactions  
• You frequently get fever blisters or cold sores  
• You are pregnant or nursing a baby  
• You have been treated with Accutane (isotretinoin) within the past 12 months 

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