Skin Resurfacing / Facial Rejuvenation

Aging, sun exposure, heredity and lifestyle factors including nutrition, alcohol consumption and smoking all may contribute to facial wrinkling.

Pigmentary changes of the skin, such as blotchiness or brown spots, may also occur with age or as a result of birth control pills, pregnancy or genetic factors. Prior acne may have made the surface of your skin uneven. These problems, as well as certain other skin conditions, may be improved by skin resurfacing.

Consultation

Skin resurfacing can be accomplished by several different techniques. Dr. Stewart will examine your skin and take photographs for your medical record. He will consider such factors as your skin tone, wrinkles positions and the degree of loose skin.

You may be a good candidate for skin resurfacing if you have one or more of the following conditions:

• wrinkled or sun-damaged facial skin
• vertical wrinkles around your mouth, such as those that cause lipstick "bleed"
• "crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area
• fine wrinkling of your upper eyelids
• brown spots or blotchy skin coloring
• certain precancerous skin growths
• acne or chicken pox scars
• superficial facial scars from a past injury

Patients may have their skin resurfaced at almost any age. You may have certain characteristics that make you a better candidate for one technique rather than another, or Dr. Stewart may have a preference based on his personal experience with the different methods.

The amount of time you can allow for recovery also may be an important factor in selecting a particular resurfacing method or determining the extent of treatment. All resurfacing techniques can be performed to varying depths.

A more superficial treatment will require less healing time, but you may need to have the procedure repeated more than once to achieve the same results as a deeper treatment. If you are having aesthetic (cosmetic) surgery, such as a facelift or eyelid surgery, you may be able to have a skin resurfacing procedure performed at the same time

How is dermabrasion performed?

Dermabrasion uses a small, rapidly spinning wheel with a roughened surface similar to fine-grained sandpaper to abrade the skin, removing its upper layers. This resurfacing procedure sometimes is selected for the treatment of facial scars such as those caused by acne and often is performed on the cheeks or the entire face.

Dermabrasion, like the deeper chemical peels, is very effective in reducing the appearance of vertical wrinkles around the mouth that often cause lipstick "bleed". It can be used on a small area of skin and on patients with somewhat darker complexions. The treated area usually will blend with the surrounding skin so that there is little if any noticeable difference in the pigmentation.

What are the different types of chemical peels?

The different types of chemical peels vary according to their specific ingredients and their strength. The depth of their peeling action may also be determined by factors such as how long they remain on the skin and whether they are applied lightly or rubbed more vigorously onto the skin.

Generally, the most superficial peels are those using alpha hydroxy acids (AHAs) such as glycolic acid . Sometimes just a single treatment with an AHA peel will give your skin a fresher, healthier appearance and a radiant glow. Repeated treatments can help to further improve the texture of your skin. AHA peels can reduce the effects of aging and sun damage including fine wrinkling and brown spots. Dr. Stewart or his Esthetician will recommend a maintenance program using AHA products that you can apply at home on a regular basis .

An AHA peel is performed in right here in the office by a trained Esthetician under the supervision of Dr. Stewart. No anesthesia or sedation is needed, and you will only feel a tingling or mild stinging sensation when the solution is applied to your face. Immediately after the procedure, you generally will be able to wear makeup, and you can drive yourself home or back to work.

A trichloracetic acid (TCA) peel is often used for the treatment of wrinkles, pigmentary changes and skin blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck and other parts of the body that have been exposed to the sun. For spot peeling of limited areas such as around the mouth or eyes, TCA formulas are often preferred because they have less bleaching effect than solutions containing phenol, another popular peeling agent. For the same reason, some surgeons have found TCA to be effective in treating darker-skinned patients.

Milder TCA peels can be repeated frequently in order to achieve cumulative effects, or TCA can be used to achieve a medium or even a deep peel, depending on the acid concentration and manner of application.

A phenol peel is sometimes recommended for treating particularly rough and sun-damaged facial skin. Phenol is effective in reducing the appearance of wrinkles ranging from fine lines to deeper creases. It can correct pigmentary problems including blotchiness or age-related brown spots and may be used in the treatment of precancerous skin conditions.

Phenol is particularly useful for minimizing the vertical lines that often form around the mouth as a result of aging. The disadvantage of phenol for spot peeling of limited areas is that it often has a significant bleaching effect. After your skin has been treated with phenol, you may need to wear makeup in order for the treated portions of your skin to more closely match the skin color of the surrounding areas. Unlike TCA peels, phenol cannot be used on your neck or other parts of your body.

Certain variations in the phenol peel formula, creating a "buffered" or milder solution, may allow for greater flexibility in its use.

How is laser resurfacing performed?

Skin resurfacing using a carbon dioxide (CO2)laser is the most recently developed of the techniques described in this document. Its effects are similar to those of chemical peels and dermabrasion, except that the laser removes skin layers by vaporization rather than with chemicals or a sanding device. Dr. Stewart is trained in the safe use of laser equipment. He is able to specify the amount of energy transmitted to the skin's surface by the laser beam and control the depth of penetration.

Like the other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for laser resurfacing. Some patients may benefit from the laser's mild "tightening" effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of aging.

Understanding Risks

Every year, many thousands of patients undergo successful skin resurfacing procedures, experience no major problems and are pleased with the results. Anyone considering treatment, however, should be aware of both the benefits and risks.

I understand that every medical procedure has risks, but how will I learn more so that I can make an informed decision?

The subject of risks and potential complications of skin resurfacing is best discussed on a personal basis between you and Dr. Stewart or with a staff member.

Skin resurfacing procedures are generally safe when performed by an experienced plastic surgeon. Dr. Stewart has been in practice for over 18 years. The various resurfacing techniques discussed in this document have similar types of risks, although there are some differences. for example, infection or abnormal healing are infrequent but may occur with any of the treatments. If you are prone to skin disorders including allergic reactions or herpes, skin resurfacing can cause eruptions of these conditions. Even an AHA peel, which is the most superficial of the resurfacing techniques, may occasionally produce temporary minor skin irritation. Tiny whiteheads may develop on the skin following some procedures. These usually disappear with use of a mildly abrasive cleanser, but occasionally may require removal by Dr. Stewart or a staff member in our office.

Some individuals have a tendency to form raised or thickened scars, and this may be unpredictable. Medications are available to treat such complications, but in rare cases some degree of scarring may be permanent. While the bleaching effect of a phenol peel is to be expected, other types of peels, dermabrasion and laser skin resurfacing sometimes may produce unanticipated color changes or skin blotchiness.

Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. This is particularly important if you have had a phenol peel which eliminates your skin's ability to tan. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.

You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions of Dr. Stewart and his staff.