Chemical peels, dermabrasion and laser skin resurfacing all achieve results in basically the same way. Layers of your skin are removed and, as the healing process progresses, a new, healthier-looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin's layers are removed. Chemical peels involve the application of a caustic solution, dermabrasion utilizes high- speed rotary wheel, and laser resurfacing uses a laser beam.
A chemical peel solution may be applied to your entire face or just to certain regions, such as the crow's feet area around your eyes or the vertical wrinkles around your mouth. Your plastic surgeon will apply the solution using a sponge, a cotton pad or sometimes, for smaller areas, a cotton swab or brush. Your surgeon decides how long to leave the solution on your face by carefully observing any changes in the appearance of your skin. With certain types of chemical peels, the solution may be "neutralized" after an appropriate amount of time has elapsed.
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.
AlphaHydroxy Acids (AHAs): Glycolic Acid is the most superficial peel, up to 30%. Sometimes just a single treatment with an AHA peel will give your skin a fresher, healthier appearance and 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. Your surgeon will recommend a maintenance program using AHA products that you apply at home on a regular basis.
An AHA peel is performed in your plastic surgeon's office. 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.
BetaHydroxy Acids (BHAs): Salicylic Acid, the most popular BHA, works mainly as an exfoliant. It causes cells of the epidermis to become "unglued," allowing the dead skin cells to slough off, making room for new skin growth. Salicylic Acid is reported to improve wrinkling, roughness and mottled pigmentation of photo damaged skin.
A salicylic acid solution can work in a way that is similar to a glycolic acid peel, but irritation may be reduced. A deep BHA peel can be superior for many skin types because the irritation and inflammation are kept to a minimum due to the analgesic action of the BHA compound. Salicylic acid is also lipid soluble; therefore, it is a good peeling agent for blemish-prone skin with blackheads. The most common concentrations used today are 20% to 30%.
Phenol peels: These peels are 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 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.
How is laser resurfacing performed?
Skin resurfacing using a carbon dioxide (CO2) laser is the most recently developed of the techniques described in this brochure. 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. Your plastic surgeon is trained in the safe use of laser equipment. He or she 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. Patients with a variety complexions, including some darker-skinned individuals, may be treated with the laser. 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 Skin Treatment Risks
Every year, may thousands of patients undergo successful skin treatment 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 your plastic surgeon, or with a staff member in your surgeon's office.
Skin resurfacing procedures are generally safe when performed by an experienced board-certified plastic surgeon. The various resurfacing techniques discussed in this brochure 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 skin 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 your surgeon or a staff member in your surgeon's 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 treatment by following the instructions of your plastic surgeon.
Your Laser Skin Resurfacing Treatment
How should I prepare for skin resurfacing?
Prior to a deeper chemical peel, laser resurfacing, or less often, dermabrasion, your plastic surgeon will place you on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment. Your surgeon will provide you with additional instructions.
Your skin resurfacing treatment may be performed in your plastic surgeon's office, a free-standing ambulatory facility or a hospital. You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.
What will happen immediately before and after the treatment?
Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with intravenous sedation is used for patients undergoing skin resurfacing procedures. Sometimes, general anesthesia may be desired.
When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.
How will I look and feel initially?
Deeper chemical peels, dermabrasion or laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the post-treatment regimen selected by your plastic surgeon, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while. It is essential that you follow your plastic surgeon's instructions and avoid doing anything that might interrupt the healing process.
About seven to ten days after your skin resurfacing procedure, a new skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but your plastic surgeon will advise you.
When can I resume my normal activities?
Straining, bending and lifting should be avoided during the early period following your skin resurfacing procedure. Generally, you should be able to return to work within a week or two. Exercise or other strenuous activities may need to be delayed a few weeks longer.
Results of Laser Skin Resurfacing
Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. Superficial resurfacing procedures, such as light chemical peels, will need to repeated periodically in order to maintain their benefits.
Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come.
Maintaining a Relationship with Your Plastic Surgeon
You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Your surgeon will encourage you to schedule routine skin evaluations at the frequency recommended for your age group.
Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.
“My skin was glowing for days after my first chemical peel!"
- E.D., Des Plaines, IL
"I had been using AHAs and scrubs for years, but after a series of chemical peels, I looked like a younger woman."
- M.M., Libertyville, IL
"These peels gave me the confidence I lost as I started aging."
- S.D., Northbrook, IL
"The aestheticians and nurses cared so much and made everything such a wonderful experience."
- A.K., Winnetka, IL