Skin Resurfacing: Which Method is Right for You?

NEW YORK, NY (Oct. 5, 1999) — For several decades, in the world of skin resurfacing the phenol peel reigned supreme. Although this procedure represented the gold standard for almost 30 years, and still may be appropriate for some patients, it has been largely replaced by other treatments. "Creams and lotions, glycolic acid, trichloroacetic acid (TCA), and lasers all have useful roles in treating patients with aging, sun-damaged or acne-damaged skin," says board-certified plastic surgeon Tracy Baker, MD, of Miami, Fla., in an article appearing in the current issue of Aesthetic Surgery Journal, an official publication of the American Society for Aesthetic Plastic Surgery (ASAPS).

Mild damage resulting from acne may be treated with a regimen of retinoic acid (Retin-A®) and the bleaching agent hydroquinone. Other types of skin damage can be divided into two general groups. Dyschromias, or discolorations of the skin, are relatively superficial and are commonly a result of sun exposure in combination with pregnancy, oral contraceptives, or aging. Wrinkles, or rhytids, result from the loss of collagen and elastin. "Although facial wrinkles are frequently associated with dyschromias, they have their origins in the deeper layers of the skin," says Dr. Baker. "That's why effective methods of treatment for rhytids must penetrate sufficiently to produce significant architectural changes within the deep dermal layer."

Mild dyschromias can be treated with glycolic acid, which is often applied during several visits by a medically-supervised aesthetician in the plastic surgeon's office. Patients for whom this treatment is appropriate are usually younger individuals with relatively mild skin damage. There is virtually no down- time following the procedure, a real advantage for people with active lifestyles.

More pronounced dyschromias may be treated with a medium-depth peeling solution containing TCA. TCA corrects most problems related to irregular pigmentation and keratin buildup. The initial healing process following a TCA peel usually requires five to ten days, although some degree of redness may persist for several weeks or longer. Facial wrinkles can be effectively treated with laser resurfacing, which is performed in an operating room with anesthesia. Carbon dioxide and Erbium lasers are able to penetrate deeply into the dermis, eliminating surface irregularities and stimulating new collagen growth in the deeper layers of the skin. Redness may persist for several months or longer following treatment. As for laser treatments of the future, studies are already underway to evaluate a new laser technology that bypasses the top layer of the skin while still reaching the deeper layers below, resulting in new collagen formation without redness.

While skin resurfacing achieves excellent long-term reduction of the static lines of aging, dynamic lines under active facial muscles, such as frown lines and crow's feet, will return to varying degrees. And if significant tightening of the skin and underlying structures is needed, there's no substitute for a facelift.

"Choosing between the options of chemical and laser resurfacing requires the plastic surgeon to have specific knowledge about the many variables associated with skin damage and to apply this knowledge appropriately, on a case-by-case basis, to achieve the best results," says Dr. Baker.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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