Skin Resurfacing

Skin Resurfacing removes the superficial layer of skin and allows the deeper layer of skin cells to regenerate a fresh sheet of skin. The new skin will have fewer wrinkles, better texture, color, and feel. There are three techniques for skin resurfacing: laser resurfacing, chemical peels and dermabrasion. All improve the fine wrinkles of aging skin as well as improve many pre-existing facial scars.

The process is similar to a controlled sun burn where new skin is regenerated over the course of several weeks. The different techniques utilize unique technologies for removing the outer layer of damaged skin.

Laser resurfacing uses laser energy to emit an infrared light that vaporizes the top layer of skin. The laser is used with great precision and is effective in treating small wrinkles caused by sun exposure.

Chemical Peels use a variety of solutions to create a peel of varying depth. The superficial peels not only rejuvenate skin texture but allow rapid recovery. Deeper peels are aimed at removing facial wrinkles, but are associated with some redness and longer recovery.

Dermabrasion uses a mechanical burr to abrade off the top layer of skin and is most often used for scars or discrete facial lesions that require a limited area of resurfacing. The abraded area regenerates new skin in a similar fashion to laser resurfacing and chemical peels.

Understanding the Procedure

Laser resurfacing is done in the operating room. Most people receive some IV sedation and local anesthesia. Several moist towels are placed around the neck and facial areas during this procedure. As the laser is applied to the skin, a small burning sensation may be felt.

Figure 1: Chemical Peel IllustrationChemical peels are performed in a minor procedure room in the office. For deeper peels, many people elect for some sedation. Vigorous hydration is essential with deeper peels. As the chemical is applied, a small stinging sensation may occur which rapidly dissipates. Several hours after the peel, a sunburn sensation may reoccur and last for a few hours.

Dermabrasion is done in a minor procedure room in the office. The affected areas can be thoroughly anesthetized with creams and small injections. The dermabrader is a hand-held instrument that makes a humming noise. One often feels some pressure, although sharp discomfort is not felt.

What to Expect After Surgery

Regardless of the method of resurfacing, the postoperative care is critical and continued moisturization remains essential. Excessive crusting and scabbing can lead to complications with scar formation. It is usually recommended that your face be lightly cleansed with mild soap followed by the application of a thick moisturizing ointment such as Vaseline. This should be performed 4-6 times a day during the first several days. Like a sunburn, the facial skin becomes pink and inflamed. On occasion, small areas of skin will peel and it is recommended that these areas be left alone; one should avoid picking at them. The redness can last for as much as four weeks following the procedure. In this respect, the postoperative recovery from a facial resurfacing procedure is often more lengthy than many surgical procedures.

Frequently Asked Questions?

What kind of complications can occur?
Prolonged pigment changes including dark and/or light spots can occur. There are a variety of creams that can assist with these areas. Individuals with a darker complexion are at greater risk for developing hyperpigmented spots that appear darker than the surrounding skin. Scar formation is also a possibility, particularly if the wounds become dried or infected. Unusual scarring can be managed conservatively – after many months, the affected areas will slowly soften and fade. Alert your surgeon if you have a history of cold sores or herpetic lesions around the lips as an outbreak can lead to scars.

Which types of wrinkles are best treated with resurfacing?
Very shallow and smaller wrinkles that are within the skin are best treated with a resurfacing procedure. Deeper wrinkles and folds of skin are uniformly poorly managed with these techniques and surgical excision of skin is often warranted.

Does smoking makes a difference?
Anything that impairs the blood supply to the skin during the healing phase can have a dramatic impact on the rate of healing and final outcome. The nicotine in cigarettes causes the small blood vessels to constrict and will greatly impair the ability of your skin to regenerate. One should absolutely NOT smoke during the recovery phase of a resurfacing procedure.

Are there other issues that can put me at greater risk?
In addition to smoking, other risk factors include the recent use of Accutaneâ„¢ (commonly prescribed for acne) or any history of herpetic lesion or cold sores. Accutane will often delay the rate of healing and increase the risk of excessive scarring. Cold sores can be reactivated during a resurfacing procedure and are predisposed to scarring.

Testimoinals

“Everything was perfect, more than perfect! I have seen many other people who have had the same procedure and they look at me and say that I still look totally natural … Everyone at UVA, all the doctors, assistants and nurses in Dr. Park’s office are so wonderful…”