The rate at which the aging process affects the skin varies from one person to another and is determined by our genes (intrinsic factors) and external (extrinsic) influences from the environment. The intrinsic changes including alteration of skeletal mass, fat compartment deflation, increased laxity of the support ligaments and muscles and reduced contractility of the skin cannot be prevented. On the other hand, preventable environmental influences such as sun exposure, chemicals and smoking are causing premature aging of the skin known as photoaging. The characteristic features of photoaging, including rough texture, fine and coarse wrinkles and leathery appearance with pigmented changes can be successfully addressed with skin resurfacing techniques.

Skin resurfacing procedures remove the skin in a controlled fashion to a specific depth, encouraging the growth of new and improved skin. Depending on the level of injury they are divided into superficial, medium-depth, and deep. Most commonly performed skin resurfacing treatments are chemical peeling, laser resurfacing and dermabrasion. Chemical peels are done with application of caustic solution, dermabrasion utilizes high speed rotary wheel, and laser resurfacing uses a laser beam.

At the initial consultation, it should be determined which of these tools is best for the individual patient, based on the severity and extent of the condition. The recovery time may be an important factor in selecting a particular resurfacing method. A more superficial treatment will require less healing time, but the procedure may have to be repeated more than once to achieve an optimal result. Additional or alternative treatments should be offered so the best one for a particular problem can be chosen. To improve the result, skin resurfacing procedures are often performed together with other surgical procedures for facial rejuvenation.

With skin resurfacing techniques, the following conditions can be addressed: wrinkled or sun-damaged facial skin, pigmentary changes, such as blotchiness or brown spots, certain precancerous skin growths, acne and superficial facial scars from previous injuries. Resurfacing is most often applied to improve the wrinkles and pigmentary changes on the face, neck, cleavage and hands.
Fine wrinkles are best treated by resurfacing methods, deep wrinkles and skin sagging will have to be addressed surgically.  We often combine the procedures to refresh the face structure (face lift) and skin quality (resurfacing) for optimal rejuvenation effect.

A chemical peel solution may be applied to the entire face or just to a certain region. Different types of chemical peels vary according to their specific ingredients and their strength. The depth of their action is also determined by the time they remain on the skin and the method of application. Mild chemicals create most superficial changes, but more irritating chemicals can make profound changes to the skin. As the potential for dramatic changes increases, so does the potential risk of undesirable side effects, such as permanent hypopigmentation and scarring.

One of the most superficial peels are those using alpha hydroxy acids (AHAs) such as glycolic acid. After a single treatment with an AHA peel the skin will have a fresher and healthier appearance, however, repeated treatments may be required to improve skin texture. AHA peels can reduce the effects of aging and sun damage such as fine lines and pigmented changes to some degree. Anesthesia or sedation is not required, and only mild tingling or stinging sensation can be felt when the solution is applied. Immediately after the procedure you can drive yourself home or back to work with makeup applied.

A trichloroacetic acid (TCA) is used in different concentration and applied in different manners to achieve the desired effect. A preparatory period of several weeks is usually recommended. During this time, the skin is treated with hydroquinone cream (to bleach it) and retinol cream (to stimulate skin replacement and surface scaling). TCA peel is often used for the treatment of fine wrinkles, brown spots and skin blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck, hands and other parts of the body that show signs of photoaging. Milder TCA peels can be repeated frequently in order to achieve cumulative effects.

A phenol peel is particularly useful for treatment of fine facial wrinkles and rough sun damaged facial skin. It can also remove pigmentary changes and may be used in the treatment of precancerous skin conditions. Phenol is frequently used for reducing the vertical lines that often form around the mouth as a result of aging. The disadvantage of phenol is that it has a significant bleaching effect compared to other substances. The face swells markedly in 6-12 hours after the procedure. The swelling gradually subsides in 3-4 days. Unlike TCA peels, phenol should not be used on the neck, torso or arms. Buffering the phenol with olive oil to make a milder solution may allow for greater flexibility in its use.

Dermabrasion is performed with rapidly spinning wheel with a roughened surface similar to sandpaper to abrade the skin. Under careful control, layer after layer of skin is removed. If the abrasion is kept superficial and only evens out the acne scars, irregularities or small wrinkles, the skin will heal without scaring. Rhinophyma can be treated with dermabrasion. For dermabrasion, some kind of anesthetic will be necessary. Small areas may require only local anesthetic, but larger areas may benefit from sedation or general anesthesia. Patients who had dermabrasion can go home the same day.

Beam of ablative lasers vaporizes the superficial skin cells and removes damaged skin in a precise manner one layer at a time. There are two kinds of ablative laser resurfacing techniques. Traditional ablative lasers remove the entire epidermis and superficial layer of dermis creating a uniform injury to the skin. Fractional ablative lasers vaporize narrow columns of tissue to a significant depth, inducing not only resurfacing but also volumetric tissue reduction. With fractional resurfacing, the majority of the skin surface is not injured, and the skin tightens by collagen contractions between the tiny laser holes. The benefit of fractional treatment is less injury on the surface and faster healing.

With ablative laser resurfacing, there is better control for the depth of injury than with a chemical peel or dermabrasion. There is also greater accuracy for treatment of isolated lesions of uneven thickness. The procedure can be used on the entire face, specific areas or just for removal of benign skin lesions and pigmentary changes. Depending on the extent of the procedure and area treated anesthesia is chosen. Commonly local anesthetic cream (EMLA) or injections of local anesthetic are adequate. Recovery depends on the depth and area of treatment.

Before the procedure, it is necessary to determine the patient’s skin type along with the problem that the patient wishes to remove. Some skin types are better suited for chemical peels than the others. Depending on the type of procedure a pretreatment program with application of special creams or gels may be recommended. Patients with latent herpes are given preventive medication. No cosmetics should be applied on the day of the treatment.

Immediately after the procedure the treated skin may be covered with protective ointment, Vaseline, dressing or bandage. The skin may feel tight at first, and it may itch a bit. Cold compresses alleviate the irritation. Deeper chemical peels, dermabrasion or laser skin resurfacing will cause redness and swelling to varying degrees. Depending on the type and depth of treatment, a crust may develop which is covered with antibiotic ointment or softening salve. The crust peels of in a week, but the redness or unnatural blush may persist for several weeks or months if treatment is deeper. However, camouflage makeup usually can be used within approximately one week.

To avoid uneven pigmentation, it is advisable that direct or indirect exposure to the sun is avoided until the redness or pinkness has disappeared. It is recommended to protect the skin with a sunblock in the following months. After the resurfacing the skin is more sensitive and has a tendency to dry out more quickly. You might be advised to use special creams for proper long term skin care.

The benefits of deeper treatments are relatively long lasting, but skin continues to age and the wrinkles can reappear. Despite this, improvements in skin quality and texture may last many years. With superficial resurfacing procedures, such as light, chemical peels, there is almost no downtime; however, they need to be repeated regularly in order to maintain the results.

Various resurfacing procedures have similar types of risks. Infection or abnormal healing with scaring are infrequent but may occur with any of the treatments especially deeper ones. Skin resurfacing can cause eruptions of skin disorders such as allergic reactions and herpes. These can be prevented to some degree if the patient is properly prepared for the procedure. Tiny, whitish spots called milia, which are oil cysts may develop. They disappear faster with the use of a mildly abrasive cleanser. Even glycolic acid (AHA) peel, which is the most superficial of the resurfacing techniques, may cause minor skin irritation. Temporary or permanent unanticipated color changes, hypo or hyperpigmentations, can develop especially if sunlight is not avoided after the procedure.