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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.
Am
I a good candidate for skin resurfacing?
| 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 your surgeon may have
a preference based on his or her 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
will my plastic surgeon evaluate me for skin resurfacing?
Your plastic surgeon will carefully examine your skin to determine
which resurfacing technique, or combination of treatments, will
provide you with the best results. Your skin type, the severity
of any sun damage, the extent of uneven pigmentation and the
depth of skin imperfections will be evaluated. Fine lines, coarse
wrinkling or deep acne scarring each may require a different
approach to treatment.
You should come to the consultation prepared to discuss your
medical history. This will include information about any medical
conditions, drug allergies, medical treatments you have received,
previous surgeries, and medications that you currently take.
Be sure to tell your plastic surgeon if you have ever had x-ray
treatments of your facial skin such as those used in the treatment
of acne or if you have had a prior chemical peeling procedure.
Current or past use of Accutane™, as well as Retin-A™
and other topical skin preparations, must be reported to your
surgeon. For your safety, it is important that you provide complete
information.
Will
my insurance help cover the cost of skin resurfacing?
Skin Resurfacing Techniques
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.
Will my insurance
help cover the cost of skin resurfacing?
Skin resurfacing procedures usually are not covered by insurance.
Occasionally, however, if the resurfacing is being performed
to treat precancerous skin conditions or improve certain types
of scars, insurance coverage may be available. Your plastic
surgeon or a member of the staff will explain how you can find
out from your insurance company if a particular procedure will
be covered.
How
is a chemical peel performed?
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.
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. Your surgeon will recommend a maintenance
program using AHA products that you can 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.
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 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. 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.
I
understand that every medical procedure has risks, but how will
I learn more so that I can make an informed decision?
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.
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 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 resurfacing treatment by following the instructions
of your plastic surgeon.
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 posttreatment 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?
Results
of 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.
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.
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
mammographic 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.
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Content provided by The
American Society for Aesthetic Plastic Surgery (ASAPS).
For advertising info, please contact Terry McGovern terry.mcgovern@latimes.com at (213) 473-2599
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