Skin Resurfacing

Photo Rejuvenating

New anti-aging treatments make it easier to turn back the clock

As we age, our skin undergoes a number of changes affecting its texture, volume, and appearance. Fortunately, dermatologists can use fillers or lasers to correct the most notable signs of aging and can recommend skin care products with added ingredients that can further repair damaged skin.

“Many fillers for the aging face are now designed to create a fuller, more youthful appearance, instead of targeting only wrinkles or fine lines. In addition, facial rejuvenation with lasers is now more targeted, resulting in quicker results and less downtime. Couple these treatments with the wide range of inexpensive skin care products with high-quality ingredients that are now available and patients can see dramatic results for many problem areas.”

New fillers pump up the volume

While skin fillers and botulinum toxin are the most widely used procedures to rejuvenate the skin, Dr. Kim explained that the newest fillers being introduced will work as volumizers to replace the plumpness of the face that is lost with aging. Similar to how a balloon deflates over time, the face loses its roundness or fullness – the sign of a youthful appearance – with age.

“As much as lines and wrinkles make us look older, we’re learning that volume loss is just as critical. “Because of that, we’re looking at the aging process a little differently now and understanding the importance of replacing volume loss in the face to restore the fullness of a more youthful appearance.”

Most facial volume loss occurs after age 40, although some people start noticing this change in their late 30s. When this happens, areas of the face that were once full get depressed and are made more prominent by shadowing or darkening – making the face look older.

The newest filler introduced and approved by the Food and Drug Administration (FDA) for facial rejuvenation is calcium hydroxylapatite. This filler restores facial volume and promotes collagen production, lasting for up to a year in most cases. This calcium hydroxylapatite filler is thicker than the hyaluronic acid fillers currently available, requiring less product to be used. However, the thickness of calcium hydroxylapatite also is associated with slightly higher adverse effects than hyaluronic acid fillers.

Lasers focus in on skin repair

New laser technologies offer another alternative to rejuvenate the skin with fewer side effects than earlier lasers. For example, fractional photothermolysis is a newer technology that works by targeting a very small percentage of the skin during each treatment, improving the damaged area and resulting in less adverse effects and downtime for the patient. Even pulsed-dye lasers, which have been around for a long time, have evolved so a dermatologist can treat visible broken blood vessels without bruising the skin by adjusting the laser to the patient’s skin.

“Laser technology continues to evolve and provide dermatologists with more options to target not only specific signs of aging, but specific cells responsible for age-related changes in our appearance, “In the future, lasers could even produce significant skin tightening or effectively target oil glands to improve acne, decrease oily skin and reduce large pores.”

Sun Damage Causes Pigmentation Problems in Light-Skinned Individuals

The main cause of dark spots in light-skinned individuals is sun damage. Years of sun exposure can result in spotted hyperpigmentation, a condition marked by increased pigment production that results in patchy skin color or a blotchy complexion. The extent of sun damage depends largely on a person’s skin color and his or her history of long-term or intense sun exposure. To treat pigmentation problems due to sun damage in lighter-skinned individuals.

Dark spots from early sun damage occurring in light-skinned individuals tend to be more superficial, affecting only the top layer of skin. Dermatologists commonly recommend topical hydroquinone or retinol (an over-the-counter form of vitamin A) as the treatment of choice.

  • When topical therapy fails, superficial chemical peels containing salicylic acid and glycolic acid may be used in combination with topical therapies to enhance results and improve the skin’s appearance.
  • Intense Pulsed Light (IPL) devices and Q-switched lasers also may be used alone or in combination with topical therapies to selectively target dark spots. Lasers and IPL devices should only be used by or under the direct supervision of a physician.
  • Daily sun protection with a sunscreen that provides broad-spectrum protection from UVA and UVB rays and has a Sun Protection Factor (SPF) of 30 or greater is essential in preventing further sun damage and resulting dark spots.

Dark-Skinned Individuals more Prone to Hard-to-Treat Pigmentation Problems

Two of the most common pigmentation problems that occur in people with darker skin tones are melasma and post-inflammatory hyperpigmentation. Melasma is a patchy brown discoloration that occurs on sun-exposed areas of the face and is commonly referred to as “the mask of pregnancy” because it often occurs during pregnancy. Those with light skin can develop melasma, but the condition is more common in dark skin. Because a deeper skin layer (the dermis) may be affected, melasma can be difficult to treat and requires a multifaceted treatment regimen.

Post-inflammatory hyperpigmentation (PIH) is a condition in which an injury or inflammation to the skin causes increased pigment production. PIH occurs in darker-skinned individuals and, like melasma, can be difficult to treat when it involves a deeper skin layer. The most common cause of PIH is acne, but it also can result from psoriasis, a burn, or an injury.

It is important to address the underlying cause of the pigmentation problem. For example, to treat PIH due to acne, treat both problems simultaneously with topical retinoids, a group of medications derived from vitamin A.

People with melasma or post-inflammatory hyperpigmentation can benefit from the following therapies:

  • A combination of over-the-counter topical products containing active ingredients such as soy or niacinimide have been found to help brighten the skin and can be used daily.
  • For melasma, hydroquinone therapy is used as a mainstay treatment.
  • Darker-skinned patients resistant to over-the-counter therapies may be good candidates for microdermabrasion or chemical peels in addition to topical therapy.
  • Combination chemical peels, which contain higher concentrations of active ingredients than those used for lighter-skin tones, allow the active ingredients to reach the deeper, affected pigment. Some of the active ingredients currently used for darker-skinned individuals include salicylic acid, lactic acid, resorcinol, kojic acid, mandelic acid, and tretinoin.
  • Non-ablative fractionated lasers and very low-level Q-switched Nd:YAG lasers can be used in difficult to treat or resistant cases.
  • Daily use of a broad-spectrum sunscreen with an SPF 30 or greater is highly recommended to prevent further darkening of the skin.

Skin Resurfacing


Skin resurfacing procedures may be performed for cosmetic reasons, such as diminishing the appearance of wrinkles around the mouth or eyes. They may also be used as a medical treatment, such as removing large numbers of certainprecancerous lesions called actinic keratoses. Physicians sometimes combine techniques, using dermabrasion or laserresurfacing on some areas of the face, while performing a chemical peel on other areas.


As the popularity of skin resurfacing techniques has increased, many unqualified or inexperienced providers have enteredthe field. Patients should choose their provider with the same degree of care they take for any other medical procedure.Complications of skin resurfacing techniques can be serious, including severe infection and scarring.

Patients with active herpesvirus infections are not good candidates for resurfacing procedures. Persons who tend to scareasily may also experience poor results. Patients who have recently used the oral acne medication isotretinoin (Accutane) may be at higher risk of scarring following skin resurfacing.


Chemical peel

Chemical peels employ a variety of caustic chemicals to selectively destroy several layers of skin. The peeling solutionsare "painted on," area-by-area, to ensure that the entire face is treated. After the skin heals, discoloration, wrinkles, andother surface irregularities are often eliminated. Chemical peels are divided into three types: superficial, medium-depth, and deep. The type of peel depends on thestrength of the chemical used, and on how deeply it penetrates. Superficial peels are used for fine wrinkles, sun damage,acne, and rosacea. The medium-depth peel is used for more obvious wrinkles and sun damage, as well as forprecancerous lesions like actinic keratoses. Deep peels are used for the most severe wrinkling and sun damage.


Dermabrasion uses an abrasive tool to selectively remove layers of skin. Some physicians use a handheld motorized toolwith a small wire brush or diamond-impregnated grinding wheel at the end. Other physicians prefer to abrade the skin byhand with an abrasive pad or other instrument. Acne scarring is one of the prime uses for dermabrasion. It also can beused to treat wrinkling, remove surgical scars, and obliterate tattoos.

Laser resurfacing

Laser resurfacing is the most recently developed technique for skin resurfacing. Specially designed, pulsed CO2 laserscan vaporize skin layer-by-layer, causing minimal damage to other skin tissue. Special scanning devices move the laserlight across the skin in predetermined patterns, ensuring proper exposure. Wrinkling around the eyes, mouth, and cheeksare the primary uses for laser resurfacing. Smile lines or those associated with other facial muscles tend to reappear afterlaser resurfacing. Laser resurfacing appears to achieve its best results as a spot treatment; patients expecting completeelimination of their wrinkles will not be satisfied.


Chemical peel

Preparation for the chemical peel begins several weeks before the actual procedure. To promote turnover of skin cells, patients use a mild glycolic acid lotion or cream in the morning, and the acne cream tretinoin in the evening. They alsouse hydroquinone cream, a bleaching product that helps prevent later discoloration. To prevent reappearance of a herpessimplex virus infection, antiviral medicine is started a few days before the procedure and continues until the skin hashealed. Patients arrive for the procedure wearing no makeup. The physician "degreases" the patient's face using alcohol oranother cleanser. Some degree of pain accompanies all types of peels. For a superficial peel, use of a hand held fan tocool the face during the procedure is often sufficient. For medium-depth peels, the patient may take a sedative or aspirin.During the procedure, cold compresses and a handheld fan can also reduce pain. Deep peels can be extremely painful.Some physicians prefer general anesthesia, but local anesthetics combined with intravenous sedatives are frequentlysufficient to control pain.


Dermabrasion does not require much preparation. It is usually performed under local anesthesia, although somephysicians use intravenous sedation or general anesthesia. The physician begins by marking the areas to be treated andthen chilling them with ice packs. In order to stiffen the skin, a spray refrigerant is applied to the area, which also helpscontrol pain. Some physicians prefer to inject the area with a solution of saline and local anesthetic, which also leaves theskin's surface more solid. Since dermabrasion can cause quite a bit of bleeding, physicians and their assistants will weargloves, gowns, and masks to protect themselves from possible blood-transmitted infection.

Laser resurfacing

Antiviral medications should be started several days before the procedure. Laser resurfacing is performed under localanesthesia. An oral sedative may also be taken. The patient's eyes must be shielded, and the area surrounding the faceshould be shielded with wet drapes or crumpled foil to catch stray beams of laser light. The physician will mark the areasto be treated before beginning the procedure.


Chemical peel

Within a day or so following a superficial peel, the skin will turn faint pink or brown. Over the next few days, dead skin willpeel away. Patients will be instructed to wash their skin frequently with a mild cleanser and cool water, then apply anointment to the skin to keep it moist. After a medium-depth peel, the skin turns deep red or brown, and crusts may form.Care is similar to that following a superficial peel. Redness may persist for a week or more. Deep-peeled skin will turnbrown and crusty. There may also be swelling and some oozing of fluid. Frequent washing and ointments are favoredover dressings. The skin typically heals in about two weeks, but redness may persist.


Following the procedure, an ointment may be applied, and the wound will be covered with a dressing and mask. Patientswith a history of herpesvirus infections will begin taking an antiviral medication to prevent a recurrence. After 24 hours, thedressing is removed, and ointment is reapplied to keep the wound moist. Patients are encouraged to wash their face withplain water and reapply ointment every few hours. This relieves itching and pain and helps remove oozing fluid and othermatter. Patients may require a pain medication. A steroid medication may be taken during the first few days to reduceswelling. The skin will take a week or more to heal, but may remain very red.

Laser resurfacing

The skin should be kept moist following laser resurfacing. This promotes more rapid healing and reduces the risk ofinfection. Some physicians favor application of ointments only to the skin; others prefer the use of dressings. In eithercase, care of the skin is similar to that given following a chemical peel. The face is washed with plain water to removeooze, and an ointment is reapplied. Healing will take approximately two weeks. Pain medications and a steroid to reduceswelling may also be taken.


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