Skin Resurfacing Guide

What it is: Skin Resurfacing is a cosmetic surgery treatment in which surface layers of skin are removed to allow new, healthier-looking skin to emerge. The three primary methods of Skin Resurfacing are Laser Skin Resurfacing, Chemical Peel and Dermabrasion.

Inside this Guide
1. How is Skin Resurfacing Performed?		7. Recovery
2. Who should consider Skin Resurfacing?		8. Results: What to expect
3. Doctor Consultation: what to ask		9. Side Effects
4. Getting ready for Skin Resurfacing		10. Cost
5. During Skin Resurfacing		11. Terminology to know
6. After Skin Resurfacing

There are three techniques commonly used for Skin Resurfacing:

1. Laser skin resurfacing uses a carbon dioxide (CO2) laser to remove 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.

2. Chemical Peel is a skin resurfacing technique in which a chemical solution is applied to the face to remove the outer surface layers of skin. Chemical Peels come in a range of strengths, from a deeper Phenol Peel to more superficial peels, such as a Glycolic Acid peel. Chemical Peels allow new, healthier skin to emerge.

3. 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.

• 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

Skin Resurfacing 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 skin resurfacing. 

In addition to your surgeon performing a history and physical examination, your doctor consultation is the time to ask questions.

• See the Skin Resurfacing consultation checklist
• Read about the experiences of others who've had Skin Resurfacing. See real Skin Resurfacing reviews.

Additionally, your doctor will evaluate the condition of your skin, discuss your treatment expectations, and review your medical history.

Skin Evaluation: 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.

Medical History: 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 AccutaneT, as well as Retin-AT and other topical skin preparations, must be reported to your surgeon. For your safety, it is important that you provide complete information.

Your plastic surgeon may 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.

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.

First few days: Skin resurfacing will produce redness and swelling to varying degrees. Depending on the post-treatment 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.

Within 7 to 10 days: 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.

Depending on the type and depth of your skin resurfacing, straining, bending and lifting should be avoided during the early period following your procedure. For deeper resurfacing, you should be able to return to work within a week or two.

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. More superficial resurfacing treatments may need to be 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..

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your 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.

• infection
• abnormal healing
• allergic reactions
• if prone to herpes, possible eruption
• raised or thickened scarring
• unanticipated skin 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. 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.

Skin Resurfacing cost can vary widely as reflected in the cost data for each of the Skin Resurfacing techniques (Laser Resurfacing, Chemical Peel, Dermabrasion) posted on RealSelf.com. A doctor's cost for Skin Resurfacing may vary based on his or her experience, the type of procedure used, as well as geographic office location.

 

• Surgeon’s professional fee
• Facility fee
• Anesthesia fee
• Medications
• Surgical garments
• Medical tests

Insurance: 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.

 

• Buffered Phenol: Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another slightly milder formula uses glycerin. Buffered phenol peels may be more comfortable for patients, and the skin heals faster than with a standard phenol peel.
• Chemical Peel: A chemical peel solution is applied to the entire face or to specific areas to peel away the skin's top layers. Several light to medium-depth peels can often achieve similar results to one deeper peel treatment, with less risk and shorter recovery time. Peel solutions may contain alpha hydroxy acids, tricholoracetic acid (TCA) or phenol as the peeling agent, depending on the depth of peel desired and on other patient selection factors.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Laser: Lasers can be effectively used to eliminate surface blood vessels on the face that become reddened and enlarged due to sun exposure. The problem is most often seen in fair-skinned individuals who cannot tan or have difficulty tanning. The use of lasers for skin resurfacing is effective in reducing the effects of sun damage. Laser resurfacing is an alternative to chemical peel for some patients.
  
• Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
• Phenol: The chemical phenol is sometimes used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup.
• TCA: Trichloroacetic acid is used for peeling of the face, neck, hands and other exposed areas of the body. It has less bleaching effect than phenol, and is excellent for "spot" peeling of specific areas. It can be used for deep, medium or light peeling, depending on the concentration and method of application.