Chemical peels remove the damaged top layers of skin to reveal fresher, younger-looking skin underneath. They’re used to combat wrinkles, hyperpigmentation, acne scars, large pores, and rough or uneven skin texture.Â
“Chemical peels come in different strengths—superficial, medium, and deep—which have an impact on the overall results,” says Dr. Green. For example, glycolic acid and lactic acid peels address only the dead skin cells that dull the top layer of skin (which explains their ability to boost brightness), while TCA and phenol peels go deeper, often into the layer where collagen is produced—which is why they’re good at smoothing lines. For deeper peels, local anesthesia may be given. Then the doctor will apply the solution to your face and let it sit for anywhere from a few seconds (for higher-strength peels) to an hour (for more superficial peels).Â
Post-treatment, your skin may look sunburned and feel sensitive, with some peeling and dryness for a few days. If you have a stronger peel, it may take two or three weeks for redness and peeling to subside. Superficial chemical peels can be performed every two to five weeks—and to make much of an impact, you’ll need a series of treatments. You can repeat medium peels every three to nine months to prolong results, while a deep peel can be done only once.Â
Related: Chemical Peels: Beyond the Basics
RealSelf Tip: Choose your provider carefully. “It is always important to go to an expert in chemical peels," Dr. Green cautions. "Matching the proper type and strength of chemical peel with skin type is essential to get the best cosmetic results and avoid any potential problems, like hypo- or hyperpigmentation or scarring.”Â
Microdermabrasion uses a special applicator with an abrasive surface to buff off dead skin cells, which then get suctioned away. The quick, 20-minute procedure brightens dull skin; evens texture; reduces acne breakouts; and improves the appearance of fine lines and wrinkles, pore size, and hyperpigmentation. No anesthesia is needed, and there’s no significant downtime, though you may experience some swelling, redness, and tenderness for a few hours. You’ll need to repeat the procedure every two to four weeks, to maintain your results.
RealSelf Tip: As this treatment becomes more popular, many people are seeking out at-home microdermabrasion options. According to Dr. Martie Gidon, a Toronto dermatologist, “Even the best at-home microdermabrasion kit will not be as effective as an in-office treatment. You will still have some smoothing of your skin and mild collagen production, but be careful—an aggressive home treatment could cause scarring.”
Microneedling can reverse superficial sun damage, such as fine lines and wrinkles, and can improve skin tone and texture, refine pores, and fade scars and stretch marks.Â
During a microneedling treatment, a handheld device with tiny needles is used to create micro injuries in the skin, which stimulates the body’s natural healing process. “The micro injuries result in cell turnover and increased collagen production,” says Dr. Green. “There are also serums and products that can be used during microneedling to help treat pigmentation, rosacea, and wrinkles.” Numbing cream is applied prior to treatment, to take the edge off, and the downtime isn’t too bad—just some redness, swelling, and sensitivity for three days (tack on another day or two, if you have fair skin). Three to five monthly sessions are often recommended.
Dr. Green recommends Aquagold, “a unique type of microneedling with gold microneedles”—a treatment that’s sometimes called a microinfusion facial. “I am able to microneedle Botox and hyaluronic acid fillers directly into the skin, to rejuvenate the skin with zero downtime,” Dr. Green says.
RealSelf Tip: Microneedling helps skin-care products penetrate more easily. That also means active ingredients like Retin-A and exfoliating acids can be too harsh for the first few days after a treatment. Stick to gentle, hydrating products and be especially vigilant in protecting your skin with sunscreen.
A Vampire Facial is a safe form of platelet-rich plasma (PRP) skin rejuvenation. The procedure involves injecting your face with hyaluronic acid filler and PRP derived from your own blood. The blood is drawn from your arm and spun in a centrifuge to isolate the PRP. After a numbing cream is applied to your face, the PRP is injected into your skin. “The growth factors in the PRP stimulate collagen production and also improve the overall health of the skin,” says Dr. Green. The procedure takes less than an hour, and there’s no real downtime—just some possible bruising around the injection sites that may last for a few days. Your skin will improve over the course of three months as the rejuvenation from the effects of the PRP kick in.Â
RealSelf Tip: Some providers offer PRP injections paired with injectable fillers, a procedure called a Vampire Facelift. PRP alone won’t add volume or lift sagging skin, so before you book a treatment, ask about your doctor’s technique to be sure you’re getting what you want.
Laser skin resurfacing or rejuvenation is a safe procedure that uses microscopic beams of light to heat the skin and treat a variety of skin conditions. Laser treatments have varying levels of intensity, controlled damage, and downtime.Â
- Non-ablative lasers used to treat moderate sun damage leave the surface skin intact and heat just the lower layer. They include Q-switched and picosecond lasers, which are used to remove pigment like brown spots and tattoos.
“Q-switched [lasers] are my preference for treating brown spots,” says Dr. Green. “They target the pigment, typically in one to two treatments, with minimal downtime. The aftercare is also very manageable—only the treated spots will need to be kept coated in Aquaphor or Bacitracin.”
Gentle laser resurfacing treatments, like Clear + Brilliant and Laser Genesis, as well as the stronger Fraxel laser, are also non-ablative. Both Clear + Brilliant and Laser Genesis treatments are used to treat fine lines, wrinkles, and enlarged pores and improve skin tone, while the Fraxel Dual can handle all that plus more serious pigmentation issues.
“Fraxel Dual helps restore your skin to its original, perfect texture and achieves smoother, fresher, younger-looking skin,” says Dr. Green. The Fraxel Dual is actually two lasers in one: the 1927 nm wavelength is a superficial treatment for improving pigmentation, while the 1550 nm wavelength targets skin texture and improves deep lines and acne scars. “The components can be used together or separately, depending on your needs,” adds Dr. Green.
You may be prescribed a numbing cream prior to a non-ablative treatment; strong non-ablative lasers like the Fraxel Dual will definitely require the cream and, possibly, over-the-counter pain medication. Most non-ablative lasers will leave your skin rough and dry for about a day, although the more aggressive non-ablative lasers will make your skin turn bronze and flaky for up to a week—but it’s nothing major.
- Fully ablative lasers remove the entire surface layer of skin and heat the lower layer, to treat more significant sun damage and wrinkles. (CO2 lasers can be fully ablative or fractional.) With a full ablative laser treatment, local anesthesia is injected or topically applied, and downtime is intense. For about a week, your face will be swollen and scabby, so plan to take a week off work so you can hide out at home until the scabs fall off. Your skin will remain pink for two weeks to a month.
“Ablative lasers are very effective for sagging and wrinkles—however, there is significant downtime associated with these treatments,” says Dr. Green. “They’re most commonly performed after surgical procedures, such as face and neck lifts, since they’re quite invasive and can be painful. If a patient is undergoing surgery, I often recommend considering one of these types of treatments but also find non-ablative lasers to be similarly effective when done in a series of treatments.”
- Fractionated lasers, which break laser energy into thousands of tiny beams that target a fraction (20–40%) of the skin at one time, break up a laser’s energy to diminish the trauma to the skin and cut down on the subsequent downtime. A fractionated laser like Fraxel Re:pair will still leave you red and raw, but healing time is typically shorter than with a traditional ablative CO2 laser. Erbium lasers like Sciton ProFractional also fall into this category.Â
Intense pulsed light (IPL) is a light therapy used to treat sun damage, like freckles and age spots, as well as birthmarks, broken blood vessels, rosacea, and varicose veins. It’s also sometimes used for hair removal, or for skin tightening with the broadband light (BBL) handpiece. While it’s similar to laser therapy, IPL has a larger wavelength, which makes it more successful in treating various skin types, and the settings can be narrowed to specifically treat hyperpigmentation. “The technology uses focused light, which penetrates the epidermis, specifically targeting the skin cells that contain excess pigment,” says Dr. Green.Â
IPL also shines as a treatment for rosacea. “IPL is the best treatment for redness due to rosacea,” says Dr. Aurora DeJuliis, a physician in Montclair, New Jersey, in a RealSelf Q&A. During an IPL treatment, the technician moves a handheld device that releases light against your skin.Â
The procedure can be a bit uncomfortable, and many people describe the sensation as being repeatedly snapped with a rubber band. IPL treatments last less than half an hour, “and they cause superficial scabs—which slough off after a few days, resulting in clearer, healthy-looking skin,” says Dr. Green. Most people need more than one treatment (sometimes as many as six), spaced four to six weeks apart.
RealSelf Tip: IPL works best on lighter skin. The melanin (pigment) in skin absorbs more light energy, so dark skin is more likely to burn and potentially scar. Tanned skin, even from self-tanners, can lead to complications, including increased pigmentation.
Radiofrequency (RF) energy
Radiofrequency energy can instantly firm the collagen fibers and tighten the skin as well as progressively boost collagen production. FaceTite is one of the most popular RF treatments. During this in-office, hour-long procedure, the doctor inserts a tiny tube called a cannula into the skin with an electrode that passes over the surface to generate a focused electrical field.Â
Dr. Green considers Thermage the gold standard for noninvasive skin tightening on not just the face, but any area of the body, including the hands and arms, abdomen, knees, and butt. “The result is an immediate collagen contraction from the heat, as well as progressive collagen remodeling over a few months,” says Dr. Green. In other words, Thermage can provide subtle skin firming right away, along with tighter, more toned skin over time. “The latest generation of Thermage, the Thermage FLX, gives even better cosmetic results with deeper penetration and increased skin tightening,” notes Dr. Green.
Fractora RF is another radiofrequency procedure used to improve sagging and create definition. A handheld device is used to create tiny punctures in the skin while shooting heat below the surface to stimulate collagen production.Â
RealSelf Tip: It’s important to have realistic expectations about how much rejuvenation RF treatments can provide. For instance, FaceTite “is really designed for that sweet spot of men and women who aren’t getting results from nonsurgical therapy but are also not ready for a facelift,” says Newport Beach, California, plastic surgeon Dr. Jonathan Zelken in a RealSelf Q&A.
