Dr. Edward Buckingham: The skin undergoes many changes related to aging that manifest themselves as pigmentation alterations, wrinkles, loss of elasticity, vascular changes, et cetera. There's modalities that are available to target many of the changes related to aging and skin, and those revolve around different surgical and non-surgical modalities, but also skin care.

Unlike some of our gravitational procedures, such as a face lift or volume replacement, that can last for years and years, skin is something that is affected by ongoing sun damage and aging more than anything else. So, the treatments that you use have to be coupled with ongoing skin care to maximize the results.

So, when somebody comes in to talk to me about skin, the first thing we talk about is skin care. There are several good skin care lines out there, but the one that we prefer is referred to as PCA Skin. I'm not going to go into a whole lot of detail about what is in PCA Skin Care, because that really encompasses another video that we're going to do on a different occasion, but say it that we would have you get into a cleanser, something like a retinol, which helps with dermal thickening and epidermal turnover, possibly something for pigment, eye creams, et cetera, that will really help to boost the skin and get it in good shape for a procedure, and then maintain the skin after that procedure.

So, deciding on what we're going to do for skin care very much depends upon what sort of down time or what sort of other procedures the patient may be doing. Sometimes, all they need is to just change their skin care, and with a little patience, they'll see enough improvement in their skin that the patient will be happy with that. But if that's not the case, then we talk about other things that can be done to do that. I typically talk about those in escalating scale of invasiveness and recovery.

So, for the person who's looking for the least invasive procedure, least amount of downtime, but is patient for results, we talk about just doing some light chemical peels, again, through the PCA Skin Care line. These are peels that my nurse will do in the office and typically have about one and a half to two days of some redness and light peeling, depending upon the intensity of the peel. There's many peels that can be done that can be targeted towards different skin conditions. Again, that is something that can use a little more detail in another video.

Beyond doing the PCA Skin Care peels, we move into things like Fraxel Laser and resurfacing. The Fraxel Laser is an erbium laser, which is a wavelength that's targeted at water, but it's fractionated. So, unlike older erbium lasers that remove the entire outer layer of the skin in one pass, a fractionated laser delivers micro spots of erbium lasers that leave untreated skin in between.

It's a procedure that takes place in the office. We put an ointment on the face that numbs the skin for about an hour, sometimes supplemented with some narcotic pain medication for those individuals who need that. Then, the procedure takes about 30 minutes. The recovery time from that is about five days in total, but in females, they can wear makeup right away and need to wear sunscreen right away. So, that can decrease the recovery. So, really you're looking at about two days of facial swelling and an additional three days of some facial redness and some roughness to the skin, that again can be covered up with makeup.

This is a series of treatments that are done at four to six week intervals. Depending on the skin condition, we'll typically do four to six treatments, and then perhaps supplement those maybe once every six months with an additional treatment, just to upkeep the skin. So, that's the next level beyond just doing some light chemical peels.

Beyond that, we move into surgeons' strength peels. For that, I use a solution of Jessner's and 35% trichloroacetic acid. Now, this is the type of peel that needs to be done under anesthesia. So, typically we're doing these peels in conjunction with facelifting procedures, [inaudible:00:04:04] plasties [SP], fat transfers, things that require an I.V. sedation. It's not common for people to choose to do a deep chemical peel as a standalone procedure. However, on occasion, some people will choose to do that.

This is a real surgical procedure, even though there's no cutting involved, in that again it requires an anesthetic, and it requires a real 10 days of downtime. During that 10 days, you're cleansing your face with a Cetaphil cleanser and applying Aquaphor ointment 24 hours a day to your skin. It's referred to as a peel because initially the solution is just applied to the face, which penetrates to a certain depth and gets rid of the outer damaged skin, the skin that has the most damage from being exposed to the sun, and down into the upper layers of the dermis.


Surgical and Non Surgical Skin Care for Aging

Dr. Edward Buckingham discusses the surgical and non surgical modalities used to target aging and skin care.