When you need more than the resurfacing procedures (such as laser micropeel, microdermabrasion or light chemical peels) performed in our Skincare Center, more aggressive methods of skin rejuvenation are performed by our team. Laser resurfacing, dermabrasion, and chemical peels that involve deep layers of the skin may require general anesthetic or deep sedation. These procedures are sometimes done in an outpatient hospital setting. Less aggressive skin resurfacing can be done in the office with local anesthetic.
All resurfacing treatments work essentially the same way: they remove layers of aging and/or sun-damaged skin. To achieve greater reduction of lines and wrinkles, deeper layers of skin cells must be treated. First, the outer layers of skin are stripped away. Then, as new cells form during the healing process and the production of collagen is stimulated, a smoother, tighter, younger-looking skin surface appears. The resurfaced skin looks rejuvenated, fine lines are diminished, and deeper wrinkles are greatly improved.
Skin resurfacing with deep chemical peels, dermabrasion, and lasers require several weeks of recovery before the "new" skin is established and healed. In general, the more aggressive the resurfacing procedure is, the more prolonged the recovery is likely to be.
The lighter resurfacing procedures done in our office, such as superficial chemical peels or MicroLaserPeels, have the advantage of a shorter recovery time. However, these less aggressive procedures may need to be repeated multiple times to achieve results comparable to those achieved with more aggressive techniques. Because of this, many patients prefer the deeper resurfacing methods, with the longer recovery time, so the process of revealing new, younger-looking skin is accomplished more quickly in one procedure.
Deep resurfacing procedures are often performed at the same time as other facial procedures, including facelift, eyelid lift, or brow lift. Although these are rejuvenating by themselves, they cannot revitalize the quality of the facial skin the way resurfacing does.
With all resurfacing methods, patients with olive, brown, or black skin may be at increased risk for pigmentation changes, such as permanent discoloration or blotchiness. Freckles may disappear in the treated area. Your surgeon will evaluate your skin characteristics and make recommendations based on your coloring.
A chemical peel relies on a chemical solution — either phenol or trichloroacetic acid (TCA) — to smooth the texture of facial skin by removing its damaged outer layers. The precise formula may be adjusted to meet each patient’s needs. A chemical peel works best on fair skin with superficial wrinkles.
Phenol is the strongest of the chemical solutions used for deep peeling to treat coarse facial wrinkles, areas of blotchy or discolored skin caused by sun exposure, and pre-cancerous growths. A phenol peel produces dramatic improvement in the surface of the skin, with fewer lines and wrinkles and more even skin tone. Since phenol sometimes lightens the treated areas, your natural skin pigmentation may be a determining factor as to whether a phenol peel is appropriate for you. A full-face phenol peel generally takes 1 or 2 hours.
With a phenol peel, the new skin frequently loses its ability to make pigment (will not tan). Not only will the skin be lighter in color, but it always has to be protected from the sun. Phenol may pose a special risk for patients with a history of heart disease so tell your surgeon if you have a history of heart problems. In such cases, the deep phenol peel will be done in the operating room so cardiac function can be carefully monitored.
Trichloroacetic acid (TCA) is most commonly used for medium-depth peeling to treat fine surface wrinkles, superficial blemishes, and pigmentation problems. The results of a TCA peel are usually less dramatic than those of a phenol peel, but the recovery time is shorter. More than one TCA peel may be needed to achieve the desired result. A full-face TCA peel usually takes about 15 minutes and may be done in the office.
With a TCA peel, your healed skin will be able to produce pigment as always because the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.
What To Expect After A Chemical Peel
Because a chemical peel removes layers of skin, tingling or throbbing of the face is common. With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about 7 to 10 days, your new skin will be apparent and you should be healed sufficiently to return to normal activities. It is best to avoid sun exposure unless you are adequately protected.
More significant swelling should be expected with a phenol peel, and the eyes may even be swollen shut temporarily. New skin will begin to form in about 7 to 10 days. Although the face is very red at first, it gradually fades to a pinkish color over the following weeks. During this time, use of a sunblock is especially important to prevent blotchy, irregular skin coloring. About 2 weeks after treatment, your skin will be healed enough for you to wear makeup and you may return to work and resume some of your normal activities.
Dermabrasion involves a mechanical scraping of the top layers of skin using a high-speed rotary wheel to "refinish" the skin surface. The scraping continues until the surgeon reaches the safest level that will make skin flaws less visible. Dermabrasion is most often performed to improve the look of facial skin left scarred by accidents, acne or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It can also remove pre-cancerous growths called keratoses. Small areas of skin or the entire face may be treated. Dermabrasion can be done alone or in conjunction with other procedures such as a facelift or scar revision.
Dermabrasion usually takes from a few minutes to 1 1/2 hours, depending on how large an area of skin is treated. It’s not uncommon for the procedure to be performed more than once, in stages, especially when scarring is deep or a large area of skin is involved.
What To Expect After Dermabrasion
Right after a full-face, deep dermabrasion, your skin will be quite red and swollen, and eating and talking may be difficult. You’ll probably feel some tingling, burning, or aching, but this can be controlled with medications prescribed by your surgeon. The swelling will begin to subside within 2 to 7 days.
As with all skin scrapes, a scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery and regularly for several days, little or no scab will form.
Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can gradually begin resuming normal activities. Return to work takes about 2 weeks. The pinkness of your skin will take about 3 months to fade completely, but this can be minimized with makeup. Sun protection is very important until the pigment has completely returned to your skin, which may take as long as 6 to 12 months.
In laser resurfacing, sometimes called "laser peel," an erbium laser is used to remove areas of damaged or wrinkled skin, layer by layer. The beam of laser energy that vaporizes the upper layers of skin is precisely controlled so it penetrates to targeted areas and skin layers. The laser is carefully passed back and forth over the skin until the level to be treated is reached. For superficial or medium resurfacing, the laser can be limited to those skin layers called the epidermis and papillary dermis. For deeper resurfacing, the upper levels of the reticular dermis can also be removed. Varied penetration allows treatment of specific spots or wrinkles.
The procedure is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes, but it also minimizes facial scars and unevenly pigmented areas. Laser resurfacing may be performed on the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery.
Laser resurfacing may take anywhere from a few minutes to 1 1/2 hours, depending on how large an area is resurfaced. When skin imperfections are especially deep, your surgeon may recommend that the resurfacing be performed in two or more stages.
What To Expect After Laser Resurfacing
You are likely to experience some mild swelling and discomfort after laser resurfacing, but this can be controlled with ice packs and medications prescribed by your surgeon. The treated skin sometimes develops a scab or crust as it heals, and any crusty areas, which will itch, must be left alone or scarring may result. This crusting can usually be minimized or prevented by application of an ointment immediately after surgery and several times a day.
Your new skin usually remains bright pink to red in the weeks following a deep laser resurfacing. After about 2 weeks or so, most patients can safely apply makeup to conceal this temporary color change. However, some pinkness may remain for up to 6 months. Protection from the sun is essential until your skin color has returned to normal.
The final result from laser resurfacing may take several months to fully appear. However, once the pinkness fades, patients usually notice a significant improvement in the quality of their skin and a fresher, smoother appearance.
Length Of Surgery
Chemical Peel: 1 to 2 hours for full face.
Dermabrasion: A few minutes to 1 1/2 hours. May require more than 1 session.
Laser Resurfacing: A few minutes to 1 1/2 hours. May require more than 1 session.
Local with sedation or general, depending on the size and depth of area treated.
Usually outpatient in hospital or in office, depending on aggressiveness of the resurfacing.
Chemical Peel: Temporary throbbing, tingling, swelling, redness; acute sensitivity to sun. Phenol: Permanent lightening of treated skin; permanent loss of ability to tan.
Dermabrasion: Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan).
Laser Resurfacing: Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months.
Chemical Peel: Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores. Phenol: Abnormal color changes (permanent); heart irregularities (rare).
Dermabrasion: Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores.
Laser Resurfacing: Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare).
Chemical Peel: Phenol: Formation of new skin: 7 to 21 days. Normal activities: 2 to 4 weeks. Full healing and fading of redness: 3 to 6 months. TCA: New skin within 5 to 10 days.
Dermabrasion: Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months. Return of pigmentation/light sun exposure: 6 to 12 months.
Laser Resurfacing: Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12 months.
Duration of Results
TCA peels are temporary. All other deep facial resurfacing procedures, including phenol peels, are long-lasting, although new wrinkles and expression lines may form as skin continues to age.