By Cooper Scurry, M.D.
In previous articles published in Forsyth Woman, I have written on the topics of facelifting, nasal surgery and cosmetic injectable products. This article deals with the topic of skin resurfacing. Skin resurfacing is any procedure that removes the outer most layers of the skin in order to improve the health and appearance of that skin. Skin resurfacing is best suited for, and therefore most commonly performed on, the skin of the face. Patient complaints which lead a person to undergo a skin resurfacing procedure include discolorations, scarring, or wrinkles of the facial skin. As mentioned in a previously published ‘facelift article’ (Forsyth Woman, October 2009), there are certain skin conditions of the aging face that cannot be improved by lifting procedures. The vertical wrinkles that surround the mouth simply cannot be improved by any form of lifting surgery. These deep wrinkles can only be improved by a skin resurfacing procedure.
Skin resurfacing procedures come in many shapes and sizes. Chemical peels, dermabrasion and laser procedures are all used to perform skin resurfacing. It does not matter which modality is chosen for skin resurfacing, since results are not determined by the modality, but by the depth of the procedure. To explain, skin resurfacing can be performed superficially, at a medium depth, or as a deep resurfacing procedure. Each of the described modalities, chemical peel, laser, and dermabrasion can be performed at each depth. Chemical peeling for example, can be performed superficially with very little postoperative redness or recovery; however, such a superficial procedure will not achieve a very dramatic change in the skin problem. While the results of a skin resurfacing procedure are ultimately determined by the depth at which they are performed, the depth of a procedure also determines a patient’s down-time and recovery process… the deeper the procedure, the more intense the recovery. Dermabrasion, a modality of skin resurfacing in which layers of skin can be carefully removed in a mechanical fashion using either a ‘wire brush’ or ‘diamond-fraise’ bit, can also be performed at either a superficial, medium, or deep level. Laser procedures are often requested by patients due to their perceived superiority. However, laser technology is actually quite scientifically complicated. Lasers are extremely specific in the types of tasks that they can perform. Lasers and other light therapies can also perform skin resurfacing at all depth levels.
For significantly deep facial wrinkles or deep acne scarring, a deep skin resurfacing procedure must be performed to achieve the most cosmetically pleasing outcome. In most circumstances, the modality chosen is determined by the surgeon’s preference and past experiences. When any deeper resurfacing procedure is performed, the patient can expect and should prepare for a careful and detail oriented recovery process. In the first week, there will be significant shedding and scaling of skin regardless of the modality chosen. After the first week, the patient will be recovering with a certain degree of bright pink skin. This pinkness represents the new skin that is growing forth from beneath. During this time, it is extremely critical that the patient be intensely meticulous about not exposing this new skin to anything that may irritate it. Anything that either ‘smells good or smells bad’ can ‘set off’ the skin in an irritating way. Bright sunlight, wind, salt air, heat, cold, perfumes, deodorants, cleaning supplies, mouth washes, and cosmetics are just a few of the irritants that can dangerously slow the healing process. The healing process is the joint responsibility of the patient and the surgeon. After a skin resurfacing procedure, the surgeon should provide the patient with careful, thorough, and strict instructions on how to care for her face. The patient should be carefully compliant with these instructions. Some post-operative pinkness can linger for up to a month’s time after a deep skin resurfacing procedure. Again, remember: the deeper the problem… the deeper the skin resurfacing procedure… the longer the downtime… the greater the result.
Skin resurfacing procedures are performed by a variety of health care professionals. Naturally, dermatologists are experts in skin medicine and procedures. Plastic surgeons and facial plastic surgeons are also experts in achieving gratifying cosmetic results for a variety of displeasing skin problems. Aestheticians are non-physician providers who, in addition to providing other skin care services and expertise, perform skin resurfacing procedures at relatively superficial depths. While many aestheticians are often quite savvy and genius with these superficial procedures, and can achieve excellent results in certain circumstances, it should not be overlooked that deep problems require deep resurfacing procedures for optimal outcomes.