Skin resurfacing employs a variety of techniques to change the surface texture and appearance of the skin. Common skin resurfacing techniques include chemical peels, dermabrasion, and laser resurfacing.
Skin resurfacing procedures may be performed for cosmetic reasons, such as diminishing the appearance of wrinkles around the mouth or eyes. They may also be used as a medical treatment, such as removing large numbers of certain precancerous lesions called actinic keratoses. Physicians sometimes combine techniques, using dermabrasion or laser resurfacing on some areas of the face, while performing a chemical peel on other areas.
As the popularity of skin resurfacing techniques has increased, many unqualified or inexperienced providers have entered the field. Patients should choose their provider with the same degree of care they take for any other medical procedure. Complications of skin resurfacing techniques can be serious, including severe infection and scarring.
Patient's with active herpesvirus infections are not good candidates for resurfacing procedures. Persons who tend to scar easily may also experience poor results. Patients who have recently used the oral acne medication isotretinoin (Accutane) may be at higher risk of scarring following skin resurfacing.
Within a day or so following a superficial peel, the skin will turn faint pink or brown. Over the next few days, dead skin will peel away. Patients will be instructed to wash their skin frequently with a mild cleanser and cool water, then apply an ointment to the skin to keep it moist. After a medium-depth peel, the skin turns deep red or brown, and crusts may form. Care is similar to that following a superficial peel. Redness may persist for a week or more. Deep-peeled skin will turn brown and crusty. There may also be swelling and some oozing of fluid. Frequent washing and ointments are favored over dressings. The skin typically heals in about two weeks, but redness may persist.
Following the procedure, an ointment may be applied, and the wound will be covered with a dressing and mask. Patients with a history of herpesvirus infections will begin taking an antiviral medication to prevent a recurrence. After 24 hours, the dressing is removed, and ointment is reapplied to keep the wound moist. Patients are encouraged to wash their face with plain water and reapply ointment every few hours. This relieves itching and pain and helps remove oozing fluid and other matter. Patients may require a pain medication. A steroid medication may be taken during the first few days to reduce swelling. The skin will take a week or more to heal, but may remain very red.
The skin should be kept moist following laser resurfacing. This promotes more rapid healing and reduces the risk of infection. Some physicians favor application of ointments only to the skin; others prefer the use of dressings. In either case, care of the skin is similar to that given following a chemical peel. The face is washed with plain water to remove ooze, and an ointment is reapplied. Healing will take approximately two weeks. Pain medications and a steroid to reduce swelling may also be taken.
All resurfacing procedures can lead to infection and scarring. It is also possible that skin coloration will be altered, or that redness of the skin will be prolonged for many months. Some of the peeling agents used in deep chemical peels can affect the function of the heart.
Depending on the resurfacing techniques selected, it is possible to improve the appearance of skin damaged by sun, age, or disease in many people. Skin resurfacing techniques address only the surface of the skin; procedures such as face-lift surgery or blepharoplasty may be needed to repair other age-related skin changes. All resurfacing procedures are accompanied by some pain, redness, and skin color changes. These may persist for several months following the procedure, but they usually resolve over time.
As noted above, resurfacing procedures can reactivate herpesvirus infections or lead to new, sometimes serious infections. All resurfacing techniques intentionally create skin wounds, creating the possibility for scarring. Abnormal results such as these can be minimized with use of antiviral medications prior to the procedure and good wound care afterward. Selection of an experienced, reputable provider also is key.
Fewkes, Jessica L. Illustrated Atlas of Cutaneous Surgery. New York: Gower Medical Publishing, 1992.
Weinstein, Cynthia. "Carbon Dioxide Laser Resurfacing." In Cosmetic Surgery of the Skin: Principles and Techniques, ed. William P. Coleman. St. Louis: Mosby, 1997.
Fulton Jr., James E. "Dermabrasion, Chemabrasion, and Laserabrasion: Historical Perspectives, Modern Dermabrasion Techniques, and Future Trends." Dermatologic Surgery 22 (July 1996): 619-628.
Matarasso, Seth L., et al. "Cutaneous Resurfacing." Dermatologic Clinics 15 (Oct. 1997): 569-582.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. <http://www.asds-net.org>.
American Society for Laser Medicine and Surgery. 2404 Stewart Square, Wausau, WI 54401. (715) 845-9283. <http://www.aslms.org>.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. <http://www.plasticsurgery.org>.
Richard H. Camer
Actinic keratosis—A crusty, scaly skin lesion, caused by exposure to the sun, which can transform into skin cancer.