"Resurfacing” is another Aesthetic Surgery procedure area in which there is frequent confusion and misunderstanding. In my effort to provide sufficient information for you to make an informed decision about resurfacing, I offer an Anesthetic Plastic Surgeon's insight into Chemical Peels and Dermabrasion.
Many times in aesthetic facial rejuvenation, there are circumstances when a surgical lift, fillers, or Botox will not provide the desired effect. This often pertains to the fine wrinkles or discolorations, ingrained into the skin, which do not improve with those mentioned procedures. It's been known for decades, that fine, ingrained wrinkles and pigment spots can often be eradicated if the outer layers of skin are removed, and the wound is then allowed to heal by itself. With healing, these wrinkles and spots often seem to magically disappear. The removal of outer skin layers can be achieved either through chemicals (peels), mechanically (dermabrasion) or through the use of controlled light energy (laser).
Over the many years I've been called upon to treat this "fine wrinkle" or discoloration issue, either in new patients or in existing patients (following their lift surgery), and I've come to favor the chemical peel. Because of its simplicity and lower cost, while providing the same beneficial result, it's difficult for me to justify more expensive methods. The drawbacks to doing a peel (or any of the abrasion methods) are the possibility of unexpected scarring, the possibility of altering the appearance of the skin pigmentation and the required two week healing time, before makeup can be safely applied. Nevertheless, when nothing else will give the desired result, a phenol (deep) peel or a TCA (moderate depth) peel is suggested.
These types of peels are significantly deeper, and potentially more dangerous, than those offered in commercial establishments where a qualified medical doctor is not in attendance. I offer this as a word of caution.
View a video description of dermabrasion is available here
Chemical Peels
As part of my aesthetic surgery practice, I frequently count on chemical peels to fulfill the "resurfacing” needs of my patients. Resurfacing is the technique required to improve the appearance of wrinkles throughout facial skin, which result from a combination of genetic predisposition and many years of environmental or sun damage.
Lasers, dermabrasion and chemical peels overlap significantly in their ability to remove outer layers of facial skin and prompt skin to regenerate (resurfacing). Having tried all of these techniques, however, I've found that the skillful use of chemical peels seems to provide the same benefit to the patient at less risk and much less cost.
There are several different types of chemical solutions that can be employed to achieve a "chemical peel”, and I have been most satisfied with the use of varying strengths of TCA solution (trichloroacetic acid) to produce a "moderate depth” peel and varying strengths of Hetter's solution (containing the active components of croton oil and phenol) when a "deep” peel is required to improve badly sun damaged and wrinkled skin. Choosing the best peel solution and its proper strength is part of the skill involved in this process. Experience matters when it comes this decision.
Regardless of the method used for resurfacing skin, the common thread shared by each is the ability to remove surface layers of facial skin to variable depths. The depth of skin surface removal determines the thoroughness of wrinkle improvement, the deeper the removal, the better the wrinkle correction. Also, the deeper the resurfacing, the longer the healing time. Deep peels, for example, often require about fourteen days for initial healing followed by many weeks of gradually fading pinkness.
Chemical peels also carry the risk of permanently affecting the coloration of areas of skin (causing permanent bleaching or dark pigmentation) and even the chance of producing unwanted scaring. For these reasons moderate depth and deep chemical peels should always be performed by an experienced and skilled surgeon.
Dermabrasion
Perhaps the oldest method for plastic surgeons to remove surface layers of skin (skin resurfacing) is the technique known as dermabrasion. It's even said to have been utilized by physicians in ancient Egypt, relying upon special "sand paper” to improve acne scarring. Dermabrasion is still around today, using diamond tipped dermabrasion equipment in a sterile operating environment, for that very same purpose.
Dermabrasion has also found its place in the area of facial rejuvenation. It serves as a mechanical means (as opposed to chemical or laser energy) to enable skin resurfacing by the aesthetic surgeon. At times, it may be preferred over the other methods because of the direct control it provides the surgeon in his effort to achieve a precise resurfacing depth. The risks of dermabrasion are similar to those of the other skin resurfacing methods.
