SKIN RESURFACING
Introduction: Skin resurfacing refers to the technique where the superficial layers of skin are removed in order to allow the raw skin beneath to heal itself resulting in a smoother skin surface.
This can be achieved by mechanical removal (dermabrasion), using a chemical to partially dissolve the outer layer of skin (chemical peel) or by vaporising the skin using short pulses of heat energy (lasers)
DERMABRASION
Introduction
Dermabrasion or "sanding" is a procedure used in selected cases and sites to remove irregularities in the skin surface. It is performed by using a rotating wire brush or diamond wheel to plane down the irregular area. An improved appearance is obtained by making the surface uniform.
Old acne scars and chicken pox marks can be improved as well as certain superficial skin discolorations. Dermabrasion is also used to treat fine lines and wrinkles especially those in the upper and lower lip regions. It must be emphasized that in severe acne scarring, several procedures will be necessary over a period of time.
Preoperative preparation : Patients are usually prescribed a course of anti cold sore (herpes) medication. The medication is commenced the day before treatment and continued for five days.
Nature of operation
The patient is admitted on the morning of surgery. Small areas can be treated under local anaesthesia. Large areas are best treated under general anaesthesia.
Crusting develops on the abraded area within one or two days and gradually lifts off in seven to ten days depending on the depth of the abrasion. A smooth, pink skin results that gradually returns to normal colour in the next six to eight weeks.
Postoperative events
Swelling invariably occurs in the immediate postoperative period. Keeping the head elevated helps to reduce this problem.
Milia Tiny white firm bumps in the skin can appear from three to four weeks post operatively and can be easily removed.
Pigment changes Pigment alteration occurs in all patients for several weeks. Initially the abraded area will appear pink and less pigmented than the surrounding skin. It may take up to 6 weeks to regain normal pigmentation. Final pigment adjustment may take several months.
Excessive pigmentation is seen in about 10% of cases. It is usually temporary but can last several months. Permanent excessive or decreased pigmentation can result but this is extremely rare.
It is important to remember that exposure to sunlight within six or eight weeks following treatment may result in unfavourable discolouration.
All patients are strongly urged to stay out of the sun for this length of time and use emollient sun block cream if exposed to sunlight.
Scarring Unfavourable healing is rare, but can occur particularly if a deep abrasion is performed. Thickened (keloid) scarring can result and mar the result. Further treatment will be necessary.
CHEMICAL PEELING - CHEMABRASION
Introduction
Chemical peels have been used for many years to improve the appearance of the facial skin. There are now several types of peels available that produce excellent results with a rapid recovery time.
Chemical peeling of the face consists of applying a liquid containing a chemical, which dissolves and destroys the superficial layers of the skin in a controlled manner. The subsequent healing that occurs produces a more youthful, healthier and smoother looking skin.
This technique can improve sun damage, sun or age spots, wrinkles, pitted acne scars, melasma (excess black pigment in the skin) as well as traumatic scarring.
Classification
A simple classification of skin peels is based on the depth they penetrate the skin.
• Superficial peels : Glycolic acid, salicylic acid and Jessner's solution (Resorcinol, salicylic acid, lactic acid, ethanol) 10% Trichloroacetic acid (TCA). These peels are used to treat mild sun damage, acne scars and melasma. A course of six to eight treatments is often required initially to give the skin a more improved appearance. Maintenance sessions are required every three months for best results. These peels are safe with very few side effects.
• Medium peels : Strong Jessner's, Resorcinol, 15-20% TCA, low concentration phenol. This depth of peel is used to treat fine lines, wrinkles, mild sun damage, superficial scars, and pigmentation. The skin flakes and there is a recovery period of several days. Side effects include redness, increased pigmentation.
• Deep peels : Phenol, 30% TCA. These peels have mostly been replaced by lasers and are rarely used in the UK . They are used to treat deeper lines and advanced sun damage. There is a two to three week recovery time. Persistent redness, pigmentation and scarring are possible side effects.
The after effects are very similar to dermabrasion.
TRETINOIN (Retinova) a derivative of vitamin A is a prescription only cream/gel for home use. Research has clearly shown that Tretinoin increases the rate of skin cell turnover, increases the thickness of the skin and increases collagen deposition. The overall effect is that the skin becomes more youthful in appearance with fine lines and wrinkles being smoothed out.
In addition tretinoin hastens the clearing of pigment filled skin cells. As a result, dark spots lighten and discolouration evens out. Tretinoin increases the skin's sensitivity to ultraviolet radiation and prolonged exposure to the sun should be avoided. It also has a marked drying effect on the skin and bland moisturisers must be applied abundantly.
