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In the past,
skin resurfacing was carried out using
chemical peel or dermabrasion (a sanding
technique). However, lasers have pretty much
replaced the techniques for deeper
resurfacing because it seems to offer added
safety and faster recovery. Our experience
with the laser for skin resurfacing has been
very positive. We are impressed with the
control that this modality offers. We agree
that healing time is shortened, compared to
other methods.
While several different types of lasers can
by used, our experience at HMC has been with
the Carbon Dioxide (or CO2) laser, which is
probably the most widely used laser in
medicine. There is a significant recovery
period with CO2 lasers in that the redness
that occurs of the face that can last for
several weeks. We feel that the CO2 laser
still offers the greatest effectiveness.
Pre-treatment options are important when
considering skin laser resurfacing. The
resurfacing vaporizes the outer most layers
of skin, which are aged, sun damaged or
irregularly pigmented, leaving the
underlying dermal skin cells to repopulate
and resurface the area treated. This usually
results in a much smoother complexion
eliminating the pigmentary irregularities
and achieving an improved final skin
surface. Pre-treatment with Retin-A, other
retinols or glycolic acid products have been
shown to be very useful in preparing
patients for laser resurfacing. Our
preference is for the use of glylcolics.
These products stimulate the turnover of the
cells deep within the skin that are
continually dividing and replacing skin
cells that are lost on the surface. By
increasing the rate of turnover of these
cells, it appears that subsequent healing
time following laser resurfacing can be
shortened with improved results. Skin
preparation before laser treatment is
usually suggested for a period of between
two and six week because this seems to be
the minimal time required to have glycolics
and other products effectively stimulate
increased activity of the skin.
Laser resurfacing is often utilized as a
compliment to surgery. It is not a
substitute for the face lift operation as it
does not correct facial laxity or sagging
skin. It is excellent for treating fine
lines on the cheeks, beneath the eyes and
around the mouth - the very lines that are
difficult to correct with surgery. Although
some patients will have resurfacing as an
isolated procedure, more often in our
practice, it is coupled with face lift
surgery.
Immediately after surgery, the skin that has
been resurfaced will be raw, but will
generally be healed in ten to fourteen days
with deeper resurfacing, and even quicker
with lighter treatments. The skin remains
red for several weeks, and pink for a few
months, although this can easily be covered
with make up.
One major advantage noted with the laser
resurfacing in comparison with the older
technique of deep chemical peeling is a
decrease in the risk of skin lightening and
scarring as reported in several clinical
studies. While these risks are not
eliminated, they seem to be less frequent.
Another advantage is that the depth of
treatment is more controllable.
Laser skin resurfacing will improve your
self confidence and restore a more youthful
appearance to your skin.
The information on this web site is only
intended as an introduction to this
procedure and should not be used to
determine whether you will have the
procedure performed nor as a guarantee of
the result.
The best method of determining your personal
options is to schedule a personal
consultation with Dr. Makki. He will be able
to answer specific questions related to your
situation.
Please don't hesitate to call for any
questions that you might have
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If you're considering
chemical peel ...
Chemical peel is especially useful for the
fine wrinkles on cheeks, forehead, and
around the eyes, and the vertical wrinkles
around the mouth.
Chemical peel uses a chemical solution to
improve and smooth the texture of the facial
skin by removing its damaged outer layers.
It is helpful for those individuals with
facial blemishes, wrinkles and uneven skin
pigmentation. Phenol, trichloroacetic acid (ITCA)
and alphahydroxy acids (AHAs) are used for
this purpose. The precise formula used may
be adjusted to meet each patient's needs.
Although chemical peel may be performed in
conjunction with a facelift, it is not a
substitute for such surgery, nor will it
prevent or slow the aging process. The
following information provides basic
information about certain types of chemical
peel treatments and the results you might
expect. It won't answer all your questions,
since a lot depends on your individual
circumstances. Once you and your plastic
surgeon have decided on a specific peel
program, be sure to ask about any details
that you do not understand.
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Chemical peel is especially
useful for the fine wrinkles on
cheeks, forehead, and around the
eyes, and the vertical wrinkles
around the mouth. |
Deciding if chemical
peel is right for you
Chemical peel is most commonly performed for
cosmetic reasons - to enhance your
appearance and your self confidence.
Chemical peel may also remove pre-cancerous
skin growths, soften acne facial scars and
even control acne. In certain cases, health
insurance may cover the peel procedure. Be
sure to check your policy and contact your
insurance company before the procedure is
performed.
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The chemical solution can be
applied to the entire face, or
to a specific area - for
example, around the mouth -
sometimes in conjunction with a
facelift. |
Alphahydroxy acids (AHAs),
such as glycolic, lactic, or fruit acids are
the mildest of the peel formulas and produce
light peels. These types of peels can
provide smoother, brighter-looking skin for
people who can't spare the time to recover
from a phenol or TCA peel. AHA peels may be
used to treat fine wrinkling, areas of
dryness, uneven pigmentation and acne.
Various concentrations of an AHA may be
applied weekly or at longer intervals to
obtain the best result. Your doctor will
make this decision during your consultation
and as the treatment proceeds. An
alphahydroxy acid, such as glycolic acid,
can also be mixed with a facial wash or
cream in lesser concentrations as part of a
daily skin-care regimen to improve the
skin's texture.
Trichloroacetic acid (TCA) can be
used in many concentrations, but it is most
commonly used for medium-depth peeling. Fine
surface wrinkles, superficial blemishes and
pigment problems are commonly treated with
TCA. The results of TCA peel are usually
less dramatic than and not as long-lasting
as those of a phenol peel. In fact, more
than one TCA peel may be needed to achieve
the desired result. The recovery from a TCA
peel is usually shorter than with a phenol
peel.
Phenol is the strongest of the
chemical solutions and produces a deep peel.
It is used mainly to treat patients with
coarse facial wrinkles, areas of blotchy or
damaged skin caused by sun exposure, or
pre-cancerous growths. Since phenol
sometimes lightens the treated areas, your
skin pigmentation may be a determining
factor as to whether or not this is an
appropriate treatment for you. Phenol is
primarily used on the face; scarring may
result if it's applied to the neck or other
body areas.
All chemical peels carry some uncertainty
and risk
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At the end of a phenol peel, a
thick layer of petroleum jelly
may be applied to the treated
area. |
Chemical peel is normally
a safe procedure when it is performed by a
qualified, experienced plastic surgeon.
However, some unpredictability and risks
such as infection and scarring, while
infrequent, are possible.
AHA peels may cause stinging, redness,
irritation and crusting. However, as the
skin adjusts to the treatment regimen, these
problems will subside.
With a TCA peel, your healed skin will be
able to produce pigment as always; 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.
With a phenol peel, the new skin frequently
loses its ability to make pigment (that is,
tan). This means that not only will the skin
be lighter in color, but you'll always have
to protect it from the sun. Phenol may pose
a special risk for patients with a history
of heart disease. It's important that you
make your surgeon aware of any heart
problems when your medical history is taken.
It is also possible that phenol will cause
some undesired cosmetic results, such as
uneven pigment changes. Certain modified
phenol peels are gentler and may be
preferred in some circumstances.
Peel formulas at a glance
Alphahydroxy acids (AHAs)
Uses:
Smoothes rough, dry skin - Improves texture
of sun-damaged skin
Aids in control of acne
can be mixed with bleaching agent to correct
pigment problems
can be used as TCA pre-treatment
Considerations:
A series of peels may be needed
As with most peel treatments, sunblock use
is recommended
Trichloroacetic acid (TCA)
Uses:
Smoothes out fine surface wrinkles
Removes superficial blemishes
Corrects pigment problems
Considerations:
Can be used on neck or other body areas
May require pre-treatment with Retin-A or
AHA creams
Treatment takes only 10-15 minutes
Preferred for darker-skinned patients
Peel depth can be adjusted
Repeat treatment may be needed to maintain
results
Sunblock must be used for several months
Healing is usually quick, much quicker than
with a phenol peel
Phenol
Uses:
Corrects blotches caused by: sun exposure,
birth-control pills, aging
Smoothes out coarse wrinkles
Removes pre-cancerous growths
Considerations:
Used on the face only
Not recommended for dark-skinned individuals
Procedure may pose risk for patients with
heart problems
Full-face treatment may take one hour or
more
Recovery may be slow-Complete healing may
take several months
May permanently remove facial freckles
Sun protection, including sunblock, must
always be used
Results are dramatic and long-lasting?
Permanent skin lightening and lines of
demarcation may occur
Planning for a chemical peel
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A protective crust may be
allowed to form over the new
skin. When it's removed, the
skin will be bright pink. |
In some states, no medical
degree is required to perform a chemical
peel - even the strongest phenol peels. Many
states have laws that permit non-physicians
to administer certain peel solutions, but
regulate the strengths which they are
permitted to apply. You should be warned
that phenol and TCA peels have been offered
by inadequately trained practitioners
claiming "miracle techniques" to rejuvenate
the skin.
It is very important that you find a
physician who has adequate training and
experience in skin resurfacing. Your plastic
surgeon may offer you a choice of peel
techniques or suggest a combination of peels
to obtain the best result for you.
During your initial consultation, it is
important that you discuss your expectations
with your plastic surgeon. Don't hesitate to
ask any questions or express any concerns
that you may have. Expect your plastic
surgeon to explain the planned procedure in
detail, including its risks and benefits,
the recovery period and the costs. If you
have a history of herpes, you should inform
your physician prior to the procedure.
Remember, chemical peel treatments are
usually not covered by medical insurance
unless they are performed for medically
related problems.
Preparing for your chemical peel
Your plastic surgeon will instruct you on
how to prepare for your peel treatment.
Sometimes Retin-A - a prescription
medication derived from Vitamin A - is used
to pre-treat the skin. This thins out the
skin's surface layer, allowing the TCA
solution to penetrate more deeply and
evenly. If your skin won't tolerate Retin-A
pre-treatment, an AHA cream may be used
instead. Hydroquinone, a bleaching agent, is
sometimes used in conjunction with Retin-A
or AHA pre treatment, especially if you have
blotchy skin areas or pigmentation problems.
You may have to spend a month or more in the
pre-treatment phase before the doctor will
schedule your actual peel.
You will need to arrange for someone to
drive you home and help you out for a day or
two if you are having a phenol or deeper TCA
peel. You probably won't need any extra
assistance if you're having an AHA peel or
superficial TCA peel.
Where your peel will be performed
Most chemical peels may be safely performed
in a plastic surgeon's office, office-based
surgical facility or outpatient surgical
center. Your plastic surgeon may want you to
stay overnight in a facility or hospital if
other cosmetic procedures are performed
simultaneously.
Types of anesthesia
Anesthesia isn't required for phenol or TCA
peels because the chemical solution acts as
an anesthetic. However, sedation may be used
before and during the procedure to relax you
and keep you comfortable.
No anesthesia is needed for AHA peels since
they cause only a slight stinging sensation
during application.
The peel
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After healing, the skin is
lighter in color, tighter,
smoother, and younger looking. |
AHA peels/treatments: Your
doctor will apply the AHA solution to your
cleansed facial skin, a process that usually
takes no more than 10 minutes. No
"after-peel" ointment or covering is
required. Depending on the strength of the
peel, periodic treatments may be necessary
until the desired effects are achieved.
For some patients, the application of an
AHA-based face wash or cream once or twice a
day at home will be sufficient to accomplish
the desired goal. Your plastic surgeon may
add Retin-A or a bleaching agent to your at
home treatment schedule. After several weeks
of at-home use, your doctor will examine
your skin to determine if your regimen needs
adjustment.
Phenol and TCA peels: Typically, the skin is
first thoroughly cleansed. Then, the surgeon
will carefully apply the phenol or TCA
solution. You may feel a stinging sensation
as the peel solution is applied, but this
feeling will quickly pass.
A full-face TCA peel usually takes no more
than 15 minutes. Two or more TCA peels may
be needed to obtain the desired result, and
those may be spaced out over several months.
Mild TCA peels may be repeated as often as
every month.
If phenol solution has been used, your
plastic surgeon may coat the treated area
with petroleum jelly or a waterproof
adhesive tape. With lighter peels, no
covering is necessary.
A full-face phenol peel generally takes one
or two hours to perform, while a phenol peel
to a smaller facial region (perhaps the skin
above the upper lip) may take only 10 or 15
minutes. A single treatment usually
suffices.
After your treatment
After an AHA peel, it is common to
experience some temporary flaking or
scaling, redness and dryness of the skin.
However, these conditions will disappear as
the skin adjusts to treatment.
After a phenol or TCA peel, your doctor may
prescribe a mild pain medication to relieve
any tingling or throbbing you may feel. If
tape was used to cover your face, it will be
removed after a day or two. A crust or scab
will form on the treated area. To help your
face heal properly, it is essential that you
follow your doctor's specific post-operative
instructions.
A TCA peel may also cause significant
swelling, depending on the strength of the
peel used.
If you've had a phenol peel, your face may
become quite swollen. Your eyes may even be
swollen shut temporarily. You will need
someone to help care for you for a day or
two. You may also be limited to a liquid
diet and advised not to talk very much
during the first few days of recovery.
Getting back to normal
With an AHA peel, the temporary redness,
flaking, and dryness that you experience
will not prevent you from working or
engaging in your normal activities. A
fresher and improved skin texture will
result with continued AHA treatments.
Remember, protecting your skin from the sun
is also important following these mild acid
peels. Ask your doctor to recommend a
sunblock with adequate UVA and UVB
protection and use it every day.
With a TCA peel, the moderate discomfort and
mild swelling you may experience will
subside within the first week. In about a
week to ten days, your new skin will be
apparent and you should be healed
sufficiently to return to your normal
activities. It is best to avoid sun exposure
unless you are adequately protected
With a phenol peel, new skin will begin to
form in about seven to ten days. Your face
will be very red at first, gradually fading
to a pinkish color over the following weeks
to months. During this time, it is
especially important that you use a sunblock
or blotchy, irregular skin coloring may
result.
About two weeks after treatment, you may
return to work and resume some of your
normal activities. Your skin will be healed
enough for you to wear makeup. (For makeup
tips, ask your plastic surgeon for the ASPRS
brochure on camouflage cosmetics.)
Your new look
Improvements from AHA
peels may be very subtle at first. You may
detect a healthier glow to your skin. With
continued treatments, you will notice a
general improvement in the texture of your
skin.
The results of a TCA peel are usually not as
long-lasting as those of phenol peel.
However, your skin will be noticeably
smoother and fresher-looking.
If you're planning a phenol peel, you can
expect dramatic improvement in the surface
of your skin - fewer fine wrinkles, fewer
blemishes and more even-toned skin. Your
results will be long-lasting, although not
immune to the effects of aging and sun
exposure.
The information on this web site is only
intended as an introduction to this
procedure and should not be used to
determine whether you will have the
procedure performed nor as a guarantee of
the result.
The best method of determining your personal
options is to schedule a personal
consultation with Dr. Makki. He will be able
to answer specific questions related to your
situation.
Please don't hesitate to call for any
questions that you might have
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