By Arthur N. Falk, M.D.
Today’s skin resurfacing options are so numerous, that it can be confusing to know just where to begin when contemplating a rejuvenation program. Clearly, there is no single treatment that is right for all people; rather it is the correct balance of clinical needs, lifestyle demands, and financial resources. Below is an overview of the kinds of treatments available through our practice and their relative indications.
Medical peels go a step beyond conventional home exfoliation treatments to achieve controlled wounding to a depth that is suitable for the specific skin condition. Traditionally, chemical peels are divided into three categories: superficial, medium and deep peels. A superficial peel penetrates no deeper than the outermost layers of the epidermis. These are true “lunchtime” peels and include peels such as glycolic, salicylic acid and lactic acid peels. They cause minimal down time and the limited exfoliation that is created can go unnoticed by all but the most discerning eyes. It is important to consider these peels not in isolation, but rather as part of a series to achieve the maximum benefit. Each peel has its specific indication. For example, a lactic acid peel is for sensitive skin types and in addition to causing mild exfoliation, it is simultaneously hydrating to the skin. Salicylic acid peels are part of acne treatment regimens because this molecule can help unplug sebaceous glands and also has anti-inflammatory properties. One of my favorite superficial peels is a Jessner’s peel, which is made up of a combination of acids including salicylic and lactic. This peel causes a bit more peeling than the others, but I believe the enhanced results speak for themselves.
Medium depth peels are defined as peels that penetrate into the dermis. These peels are typically based on trichloroacetic acid and cause substantially more exfoliation. The recovery is longer, averaging about one week. This peel targets more intense sun damage including age spots, rough texture and wrinkles. Falling out of favor, are the true deep peels or phenol based peels. This peel has greater toxicity and down time which we can avoid now with other combination techniques.
An alternative to chemical peels are laser peels. They offer more precision than with a chemical peel, and in general, are a bit more expensive based on the added cost of the technology and expertise required to safely operate the laser. Erbium laser peels are replacing carbon dioxide laser technology, which gave laser resurfacing a bad name for a while on account of prolonged recovery periods and annoying lingering facial redness, which could persist for months. In contrast, Erbium laser peels produce very controlled levels of wounding, which can be titrated down to fractions of a millimeter. This enables the physician to peel as little or as much of the skin as he or she feels necessary. Laser peels also introduce the element of thermal heating. The heating of the skin produces a stimulus for collagen formation and skin smoothing. All things being equal, if one was to compare a comparable depth laser and chemical peel, the laser peel would produce more skin improvement.
FraxelTM laser resurfacing represents the newest twist on laser skin resurfacing which is quite remarkable. FraxelTM resurfacing technology borrows from laser resurfacing by producing a controlled skin wound, but does so on a microscopic level, laying down a series of non-overlapping tiny spots. Only a portion of the skin’s total surface area is treated with each session, so it takes about five sessions to complete a full facial treatment. Each treatment is associated with a two-three day period of slight skin bronzing. The end result is similar to a deep laser peel but without a prolonged recovery period. It is particularly good for acne scarring and melasma—two conditions that can be very difficult to treat by other methods.
Admittedly, this information can be very confusing when presented for the first time. I recommend that individuals who are serious about embarking on a rejuvenation program, or who just want to learn more about their options, consider attending one of our seminars or schedule an individual consultation. Peels have many salutary effects on our skin that go well beyond mere aesthetic enhancement.
Dr. Falk is the Medical Director of the Center for Facial Plastic Surgery and Aesthetic Skin Care located at 35 Hackett Boulevard in Albany. To schedule a consultation appointment, please call 262.7193 or visit www.universityent.com and click on Servcies/ Facial Plastic Surgery.