Laser and Chemical Peels
Laser resurfacing removes the outer layers of the skin by heat, usually with a CO2 (carbon dioxide) laser. It is as effective as the strongest peel (phenol), but causes less color change. A milder laser resurfacing is obtained with the Erbium laser.
Fractional laser treats the deeper layers of the skin, to stimulate collagen. It improves lines and elasticity, while minimizing recovery and the risk of color changes. Sometimes it is combined with intense pulsed light (IPL) or a very shallow resurfacing or peel to treat surface irregularities.
Intense Pulsed Light (IPL) is a very powerful pulse of light, tuned to be absorbed by brown pigment or blood vessels. It is very useful for treating brown and red discolorations. At higher power, it will also give a light peel.
A chemical peel consists of peeling off the outer layers of the skin using a mild acid. It improves the fine wrinkling and blotchiness that occur with sun damage, as do Retin-A cream and bleaching agents. The changes however are faster and more dramatic.
Many peeling agents such as phenol (carbolic acid), TCA (trichloroacetic acid), glycolic acid or resorcinol, and strengths have been used according to the individual problem. The traditional phenol peel has largely been replaced by the laser, because it bleached the skin significantly. I use TCA peels for some patients, and glycolic acid is a common over the counter beauty ingredient.
Fine wrinkles are usually best treated by a peel or laser. (A facelift is needed for the deeper wrinkles and sagging of the skin that occur with aging.) Sometimes both procedures are needed, then the chemical peel is done six weeks to six months after the face lift surgery.
Fair skinned people with sun damage are the commonest candidates for a peel. Darker skinned people may also benefit when skin damage has resulted in uneven pigmentation.
Fractional laser and TCA peels can be used on the neck with only a low risk of scarring. The CO2 laser carries a higher risk of scarring if used on the neck, and scarring can also be a problem with the Erbium laser.
What to expect
Fractional laser is very popular because it is the fastest recovery of any of the major skin treatments. I usually use a combination of local anesthetic gel and local anesthesia nerve blocks for fractional laser. It creates a fine pattern of dots on the skin. Sometimes there is a little bleeding from these dots in the first few hours after treatment. After that a little clear fluid oozes from the dots for 2 or 3 days, and the skin is pink. At 5 to 7 days, most patients can resume makeup and normal activity.
Remaining pinkness is usually gone in another week, but can be concealed with makeup until then. Because the fractional laser stimulates collagen production in the deeper layers of the skin, it typically takes 6 to 8 weeks to see maximum correction.
With a T.C.A. peel, I usually pre-treat the skin with Retin-A for one to two months. Chemical peeling is sometimes performed with some sedation. No anesthesia is needed. A burning sensation occurs as the solution is applied, then the skin rapidly becomes numb. The skin usually peels like a sunburn only. After the new skin grows, the face is pink for one to two months.
Following your peel it is very important to stay out of the sun or use sun block at all times, until the redness has settled. Sun exposure during this time may cause changes in skin color.
A mild peel may be repeated several times to get the desired effect. Peeling improves skin tone and elasticity. Most of the fine wrinkles disappear. Interestingly, microscopic examination of the peeled skin shows that many of the changes of sun damage are reversed.
CO2 Laser resurfacing requires general anesthesia or local anesthesia (injections to freeze the skin) with sedation. It is generally an out patient procedure. The skin is removed down to a raw surface, and heals over 7 to 10 days.
Generally there is some redness for two to six months. Generally the CO2 laser gives more correction than the T.C.A. peel in return for the longer recovery period. I rarely use the Erbium laser, since the correction is very equivalent to a T.C.A. peel, but because of the cost of the laser, the patient cost is higher.
If you are considering laser or peels in Orange County, please click here to contact Newport Beach Plastic Surgeon, Dr. Bailey, for a consultation.
Before and After Pictures
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