Healing of Laser Treated Skin

        Healing time for disappearance of redness following erbium laser treatment is typically two weeks with a maximum of eight weeks compared to four or ten weeks with CO₂ laser treatment.

        Postoperative treatment includes cleansing the area and coverage with a moisturizer, bandage or some other wound care regimen, particularly during the first week. Within two weeks, the swelling largely resolves and the redness begins to fade to a color that can be easily controlled with cosmetics. Complete resolution of the redness may take several months. Occasionally, patients will develop irregular hyperpigmentation (brown spots) during their healing interval but this is typically self-limited and if it does not resolve spontaneously, the hyperpigmentation may be treated with a bleaching medication.

Lasers for Acne Scar Removal

        Acne scars can also be improved with the smoothing effects of the laser. The same smoothing technique is used as for wrinkle removal. Small scars will disappear and deeper scars will become less deep and less noticeable. In severe cases with very deep scars, minor surgery is used to reduce larger scars first and is then followed by laser treatment.

Chemical Peels

        Peels still remain one of the most effective techniques available for alleviating fine to moderate wrinkles, weathered skin, freckling, blotchy pigmentation, sun damage, age spots, mild acne scars, benign overgrowths of skin, flat warts  and shallow acne scars. It can also be very effective for superficial acne and skin problems associated with chicken pox and pigmentation problems. Although one peel can improve the appearance of the skin, a series of peels is often employed. Following treatment, new lesions or patches are less likely to appear.

        However, sags, bulges and more severe wrinkles do not respond well to peeling and may require other kinds of cosmetic surgical procedures, such as an eyelid lift or soft tissue filler.

        A chemical peel applies a controlled chemical burn to the top layers of your skin. Chemical peels are categorized into superficial, medium and deep peels depending upon the severity of the patient's wrinkles and the degree of sun damage present. The depth of the burn depends upon the concentration of acid that is used. The peel itself should take no more than 30 to 60 minutes and may be painful for the first few hours following the procedure. This pain is usually well controlled with oral pain medicines.

        After the peel, patients are usually sent home or to an outpatient nursing facility for a day or two. The skin will begin to peel 24 to 48 hours following the application of the acid. New skin will replace the peeled skin within seven to ten days. However, chemically peeled skin takes longer to look normal. A pink hue to the skin can be expected for six months, often necessitating blending with makeup.

        There can be significant benefit from one acid peel, however, up to six treatments may be recommended for maximum benefits.

Chemicals Used

        Glycolic acid is often used at concentrations of 20 to 70 percent in a series of 3 to 6 peels for the desired effect.

        TCA (trichloroacetic acid) is a very strong acid that is one of the most effective peeling chemicals.  TCA is used at concentrations from 15 to 35 percent. 20-25 percent TCA is a light peeling agent and if repeated every two to four weeks, can give the results of a deeper peel without the risk of scarring as sometimes seen with stronger agents. In addition, the peel stimulates new cells to grow thereby tightening the skin, which decreases wrinkling.

        Other acids such as salicylic acid, lactic acid, or carbolic acid and phenolic acid may also be used.

How Is the Peel Performed?

        Peels are performed as an outpatient in the doctor's office. A solution containing the chemical is applied to your skin. During the procedure, most patients experience a warm to somewhat hot sensation lasting about five to 10 minutes, followed by a stinging sensation. Most patients choose not to use any sedation or anesthesia. Deeper peels may require pain medication during or after the procedure.

        When a chemical peel is applied to the skin, it causes the top layers of cells to dry up and peel off over a period of several days. Medium-depth and deep peeling can sometimes result in swelling and blisters that may break, crust, turn brown, and peel off over a period of 7 to 14 days. Sometimes surgical tape may be placed on the treated skin. When the old skin has peeled off, it exposes a new layer of undamaged skin which has a smoother texture and more even color.

        Most people heal within 7 days after a peel. During the healing process there is no pain, but the skin looks as if it has had a severe sunburn. The skin becomes more sensitive to sunlight for at least 6-8 weeks after their peel. It is very important to protect the new skin with sunblockers, hats and the avoidance of strong sunlight.

        There is a small incidence of the reactivation of cold sores or Herpes simplex infection in patients with a history of fever blisters.

        Chemical peeling will not remove deep scars. Dermabrasion, punch grafting, punch elevation, scar excision, or soft tissue fillers may be much more effective for scars and should be discussed with your dermatologist.

Skin "Deep-Peeling" Disasters

        When deep skin peels are performed by poorly skilled persons, disasters can results. Because of this, many dermatologists are moving toward a series of milder skin peels rather than one deep peel. For example, the Mayo Clinic now often recommends a series of six peels to renew a skin area.

        The following are true examples of calls we get at Skin Biology:

     1. I had a acne mark on my check and the dermatologist tried a strong phenol peel which left the area scarred worse then ever. Then two more dermatologists re-peeled the check area and things only got worse. Now I have a deep, scarred depression in my check. As a result of these peels, I contracted a staphylococcus infection and am now on three different antibiotics to control the infection.

     2. I had a 35% TCA peel 4-5 weeks ago and was very much misled on the seriousness of this peel and the possible complications.  I am a young women with fair skin.  Dr. "X" of the, ""X" Skin Institute," did the procedure in a very uncontrolled manner.  The peel came out severely uneven.  The result is that the right side of my face, and parts of my nose seem to be forming raised and very red scars [...] it has still only been a month but the healing process has been so extreme and the unevenness so unbelievable -- I look like I went through a windshield.  What I am wondering is if there is anything I can do to speed up this healing process and what kind of hope do I have for looking "normal" in the future?

        Again, the best results with skin peels require highly skilled medical personnel using somewhat conservative and slower techniques. The "one peel to beauty" is often unsatisfactory.

Dermabrasion

        Dermabrasion resurfaces the texture of the skin by removing its top layers. The procedure is most often done on the face to remove skin damaged by acne scarring. It is also done to lessen the visibility of wrinkles, tattoos and various other skin lesions. All or a small portion of the face can be done. Blotchy brown spots that occur on the cheeks, temples or forehead also may be treated with the technique. Dermabrasion has much the same effect as a chemical peel.

        While dermabrasion is more than one hundred years old, dermabrasion has enjoyed a resurgence of popularity since the 1960s. The technique has been further refined over the last few decades.

What is Dermabrasion?

        Dermabrasion, or surgical skin peeling, is a surgical procedure in which the dermatologic surgeon removes or sands the skin with a rotary abrasive instrument which is either a wire brush or a diamond fraise to remove the upper layer of akin. This abrasive or peeling action evens out the skin, and a new layer of skin replaces the abraded skin. This leveling or smoothing of the surface skin which makes scars less noticeable is considered the best treatment for improving acne scars. Sometimes it is necessary to have a second procedure to get the maximum results.

        When dermabrasion was first developed, it was used predominantly to improve scars resulting from acne, chicken pox, accidents or other disease. Today, it is also used to treat other skin conditions, such as tattoos, age (liver) spots, and certain skin changes associated with chronic sun damage.

        Dermabrasion is performed in the dermatologic surgeon's office or in an outpatient surgical facility. Medication to relax the patient may be given prior to surgery. The area is thoroughly cleansed with an antiseptic cleansing agent. The area to be "sanded" is treated with a spray that freezes the skin. A high-speed rotary instrument with an abrasive wheel or brush removes or abrades the upper layers of the skin and improves irregularities in the skin surface. Soothing ointments and dressings are then applied.

        For a few days, the skin feels as though it has been severely sunburned. A scab normally forms on the treated area for five to seven days. When this comes off, the skin is healed but very pink. Makeup may be used to hide the pink skin.  Discoloration and swelling usually occur for two to three months while the skin is healing. In several months when the skin has faded, it may have a slightly different color, usually lighter. This is more likely to happen with dark complected people. If this occurs, it can be balanced with makeup.

        Medications may be prescribed to alleviate any discomfort the patient may have, but most people do not experience severe pain. Frequent showering and the application of emollients help speed the skin's recovery. Infection and excessive bleeding are rare and can be treated easily if they do occur. Scarring within the healed skin is rare.

        Generally, most people can resume their normal occupation in seven to ten days after dermabrasion. Patients are instructed to avoid unnecessary direct and indirect sunlight for three to six months after the procedure and to use a sunscreen on a regular basis when outdoors.

Potential Complications From Dermabrasion

        Some individuals have a propensity to develop increased or decreased pigment after dermabrasion treatment. Dermatologic surgeons can usually treat increased pigmentation with the use of certain bleaching creams. However, decreased pigmentation may be permanent.

        Rarely, one may develop thickened skin in certain areas after dermabrasion, similar to keloids to which some families may be prone. Several therapies, such as cortisone creams and injections, can be administered to treat this problem and help the skin return to normal.

        People who are prone to frequent herpes infections may require anti-viral medication to prevent the recurrence of fever blisters while the skin is healing from dermabrasion and to avoid the risk of the herpes spreading into the newly abraded skin.

        Dermabrasion cannot be expected to eliminate or improve all scars in all patients under all conditions. Some scars require the use of ancillary procedures to obtain the best results. These include careful surgical removal of the scars followed by small skin grafts or suturing. Dermabrasion is then used to smooth over these scars six to eight weeks later.