April 17, 2007

Other Skin Treatment Options


From the beginning of time, people suffering from the disfigurement of facial scarring have searched for ways to improve these imperfections. Thanks to refinements of a number of dermatologic surgical techniques, there are several safe, effective procedures available today to improve facial scarring, including dermabrasion or scarabrasion.

What is Dermabrasion?
While more than 100 years old, dermabrasion has enjoyed a resurgence of popularity since the 1960's. The resurfacing technique has been further perfected over the last few decades.

During dermabrasion, or surgical skin planning, the dermatologic surgeon freezes the patient's skin, scarred from acne, chicken pox or other causes. The doctor then mechanically removes or "sands" the skin to improve the contour and achieve a rejuvenated appearance as a new layer of remodeled skin replaces the damaged skin. The new skin generally has a smoother and refreshed appearance. Results are generally quite remarkable and long-lasting.

When is Dermabrasion Indicated?
When dermabrasion was first developed, it was used predominantly to improve acne scars, chicken pox marks and scars resulting from accidents or disease. Today, it is also used to treat other skin conditions, such as pigmentation, wrinkles, sun damage, tattoos, age (liver) spots and certain types of skin lesions. The treatment may also be applied to select areas of deformed skin.
The conditions under which dermabrasion would not be effective include the presence of congenital skin defects, certain types of moles or pigmented birthmarks, and scars from burns.

What Happens Prior to Surgery?
Before surgery, a complete medical history is taken and a careful examination is conducted in order to evaluate the general health of the patient. During the consultation, the dermatologic surgeon describes the types of anesthesia that may be used, the procedure, and what results might realistically be expected. The doctor also explains the possible risks and complications that may occur. Photographs are taken before and after surgery to help evaluate the amount of improvement. Preoperative and postoperative instructions are given to the patient at this time.

How Does the Procedure Work?
Dermabrasion can be 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 antiseptic cleansing agent. The area to be "sanded" is treated with a spray that freezes the skin. Sometimes local tumescent anesthesia can be used. 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.

What Happens After the Surgery?
For a few days, the skin feels as though it has been severely "brush-burned." Medications may be prescribed to alleviate any discomfort the patient may have. Healing usually occurs within 7 to 10 days.

The newly formed skin, which is pink at first, gradually develops a normal appearance. In most cases, the pinkness has largely faded by eight to 12 weeks. Make-up can be used as a cover-up as soon as the crust is off. Generally, most people can resume their normal occupation in seven to 10 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.

Chemical Peeling

Chemical peeling is a technique used to improve the appearance of the skin which is typically performed on the face, neck or hands. In this treatment, a chemical solution is applied to the skin that causes it to "blister" and eventually peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is also temporarily more sensitive to the sun.

Dermatologic surgeons have used various peeling agents for the last 50 years and are experts in performing multiple types of chemical peels. A thorough evaluation by your dermatologic surgeon is imperative before embarking upon a chemical peel.

What Can a Chemical Peel Do?

Chemical peeling is often used to treat fine lines under the eyes and around the mouth. Wrinkles caused by sun damage, aging and hereditary factors can often be reduced or even eliminated with this procedure. However, sags, bulges, and more severe wrinkles do not respond well to peeling and may require other kinds of cosmetic surgical procedures such as a face lift, brow lift, eye lift or soft tissue filler.

Mild scarring and certain types of acne can also be treated with chemical peels. In addition, pigmentation of the skin in the form of sun spots, age spots, liver spots, freckles, splotching due to taking birth control pills, and skin that is dull in texture and color may be improved with chemical peeling.

Chemical peeling may be combined with laser resurfacing, dermabrasion or soft tissue fillers to achieve cost-effective skin rejuvenation customized to the needs of the individual patient. Areas of sun-damaged, precancerous keratoses or scaling patches may improve after chemical peeling. Following treatment, new lesions or patches are less likely to appear. Generally, fair skinned and light haired patients are ideal candidates for chemical peels. Darker skin types may also experience good results, depending upon the type of skin problem encountered.

How Are Chemical Peels Performed?

Prior to surgery, instructions may include the elimination of certain drugs and the preparation of the skin with topical pre-conditioning medications. The patient may be advised to clean the area with an antiseptic soap the day before surgery.

A chemical peel can be performed in a doctor's office or in a surgery center as an out-patient procedure. At the time of treatment, the skin is thoroughly cleansed with an agent that removes excess oils, and the eyes and hair are protected. One or more chemical solutions - an alpha hydroxy acid, such as glycolic acid, salicylic acid, or lactic acid; trichloroacetic acid (TCA); or carbolic acid (phenol) - are used. Dermatologic surgeons are well qualified to select the proper peeling agent based upon the type of skin damage present. During a chemical peel, the physician applies the solution to small areas on the skin. These applications produce a controlled wound, enabling new, refreshed skin to appear. Most patients experience a warm to somewhat hot sensation which lasts about five to ten minutes, followed by a stinging sensation. A deeper peel may require pain medication during or after the procedure.

What Should Be Expected After Treatment?

Depending upon the type of peel, a reaction similar to a sunburn occurs following a chemical peel. Superficial peeling usually involves redness, followed by scaling that ends within three to seven days. Medium-depth and deep peeling may result in swelling and the presence of water blisters that may break, crust, turn brown, and peel off over a period of seven to 14 days. Some peels may require bandages to be placed on part or all of the skin that is treated. Bandages are usually removed in several days and may improve the effectiveness of the treatment. It is important to avoid overexposure to the sun after a chemical peel since the new skin is fragile and more susceptible to complications. The dermatologic surgeon will prescribe the proper follow-up care to reduce the tendency to develop abnormal skin color after peeling.


Laser stands for Light Amplification by the Stimulated Emission of Radiation. Lasers work by producing an intense beam of bright light that travels in one direction. The laser beam can cut, seal or vaporize skin tissue and blood vessels. The laser has the unique ability to produce one specific color (wavelength) of light that can be varied in its intensity and pulse duration. Ordinary light from non-laser sources is composed of many different colors and appears white. This broad spectrum of light can also be pulsed to a specific duration and varied in intensity as well as the exact range of wavelengths. This allows broad spectrum Intense Pulsed Light (IPL) the ability to specifically treat blood vessels and pigmentation. The wavelength and power output of a particular laser or IPL typically determines its medical application. When the laser or IPL light is directed at skin tissue, its light energy is absorbed by water or pigments found in the skin. Water is found in large amounts in all living cells. Pigments of the skin include hemoglobin, a protein that makes blood red, and melanin, the tan or brown-colored pigment. All three targets absorb laser light of different colors.

Lasers may offer you and your dermasurgeon the following general benefits:
Improved therapeutic results
Reduced risk of infection
"Bloodless" surgery with most lasers
An alternative to traditional scalpel surgery, in some cases
Less scarring, in most cases
Precisely controlled surgery, which limits injury to normal skin
Safe and effective outpatient, same-day surgery for many skin conditions

Different types of lasers and IPL are used to treat a variety of skin conditions, birthmarks and growths and cosmetic complaints. Presently, no single laser or IPL is capable of treating all skin conditions, but certain lasers can be tuned to a variety of colors of light or coupled to a robotized scanning device to expand their clinical effectiveness. Your dermasurgeon will carefully evaluate your individual condition and suggest the appropriate type of laser and/or IPL system to achieve the best results.

Experts in skin care, dermasurgeons have extensive training and experience with laser and IPL surgery. In fact, most of the latest advances in laser and IPL technology and its applications were pioneered and refined by dermasurgeons.


The CO2 laser system can be used in several ways: "focused" for cutting skin without bleeding; "defocused" for superficially vaporizing skin; and "ultra pulsed" for facial resurfacing. By delivering very powerful, rapid pulsing or scanning of the latest generation of CO2 lasers, dermasurgeons are able to resurface the skin for cosmetic improvement. This technique removes fine lines and wrinkles of the face, smoothes acne scars, and rejuvenates aging and sun-damaged skin as it contours the skin surface.

When the CO2 laser's energy is defocused and not continuous (pulsed), the dermasurgeon can treat warts, shallow tumors and certain precancerous conditions.
When the CO2 laser energy is continuous and focused into a small spot of light, the beam is able to cut the skin. It is used in this way to remove skin cancers, to treat a variety of nonvascular and pigmented lesions and for eyelid operations. This technique is also used to remove warts and for some surgical incisions.

The high-powered erbium:YAG (Er:YAG) laser produces energy in a wavelength that gently penetrates the skin, is readily absorbed by water and scatters the heat effects of the laser light. These properties enable dermasurgeons to remove thin layers of aged and sun-damaged skin tissue with exquisite precision while protecting healthy surrounding tissue. The Er:YAG laser is commonly used for skin resurfacing to improve moderate facial wrinkles, mild surface scars or splotchy skin discolorations. Newer Er:YAG lasers have an extended pulse duration that allows them to act in a similar manner to the CO2 laser. Your dermasurgeon is best able to determine which of these lasers, alone or in combination, are best suited to correct your specific concern.

Through the use of an organic dye, short pulses of yellow-colored light are produced. A popular yellow light laser is the pulsed dye laser. Because yellow light is more precisely absorbed by the hemoglobin than other colors, these lasers are effective in the treatment of blood vessel disorders, such as port wine stains, red birthmarks, enlarged blood vessels, rosacea, hemangiomas and red-nose syndrome. Certain yellow light lasers may also be used to treat stretch marks and are safe and effective for infants and children. The krypton and Nd:YAG lasers are dual light systems. The uses of the yellow light are similar to those already described.
The green light, in contrast, is used for the treatment of benign brown pigmented lesions, such as café-au-lait spots, the "old age" spots commonly found on the backs of the hands and lentigines or freckles. Green light lasers are also used for the treatment of small blood vessels on the face and legs.

The red light spectrum produced by the ruby or alexandrite light laser is emitted in extremely short, high-energy pulses due to a technique known as Q-switching. The Q-switched ruby or alexandrite laser systems were initially used to remove tattoos, but are now commonly used to treat many brown pigmented lesions, such as freckles or café-au-lait spots.

When the pulse duration of the ruby or alexandrite lasers is lengthened, it is effective in removing unwanted hair for long periods of time, sometimes even permanently.


Delivering infrared light, it is used to remove tattoos and deep dermal pigmented lesions, such as nevus of Ota. This laser can also be tuned to produce a green light for the treatment of superficial pigmented lesions like brown spots, as well as orange-red tattoos.

The KTP emits a green light and is capable of treating certain red and brown pigmented lesions. When the pulse duration is lengthened, the Nd:YAG laser is also effective in removing hair and an inflammatory condition termed pseudofolliculitis barbae for months and sometimes permanently. This is particularly useful in the treatment of dark-skinned patients.

Instead of heating and removing the top skin tissue, non-ablative (non-wounding) lasers work beneath the surface skin layer to improve skin tone and texture and minimize fine lines with few side effects and a speedy recovery. Light-based devices that produce a broad spectrum of light (wavelengths) with computer-controlled parameters of energy delivery (Intense Pulsed Light, or IPL) can be adjusted according to a patient's skin type and condition. This technology is primarily used for the treatment of benign red and brown lesions, hair removal and facial skin rejuvenation.

Laser technology is presently being utilized for efficient and long-lasting body hair removal. The laser energy causes thermal injury to the hair follicle, stunting hair growth. Several laser hair-removal systems, including the diode laser, the long-pulsed alexandrite and Nd:YAG lasers and the IPL, are being used successfully with long-lasting results.

Until recently, lasers were used primarily for superficial facial veins. Thanks to the newest technologies, leg veins may be effectively treated with a variety of lasers and intense pulsed light systems.

Adapted from: Merck & Co. Inc