Article medically reviewed by Dr. Gavin Chan (MBBS, cosmetic physician, liposuctionist)
Templestowe Lower and Berwick Clinics
Dr. Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling, and laser treatments. He is a doctor trainer for various dermal fillers and anti-wrinkle injections.
What is skin resurfacing?
Skin resurfacing is the process of ablating, heating, and therefore regenerating skin using lasers, chemical peels, plasma energy, or by mechanical means.
Why is skin resurfacing performed?
It is primarily used to reduce wrinkles, improve skin texture, tighten skin, reverse sun damage, correct some pigmentation problems and help reduce acne scarring for example, or those caused by trauma or burns.
How is skin resurfacing performed?
Skin resurfacing is performed and has been performed in a number of ways. Essentially, all methods involve removing layers of the skin, whether it be with a laser, chemical peel, plasma energy or by mechanical means. In most cases, the procedure results in dramatic improvements in the skin wrinkling, texture, tightness, pigmentation, and scarring, but require a period of downtime or recovery.
Generally speaking, the procedures that are more aggressive have more downtime and usually have better results. New technologies, especially fractional laser technology, have tried to break this rule by obtaining better results with less downtime/recovery. To an extent, this has been possible with minimal compromise in the effectiveness of that procedure and significantly reduced recovery period. Where these new technologies have been able to make breakthroughs also is by decreasing the overall risks of a procedure to obtain a certain result.
How is skin resurfacing performed?
One of the first methods used to resurface skin was dermabrasion. This involves mechanical sanding (using a machine) of the skin under general anaesthesia. It should not be confused with microdermbrasion which is a very gentle procedure. True dermabrasion was commonly used for acne scars and wrinkles, but has since fallen out of vogue due to the high risk of scarring, pigmentation changes, and prolonged recovery (months) from the procedure.
Chemical peels are also a means of resurfacing the skin and these have been performed for many years. Particular peeling agents are used to remove and resurface layers of the skin. Generally, these are strong acids such as trichloroacetic acid or phenol, and when used in a controlled manner in a standardised setting, the results can be safe and effective. The results from peels however are very operator and peel dependent. As they can be performed without the need of expensive equipment, peels tend to be very cost effective in comparison to other methods of skin resurfacing.
The 1990s saw the rise of laser skin resurfacing. One of the first lasers used for this, which is still used today, albeit much less frequently, is the (fully ablative) carbon dioxide (CO2) laser. The carbon dioxide laser tends to removes a layer of skin with each pass, and causes some thermal injury or heating of the skin to help produce tissue contraction/tightening. The results were (and sometimes still are) considered to be the ‘gold standard’ for skin resurfacing, but often carbon dioxide resurfacing results in prolonged recovery periods, prolonged skin redness, scarring, an unnatural ‘waxy’ looking appearance to the skin, and gradual loss of pigmentation in the skin (hypopigmentation).
To combat the problems of the carbon dioxide laser, the erbium laser was introduced. The erbium laser was introduced as an alternative to the carbon dioxide laser that would require a more acceptable recovery period as well as fewer side effects, whilst still being an effective means of resurfacing the skin. The carbon dioxide, due to its heating of skin, causes more skin contraction/tightening than the erbium laser. The erbium laser removes a very thin slice off the the top layers of the skin to resurface it, but does so without much thermal energy. Usually multiple passes are required to achieve an adequate penetration depth. Recovery is quicker with erbium resurfacing, but there is not as significant skin contraction or results as the carbon dioxide laser.
More recently, fractional laser resurfacing has emerged as an alternative to traditional carbon dioxide or erbium laser resurfacing. As the name suggests, fractional lasers treat only a certain percentage of the skin. They achieve this by firing columns of laser energy into the skin, and leaving the skin adjacent to the columns relatively unaffected. This reduces the recovery period of the procedure, reduces the risks of the procedure, but also to some extent reduces the effectiveness of the procedure. For many patients, this is a viable compromise, given the potentially long recovery periods associated with fully ablative carbon dioxide/erbium laser resurfacing. Fractional laser resurfacing provides an excellent balance between recovery times, risks, and results. At The Victorian Cosmetic Institute, we use the Lumenis Ultrapulse carbon dioxide laser.
Table: A comparison of the various skin resurfacing procedures available
|Procedure||Dermabrasion||Chemical peels||CO2 laser||Fractional CO2||Erbium laser||Plasma skin regeneration|
|Downtime||+++++||+++||+++++||++ to +++||+++||++++|
Case study video diary
Dr Gavin Chan uses the CO2 laser to rejuvenate the under eye and upper lip area of his patient. Video diary post treatment.
Case Study 1
This patient is actually one of our theatre nurses. She is in her fifties, and has a significant degree of sun damage, wrinkles, and pigmentation in her before photo. She undertook carbon dioxide laser resurfacing, and the results, as seen in the after photo, are quite dramatic and show improvements in skin texture, wrinkles, pigmentation, and skin tightness (especially of the upper eyelids). There is approximately 6 weeks between the two photos.
What is involved with skin resurfacing?
In most cases, skin resurfacing will involve preparation of the skin prior to to treatment. This may involve sun avoidance, using sunscreens, topical retinoids, or topical lightening agents. These help to reduce the potential risks of resurfacing including pigmentary changes or scarring.
The procedure itself usually requires some form of analgesia/anaesthesia, and the degree of analgesia/anaesthesia required will depend on the depth or intensity and the surface area of the resurfacing. It can range from as little as numbing cream to as much as intravenous sedation with local anaesthetic injections.
After skin resurfacing, there is usually a recovery period of several days to weeks. Again this will depend on the type of procedure, and the depth and intensity of the procedure performed. Usually there is a degree of skin rednesss, swelling, crusting, and peeling that occurs. Skin usually needs to be kept moist with balms or vaseline during the pre-peel phase. Sun avoidance and gentle cleansing of the skin is also important during this time.
Why choose The Victorian Cosmetic Institute as your provider of skin resurfacing treatments?
At The Victorian Cosmetic Institute we use a combination of fractional carbon dioxide, and erbium laser resurfacing for skin resurfacing. We have been performing skin resurfacing for more than 10 years. We are able to provide you with the right settings for your skin and appropriate follow-up for your procedure.
Our treatments are performed by doctors specialising in this area, and we take all necessary precautions to ensure that your treatment is safe, effective, and pain-free, and that your post-treatment recovery is followed closely.