Skin Resurfacing

Dermabrasion is a surgical skin resurfacing procedure that mechanically removes controlled layers of the skin.

Dermabrasion should not be confused with microdermabrasion, a much more superficial, noninvasive treatment. Microdermabrasion uses abrasive crystals or a diamond-tipped device to gently exfoliate the outermost layer of the skin. Dermabrasion works more deeply, extending through the epidermis into controlled depths of the dermis.

Dermabrasion typically uses a rapidly rotating handpiece fitted with a diamond fraise or other abrasive attachment to precisely abrade the skin. Because the procedure is highly operator-dependent, careful control of treatment depth is important. Treating too deeply can increase the risk of scarring and other complications.

Dermabrasion can improve certain facial scars and acne scars by smoothing irregularities and blending scar edges more evenly with the surrounding skin. It may be particularly useful for certain superficial rolling and boxcar acne scars, while deep ice-pick scars generally require other treatment approaches.

Dermabrasion can also be performed at more superficial depths to improve selected textural irregularities and signs of skin aging. The controlled injury initiates healing and collagen remodeling, which can improve skin texture and reduce the appearance of fine lines.

Watch Dr. Athré demonstrate dermabrasion.

Learn more about dermabrasion.

Chemical peels use a carefully selected chemical solution to create a controlled injury in the skin, allowing damaged outer layers to shed as the skin heals.

Chemical peels can be performed at different depths depending on the concerns being treated. They are generally classified as superficial, medium-depth, or deep. Peel depth depends on several factors, including the peeling agent, its concentration and formulation, the number and method of applications, skin preparation, and the desired treatment endpoint.

Common peeling agents and formulations include alpha-hydroxy acids such as glycolic and lactic acid, salicylic acid, trichloroacetic acid (TCA), and phenol-croton oil formulations. Some agents can be used at different depths depending on how they are formulated and applied, so the peeling agent alone does not determine the depth of treatment.

During treatment, Dr. Athré applies the selected peeling solution carefully and evenly to the treatment area. Treatment is completed according to the specific peeling agent and the desired clinical endpoint. Certain chemical peels may also be used on areas such as the décolletage and backs of the hands when appropriate.

Superficial peels can improve concerns such as mild discoloration, rough texture, and superficial signs of photoaging, while deeper peels can produce more substantial resurfacing for appropriately selected patients. Greater treatment depth also involves more recovery and a higher risk of complications, so deeper peeling is not appropriate for every patient.

Chemical peeling is highly technique-dependent. Safe, predictable results depend on appropriate patient selection, careful control of treatment depth, and experience with the specific peeling agent being used.

Learn more about chemical peels.

Ablative laser resurfacing uses precisely controlled laser energy to remove targeted layers of skin and stimulate healing and collagen remodeling.

Two commonly used ablative resurfacing lasers are the carbon dioxide (CO₂) and erbium:YAG (Er:YAG) lasers. Both use energy that is strongly absorbed by water in the skin, allowing targeted tissue to be precisely ablated at controlled depths.

Ablative laser resurfacing can improve fine lines and wrinkles, including those around the eyes and mouth, as well as certain facial scars, uneven texture, and signs of sun damage. Some ablative lasers also have medical applications for specific superficial skin lesions, but these require appropriate diagnosis and treatment planning.

Laser resurfacing can be performed using either full-field or fractional treatment. Full-field resurfacing treats the entire targeted surface, while fractional resurfacing creates microscopic treatment columns surrounded by areas of untreated skin. This generally allows faster healing and can reduce some risks compared with full-field treatment, although results and recovery depend on the laser and treatment settings.

One way to picture the difference is to think of a garden hose. A full-field treatment is like a continuous stream covering the entire treatment area. Fractional treatment is more like placing a nozzle over the hose so the water reaches the surface in many small streams, leaving spaces between them.

Treatment intensity affects both results and recovery. More aggressive ablative treatments generally involve longer healing and greater risks, including prolonged redness, pigment changes, infection, and scarring. The appropriate laser and treatment settings depend on factors such as the condition being treated, skin characteristics, treatment goals, and acceptable recovery time.

Laser resurfacing can be performed on the full face or targeted to specific areas. When appropriate, Dr. Athré may also combine resurfacing with procedures such as eyelid surgery or a facelift to address both skin-surface concerns and other signs of facial aging.

Learn more about laser resurfacing.