Through the Decades in Skin Resurfacing

Skin Resurfacing-

Skin resurfacing involves removing the epidermis or top layer of the skin and variable levels of the deeper dermis to allow a new skin to grow from skin appendages. The removal can be performed with chemicals, by a mechanical technique such as diamond fraise wheel, or with various lasers. If the epidermis is completely removed the treatment is “ablative” and if no it is “non-ablative”.

 My first exposure to skin resurfacing was as a medical student at Tulane in New Orleans. I was rotating with Jack Anderson and attended his cosmetic surgery course. At that time the choice for resurfacing was a “Baker Gordon Peel” which was mixed from phenol, croton oil, water and green soap. This was applied followed by tape for days.  Healing was prolonged-  some results were good but other patients had a waxy unnatural look afterwards. Hetter later noted that croton oil was the active ingredient and described variations of  concentrations of ingredients. We later used various combinations of tricholacetic acid (TCA)..    Frustrated with our inability to treat the deeper wrinkles particularly around the mouth effectively and safely, we also used mechanical abrasion or dermabrasion with good results. Dermabrasion was very technique dependent and results varied from surgeon to surgeon.

In the early 1990’s the CO2 laser was developed to resurface and was especially effective for aging changes. We were quite excited with the results of the early full field CO2 lasers. Unfortunately there were some problems, the worst of which was “delayed hypo pigmentation”—basically the skin could lighten as much as 18 months after the initial treatment. Later came the concept of “fractional” laser resurfacing which used small “dots” of laser and left normal skin between. 

For many years the fractional CO2 laser was our “go to” for laser resurfacing of the photo aged skin. It is still useful but does generate collateral heat surrounding the treated areas and thus can cause pigmentation problems. More recently we have adopted the Joule system from Sciton Lasers. This Erbium system allows us to really individualize the depth of treatment and achieve optimal results with fewer problems. Erbium unlike CO2 generates less surrounding heat. Full field Erbium with the Sciton Contour system is now our laser of choice for deeper wrinkles.

 What is really exciting however are the non-ablative lasers that over a few treatments can approximate the results of ablative lasers. Our current favorite is the Halo treatment. Halo combines two wavelengths the 2940 nm wavelength erbium and a new wavelength 1470 nm- both can be finely tuned and their coverage varied. Both absorb strongly to water and thus are less painful. Halo is an excellent option for those who don’t wish the more prolonged healing seen with full field Erbium treatments.

#laserresurfacing #Halo #facialrejuvenation