Fine Facial wrinkles, uneven pigmentation and scars (such as those caused by acne) can be improved by a number of resurfacing techniques.These Include Chemical peels, dermabrasion and skin laser resurfacing.

In essence the principle of these techniques are the same i.e. they address the problem by removing the superficial layers of the skin and improvement follows with new skin regeneration. The difference lies in the method by whichthe upper layers of skin are removed.

Chemical peels involve the application of a caustic solution to the face, causing coagulation of the upper layers of skinwhich "peel" off. There are a number of solutions which are used, the most common of which are alpha hydroxy acids (AHA's) , Glycolic acid is a widely used AHA found in most of your off the counter night creams, In low concentrations which causes peeling over a period of time. Higher concentrations of AHA are used by some plastic surgeons in their clinics as well. No anaesthesia is generally needed and the patient only feels a tingling sensation. You may apply make up straight after the procedure. Other chemicals used are trichloroacetic acid (TCA peels) and phenol, which have deeper penetration will require protection of the face afterwards and will leave the face erythematous ( red) for a while depending on the initial concentration of the solution. These chemicals offer an enhanced result in a much shorter period of time. The deeper the peel, however, the more risk of side effects such as changes in skin pigmentation, (especially in darker coloured skin) and potential hazard of scarring.

Dermabrasion involves the use of a small spinning wheel which has a rough surface, attached to a handpiece. This mechanically removes the upper layers of skin and is in effect a deep peel. It was used extensively some years ago for scarring to even out irregularities. It has been used with some success for acne scarring in particular.

Lasers have come into vogue in the last few years and are the most modern of the techniques used for resurfacing of the skin. In addition many different systems have developed over the last few years to cater for the demand, and manufacturers quote advantages of each system which add to the confusion of the patients! Much media publicity has been given to laser such that most people feel it is the "cure all" for skin problems which is really not the case. Lasers are different in their wavelengths, and the targets which they best address, and each one has its optimum use. No one laser system is able to do everything.

The carbon dioxide or C02 laser was widely used initially, but has problems of prolonged redness of skin in patients, and problems with pigmentary changes in the middle eastern skin types. The Erbium :Yag laser is far less invasive, and gives the surgeon more control over ablation of the upper layers of skin. For this reason it has been far more successful In the East, where darker skin types are more common.

Skin resurfacing with Erbium has been very useful to treat fine wrinkles, acne scarring, age spots, areas of varied pigmentation, and superficial skin lesions around the eyes especially. The procedure may be done under local anaesthetic, however full resurfacing procedures may require some additional sedation, Urethane ( redness of the skin) with this laser generally lasts no longer than two weeks. The skin is usually fully healed In five to seven days, during which daily dressings are done to keep the newly formed skin moist.

The resurfacing techniques listed above are generally very safe procedures when carried out by properly trained Surgeons. With regards to laser resurfacing, it is a question of balancing the amount of energy delivered to the skin so that the desired result is achieved without scarring or pigmentation problems. In Middle Eastern or Asian skin types, I usually prepare the patients skin for laser treatment with certain creams used for two to three weeks before doing the actual procedure, Less invasive procedures , simply used to refresh the skin can also be done with this laser, such that the down time to healing is much reduced and one can apply make up In 48 hours.