Patients are often confused about the different modalities available to rejuvenate the skin. Lets see if we can simplify the problem. As we age our skin undergoes a number of changes which essentially manifest themselves as fine wrinkles, blotchy spots, pigmentary alteration and sometimes increased porosity. The skin becomes thinner, due to the decrease in elastic and collagen fibres in the dermis. So how do the different types of treatment help. The principles are exactly the same Whether it is a cream, a peel, a dermabraision or a laser, each one has the same aim. That is to remove the upper layers of skin and allow the new cells to replace them . In doing so, a rejuvenating effect is seen. Creams such as Glycolic acid based products and Retin A are all useful, but take a long time (months) to achieve their effect. I think they are best thought of as maintainence tools rather than therapeautic agents. Peels may be with higher concentrations of glycolic acid or Trichloroacetic acid (TCA) which can give excellent results in a few weeks of regular treatment. Essentially these acids cause a coagulation of the upper layers of skin which then "shed" over the next few days.

The depth of the peel is determined by the concentration of the acid, and how long it is allowed to work on the skin before being neutralised. A TCA peel can be done in ten minutes in the office, and makes the skin slightly red. You can wash your face the next day and wear makeup, with no need to take time off. What about dermabraision? This is a process whereby the upper layers of skin are removed by mechanical means. A number of beauty parlours have acquired so called "microdermabraision" tools such as the so called "diamond peel". Rather than having a rotatating sandpaper like head which is characteristic of the traditional dermabraidors, the microdermabraidor uses crystals of Aluminium Chloride which are fired at the skin at great velocity through a hand piece, and quickly sucked back taking with it exfoliated epidermal cells. These are useful if the problem lies in the uppermost layers of the skin. Any deeper dermabraision results in bleeding and was used in the past for treatment of acne scars. This has now been surpassed by the Erbium Yag laser, which is no doubt the finest skin sculpting tool now available. The surgeon can remove the upper layers of skin with great precision concentrating more on problem areas and "feathering" the surrounding areas for blending purposes. The laser is very useful as an alternative to surgical excision of compound naevi ( moles) on the face. Treatment for acne scarring will involve rnultiple laser sessions, and a few months need to pass before the improvement is fully apparent. Facial resurfacing can be done in the office, under local anaesthetic.