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Skin resurfacing using a chemical peel, laser peel or dermabrasion is one of the most popular methods of achieving younger-appearing skin. Plastic surgeons can use these techniques to improve the skin's appearance by removing the superficial surface of the skin (the epidermis and, in some cases, dermis) and allowing newer, undamaged skin (called the epithelium) to replace it.

Skin resurfacing may improve skin color, texture and pigment (brown spots, age spots and dark areas due to a variety of environmental factors), explains Jillian Banbury, MD.

Your plastic surgeon can help you decide which type of peel will best address the depth or severity of the problem you want to correct, such as wrinkles, fine lines, scars, etc. Deeper wrinkles or deeper injuries require deeper peeling techniques, which increase recovery time, post-treatment redness and risks. Although many patients are tempted to choose the least-invasive option possible to minimize their recovery, Dr. Banbury warns that being too conservative can lead to disappointing results.

"We can determine the depth of the damage in the office with an examination and use of diagnostic techniques such as ultraviolet photography," she says. "Many spas or salons are unable to make such a thorough medical assessment of their clients and therefore may recommend a technique that will not yield the desired improvements."

Types of Skin Resurfacing Techniques

For superficial peeling, chemicals such as glycolic acid, salicylic acid or Jessner solution are often used. Intermediate depth peels include various types of TCA (trichloroacetic acid). The Obagi Blue Peel, for example, is a TCA-type peel with blue coloring included to help the surgeon gauge how deeply it is penetrating. Deeper peels are required when wrinkles, lines related to aging or acne scars are deep. Such deep chemical peels utilize phenol-croton oil techniques. Laser techniques can also be used for deep injury.

Superficial peels require minimal downtime afterward. Intermediate-depth peels generally require a recovery time of a week to 10 days, and deeper peels require two weeks before makeup can be worn and before most patients can socialize without being self-conscious. The duration of redness is also related to the depth of injury or depth of the peel, Dr. Banbury explains.

How Peels Are Performed

In most cases, pretreatment with skin care products such as Retin-A or similar exfoliating agents and/or bleaches will be prescribed by your doctor prior to your peel. Superficial peels are performed on an outpatient basis without sedation; deeper peeling techniques require sedation.

Superficial peels require minimal aftercare. Intermediate peels with TCA require frequent moisturizing afterward. Laser peel aftercare often requires using tape to cover the affected area.

Superficial peels may be performed over the entire face, including the neck. Intermediate techniques may be performed over the entire face or over a portion of the face, such as the eye or mouth areas. Similarly, deep peels can be performed in specific areas only, such as the lips and mouth, or over the entire face.

Skin Resurfacing Risks

The risks with superficial peeling techniques are minimal. Occasionally peeling will occur for a short period of time, usually about 24 hours.

With intermediate and deep-peeling techniques, skin darkening (hyperpigmentation) or skin lightening (hypopigmentation) may occur. Hyperpigmentation is minimized by pretreatment as discussed earlier. Hyperpigmentation is treated with bleaches and will resolve over time. Hypopigmentation occurs because of injury to the pigment-producing cells and is related to the depth of the chemical peel; it is more common in darker-skinned patients.

Once the skin has healed, patients should resume their skin care regimen to maintain their results and avoid sun exposure for several months, Dr. Banbury cautions.