Skin Rejuvenation - Exfoliation to Resurfacing
By Peter T. Pacik, M.D., F.A.C.S.

Part 4- Resurfacing

Long before advanced skin care products became available, plastic surgeons and dermatologists used resurfacing procedures to help freshen the skin. Resurfacing is a deeper removal of the outer layers of skin than exfoliation, accomplished by chemical peel, dermabrasion or laser. New cells are made by the remaining dermis (under surface of the skin) resulting in a newly healed surface ("resurfacing"). This results in fresher, healthier, and more radiant skin and is suitable for wrinkles, sun damage, pre-cancerous actinic keratoses, and acne scarring. There is a period of healing during which time the skin is moist and weeps fluid. Light resurfacing allows the skin to heal in 3-5 days and deep resurfacing may take 7-10 days or more. Initially, the healed skin is red. After a few weeks to months (depending on the depth of resurfacing), the skin turns pink and then later a more normal color.

There are a number of advantages and some disadvantages to resurfacing. In patients with facial aging and sun damage, microscopic analysis of the skin shows disarray of the pink stained collagen fibers. After resurfacing, the collagen fibers are arranged in a more parallel formation as would appear in younger, healthy skin. By removing the upper layer of keratin and dead cells, the skin can be penetrated more easily by moisturizing agents. Additionally, pre-cancerous actinic keratoses (scaling lesions of sun damaged skin) are improved and often eliminated. Wrinkles are smoothed, and acne scarring can be improved. Disadvantages of resurfacing procedures include the need for some form of anesthetic, recovery time, and the potential loss of pigment due to the destruction of underlying melanocytes. In recent years, doctors doing resurfacing procedures have recognized the importance of doing lighter and possibly more frequent resurfacing to allow the skin to maintain a normal color.

Advanced skin care with the use of glycolic compound exfoliates the outer layers of skin (keratin layer and dead cells) and also allows better penetration of moisturizing agents. After healing, resurfaced patients should follow the MD Forte 3-Step Advanced Skin Care Program. See below for links to individual products.

1. Facial Cleanser I or II (start with I -12% glycolic compound, advance to II -15% glycolic compound). Gentle, creamy cleanser removes daily residue, makeup and oil without harshness or dehydration.

2. Facial Cream I, II or Skin Rejuvenating Lotion I or II. Facial Cream I (15% glycolic compound) and II (20% glycolic compound) exfoliates, softens and refines dry skin. Skin Rejuvenation Lotion I (5% glycolic compound) improves dull, lifeless complexion or for sensitive skin. Skin Rejuvenation Lotion II (20% glycolic compound) is a higher strength for advanced correction.

3. Aftercare Environmental Protection Cream SPF 30 (glycolic free) for maximum protection against UVA/UVB exposure.

LRS and Kinerase are added to enhance the skin care program. These products will re-establish moisture and maintain the healthy, glowing appearance of the new skin.

Over-the-counter and esthetician products contain a smaller percentage of glycolic acid. These products are often neutralized to the degree that they are poorly effective. Forte has stronger concentrations of glycolic acid; and therefore, is both more effective and works quicker. Because of these stronger concentrations, they are available only through a doctor's office.

In future e-mails, I will discuss dermabrasion, chemical peel, laser, the proper use of sunscreens and much more. If there are any topics that you would like covered in these educational e-mails, please let us know. We encourage you to share your experiences both positive and negative with us. Your comments are important to us.