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

Part 1 - Exfoliation

It is our desire to send you periodic educational e-mails so that you can be better informed. There are many choices in advanced skin care, sometimes leading to confusion. These e-mails will try to differentiate between hype and techniques that work. This will be the first of a series of e-mails dealing with exfoliation and resurfacing.

Exfoliation is the superficial removal of dead cells on the surface of the skin. The word exfoliate is derived from the Latin exfoliatus "to strip of leaves." Webster defines the word "to cast or come off in flakes, scales or layers as in skin, bark, etc." This results in more rapid cellular turnover giving patients the benefits of healthier more radiant 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. Whereas resurfacing may take 3-10 days to heal (depending on the depth of resurfacing), exfoliation requires no healing time and except for occasional redness or irritation, the skin remains intact.

Many of the MD Forte advanced skin care products contain glycolic acid in different strengths. Glycolic acids are part of the Alpha Hydroxy Acid (AHA) compounds. The application of these products results in exfoliation. As the skin becomes conditioned to glycolic compound treatments, stronger concentrations of glycolic compound can be used. This results in a deeper exfoliation without the discomfort of burning, redness or irritation. It is important to maintain the program daily (or twice a day) to avoid the buildup of keratin and dead cells. In this way, moisturizing creams will penetrate more deeply.

At times, a deeper form of exfoliation may be needed, such as microdermabrasions and mild office peels. Together with skin care products, this will speed up the entire process of exfoliation. Candidates for this combined approach are patients with moderate sun damage, early wrinkling, or just dull looking skin. Candidates for a deeper form of resurfacing (dermabrasion, chemical peel or laser) together with skin care products are those patients with more advanced sun damage, deeper wrinkling, pre-cancerous lesions, and acne scarring.

Patients desiring exfoliation should follow this 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 Rejuvenation 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.

SUGGESTION: Don't forget to include the ears and the tops of the hands in your skin care program. These areas are beaten by the sun. I have taken care of many skin cancers involving these areas. Hands and ears should be protected by sunscreens and nourished with skin care products. Use your sunscreen thirty minutes before sun exposure to give ingredients time to work.