FACIAL RESURFACING
Facial Rejuvenation

• What is Facial resurfacing?		• Am I a Good Candidate?
• Are There Alternatives?		• What are the Risks?
• Laser Skin Surfacing		• Chemical Peels
• Non-Surgical Options

What is Facial resurfacing?

Many factors contribute to the development of facial wrinkles and damage to the skin. Aging, sun exposure, one's genetic background and lifestyle, and other factors such as nutrition, smoking, and alcohol consumption, all play a role in the way our skin looks, causing it to appear thin, wrinkled, and dried-out. Blotchiness, pigmentation changes, and brown spots may occur as a result of oral contraceptives, pregnancy, or genetic factors. In some patients, a history of acne in adolescence may have left the skin rough and uneven. The aged, damaged appearance of the skin that results from these multiple factors over time can often be improved by skin resurfacing.

A number of techniques have been developed to accomplish the goal of a refreshed appearance of the skin. These include dermabrasion, chemical peel, and laser resurfacing techniques.

Am I A Good Candidate for Skin Resurfacing?

You may be a good candidate for skin resurfacing if you have one or more of the following conditions:

• wrinkled or sun-damaged facial skin which has lost it's elasticity and firmness
• vertical wrinkles around the mouth, causing your lipstick to "bleed" into these lines
• "crow's feet" at the corners of the eyes, or a "crinkled" appearance of the eyelid skin
• brown spots or blotchy, irregular skin coloring
• acne or chicken pox scars
• certain types of pre-cancerous rough skin growths
• old, superficial scars from previous injuries or stitches

Patients with these characteristics are candidates for a skin resurfacing procedure, which can be done at any age. Because each patient's skin condition, genetic background, and risk factor profile is unique, not every technique is applicable in all cases. Patients who are currently taking Accutane", Retin-A", or other topical skin treatments, those who have previously had resurfacing procedures, or those with active skin infections involving the areas to be treated may not be good candidates. Generally, treatments which are more superficial will require less time for healing, however the results may not be as long-lasting. In such cases, the procedure may need to be repeated at a later date in order to maintain the same type of result as might be expected from a deeper, more extensive treatment. Dr. Cambre will help you to determine which Skin Resurfacing procedure is right for you.

Are there Alternatives to Skin Resurfacing?

Realistic expectations are important. Not all skin flaws will be removed by skin resurfacing, and the skin will continue to age. Lines which are the result of normal facial muscle activity - smiling, laughing, squinting, etc. - will naturally recur over time. Other measures, such as Injectable Fillers (Collagen, Restylane, Radiance, etc.) or Botox treatments, may be required for heavier lines, or those caused by excessive muscle activity in certain locations on the face. In some cases, excessive laxity of skin cannot possibly be tightened sufficiently by skin resurfacing, and other facial rejuvenation procedures, such as Facelift, Brow Lift, or Blepharoplasty (Eyelid Lift) are necessary, to help you achieve the results you desire.

What should I know about The Risks of Facial Resurfacing?

All skin resurfacing techniques carry some risk of complications, although such complications are infrequent and usually minor. However, because of individual patient variables in existing skin conditions, wound healing characteristics, nutrition, lifestyle, etc., the risks are not always predictable. Minor complications include the development of tiny whiteheads (milia) due to skin irritation during healing. These may require a minor treatment for removal, or the use of an abrasive skin cleanser. The skin may be temporarily more sensitive to drying or cracking, and may require the use of moisturizers. Patients who suffer from cold sores may experience a flare-up of this condition following resurfacing. Some treatments (especially phenol peels) may produce a bleaching effect on the skin, but other types of resurfacing treatments may cause unanticipated color changes or skin blotchiness. Rarely, raised or thickened scars may occur, which may be permanent.

Laser Skin Resurfacing

Of the various techniques for skin resurfacing, the use of the laser for this purpose is the most recent development. Dr. Cambre uses one of the newest lasers, the Ultrapulse carbon dioxide (CO2) laser, to treat sun-damaged skin, facial wrinkles, and scars.

What is a LASER?

The word "laser" is an acronym, which stands for Light Amplification by the Stimulated Emission of Radiation. A surgical laser, such as the CO2 laser, produces a beam of light capable of sequentially removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of high-energy photons (light particles) that are absorbed by water in these cells. Laser light penetrates to a precise depth which can be controlled and adjusted depending upon the chosen energy setting. This makes the procedure safe and predictable, while reducing the risk of scarring or pigmentation problems. Laser skin resurfacing is performed on an outpatient basis under light sedation or general anesthesia. Laser resurfacing may also be combined with other aesthetic surgical procedures. As a result of this treatment, you are left with fresher, firmer, smoother-looking skin.

What Areas Can Be Treated With Laser Resurfacing?

The laser is used to reduce fine wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve blotchy, sun-damaged and acne scarred skin, problems that often cause concern to both men and women. The entire face and eyelid areas can be treated, and patients with a variety of complexion types, including darker skin, can also be treated.

What are the Benefits of, and Alternatives to, Laser Resurfacing Treatment?

Laser resurfacing is an alternative to other techniques of Skin Resurfacing such as chemical peel and dermabrasion. The benefits of the laser technique may include less pain and a faster recovery time. There is somewhat less likelihood of bleaching of the skin with the laser technique than with Phenol peels. Patients may also notice improvement in areas of facial pigmentation irregularity. In many cases, there is a mild "tightening" effect on the skin, which is especially useful in the lower eyelid areas.

Before Your Laser Resurfacing

Prior to your laser resurfacing Dr. Cambre will discuss your goals for improvement of the facial skin. The skin is usually pre-treated with Retin-A, Glycolic Acid products, or pigmentation lighteners before surgery, to improve the healing time.

The Laser Resurfacing Procedure

A local anesthetic is given to ensure that you are comfortable throughout the procedure. General anesthesia or sedation is usually advised, to avoid discomfort in areas that may not be completely numbed by the local anesthetic. Dr. Cambre directs the laser beam toward your skin imperfections. The laser quickly and accurately vaporizes the outermost layers of skin with each pass. Each area may be treated more than once in order to achieve optimal tightening and removal of imperfections. Treatment may be directed to specific areas (e.g., around the eyes and/or around the mouth) or to the entire face. If the eyelids are to be treated, special metal shields will be used to protect the corneas. At the completion of the procedure, a light ointment is applied to the treated skin areas, to facilitate healing and to provide comfort.

Your New Look

In most cases, only one treatment session is needed. After approximately a week to ten days, the new skin surface growth will be complete. The initial redness of the skin fades in a few weeks to a light pink, which can be concealed with makeup. The discoloration usually disappears in two to three months. The goal of laser resurfacing is to improve the appearance of the facial skin. Results of the surgery depend on many factors such as your hereditary skin type and quality, your age, sun exposure, and overall health habits. Expectations by the patient must be realistic, and results should be anticipated as improvement rather than total correction of the quality of the skin.

Dr. Cambre will continue to monitor your progress and work with you to arrange a program of healthy lifestyle, skin care, and periodic maintenance procedures to enhance the longevity of your result, and to keep you looking your best following your Laser Resurfacing procedure.

Chemical Peels

Chemical peel is helpful for wrinkles, light acne scarring, and irregular pigmentation such as freckles and age spots. It is meant to diminish imperfections by peeling away the skin's top layers. Chemical peels vary according to their specific ingredients and their strength. Depth of peeling action may also depend on factors such as how long solutions remain on the skin and whether they are lightly applied, or more heavily or vigorously applied. Pre-cancerous conditions such as keratoses (thick, rough, reddish growths) also respond well to this procedure.

There are several types of chemical peels:

Alpha Hydroxy Acid (AHA) peels are the lightest type of chemical peel. They are derived from purified forms of a number of naturally-occurring biological acids, such as glycolic (apple) and lactic (milk) acids. The concentrations (strengths) of these acids can be varied, and they can be applied at weekly or longer intervals in order to achieve the desired effect.

What Are the Benefits of AHA Peels?

• No anesthesia or sedation is needed. Usually, patients experience only a mild tingling or stinging sensation when the solution is applied.
• Sometimes a single treatment will give skin a healthier, radiant look.
• No downtime--patients can immediately resume normal activities.
• AHA's can be mixed with a facial cream or wash in milder concentrations as part of a daily skin-care regimen.

Generally, AHA peels may require multiple treatments in order to maintain their beneficial effects.

Tri-Chloro-acetic Acid (TCA) peels are an intermediate-strength chemical peel. TCA generally penetrates to a deeper level than AHA peels, and has a longer-lasting effect.

What Are the Benefits of TCA Peels?

• TCA is especially effective in treating darker-skinned patients.
• TCA can sometimes be used to achieve some effects of a deep peel, depending on the concentration and manner of application. Recovery time is generally shorter than with a deep (phenol) peel.

TCA peels may require pretreatment with AHA or Retin-A creams. Often, repeat treatment may be required in order to maintain the beneficial effects. Deeper TCA peel may require up to 10 days for sloughing and healing of the peeled skin to occur, prior to the use of camouflage cosmetics, or scheduling of social engagements.

Phenol peels are the strongest form of chemical peel. Phenol peeling is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area, and in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas.

What Are the Benefits of Phenol Peels?

• Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient's skin can be quite dramatic.
• Normal work schedule and other activities can be resumed after 1 to 2 weeks.
• Variants in the phenol peel formula can create a milder solution for broader use.

Possible postoperative complications can include scarring, infection or abnormal pigmentation. Phenol tends to have a bleaching effect, and a patient may need to wear make-up to blend treated and untreated areas. While AHA and TCA peels can often be done in the office, Phenol peels are a major procedure that must be done in an outpatient surgery center setting, with EKG monitoring. Phenol cannot be used on the neck or other parts of the patient's body.

Chemical peels are generally not as effective in treating individuals with dark, oily complexions. Some facial skin disorders do not respond to chemical peeling. Skin pores may appear larger, and the skin may not tan properly in some cases, after a chemical peel. Patients with a previous history of Herpes Zoster or cold sores may be prone to re-activation of the virus. All forms of deep skin peels include the risk of delayed healing and scarring. Before Your Chemical Peel

Dr. Cambre will discuss with you your goals for the chemical peel process. In some cases, Dr. Cambre will choose to perform a small "test" patch of the chemical peel in an inconspicuous area of the forehead or behind the ear, to be certain that the chosen technique is compatible with your skin type, before treating the entire face or target area. Dr. Cambre may also suggest the use of bleaching agents or light peeling treatments in order to enhance your outcome or to speed your recovery after the peel.

The Chemical Peel Procedure

Dr. Cambre will select the best chemical or chemical mix for the individual characteristics of your skin, after fully discussing with you the options and alternatives, and your desires. The chosen solution is applied--using a sponge, cotton pad, cotton swab or brush--to the areas to be treated. This may take only a few minutes for the lighter AHA or TCA peels, and can typically be accomplished without anesthesia. For the deeper Phenol peels, you will usually require general anesthesia, and the procedure will take from one to two hours to complete. After the lighter peels, there is often no need for dressings or ointment to be applied to the skin. For the deeper Phenol peels, Dr. Cambre will typically cover your skin with an occlusive ointment. In the case of severe wrinkles around the mouth and eyes, Dr. Cambre may also apply a tape mask to enhance the penetration of the peel. This mask will be removed in about two days after your peel, under a light anesthetic.

Your New Look After a Facial Resurfacing Chemical Peel

The lighter peels can be accomplished with minimal or no "down-time". In most cases, there is a slight flaking and mild redness of the skin, which may also seem slightly dryer. The amount of improvement varies and depends upon the initial condition of the patient's skin. Significant improvement of damaged skin can be achieved, which can produce dramatic results.

Non-Surgical Skin Rejuvenation

A skin rejuvenation program is often used in conjunction with either chemical peels or laser wrinkle removal to reduce the fine wrinkles of the face, to lighten areas of hyperpigmentation, and to produce a softer texture to the skin. The program can be carried out separately or in conjunction with the other surgical facial rejuvenation or skin resurfacing procedures listed here. After a consultation establishment of a treatment plan for your cosmetic needs, Dr. Cambre will recommend skin care products you can use at home on an ongoing basis, to maintain your new look.

We invite you to inquire about laser skin resurfacing, chemical peels, microdermabrasion, and daily home skin care regimens, and hope it can help you achieve smoother, fresher, younger-looking skin.