I want my skin to look better and rejuvenated but I don’t
want the downtime associated with surgery… so what are my options?
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By Steven H. Dayan, MD, FACS
A common question and one recently asked. The answer is greatly dependant on
your skin type and goals. For many baby boomers and generation Xers, sun worshipping
was a teenage right of passage, unfortunately by the time most realized the
cumulative negative effects much of the damage had already been done. Not only
does excess sun promote skin cancer (the most common cancer in the U.S.) but
it also accelerates aging of the skin. On a microscopic level collagen and elastic
fibers are broken down and pigmentary cells are over-activated. Outwardly the
skin becomes thin, blotchy, scaly, wrinkly, and at times can look like leather.
So what are options for improving skin if you think you may be heading down
this road? Well first and foremost the most important thing you can do is avoid
excess sun, smoking and wear sunscreens. Over the counter creams, lotions and
potions are highly touted to stop skin aging and promote collagen formation.
But while some of the ingredients used in these highly advertised products may
have some merit if used in the appropriate concentrations, when they are mixed
in these marketed solutions their efficacy is probably of little true lasting
value. Besides if these products do what they are claimed to than they would
or should be regulated as pharmaceuticals and have to provide scientific documentation
of their success. Medicinal products such as Tretinoin (Retin A) and higher
concentrations of alpha and beta hydroxy acids, vitamin C esters have been scientifically
documented to affect the upper layers of the skin in a rejuvenating manner,
however, their potency can be fragile and highly dependant on how they are mixed.
Also Retin A can cause a severe skin sensitivity reaction from the sun. But
if these home care products are used correctly they can provide real benefit.
At the other end of the facial rejuvenating spectrum are the deeply penetrating
aggressive treatments such as CO2 laser resurfacing, dermabrasion and phenol
chemical peels. While the results from such treatments can be dramatic the recovery
period is prolonged lasting up to months and real concerns for permanent complications
such as skin color changes is warranted.
++Renewed excitement has surrounded the highly effective and patient friendly
Erbium Yag laser resurfacing. This treatment removes upper layers of damaged
skin, stimulating collagen production and generating a fresh, new, healthy layer
of skin. This procedure can be done in the office, relatively quickly and with
little to no discomfort. Following a short recovery period, patients can expect
smoother skin, a decrease in wrinkle appearance and a fresh glow to their skin.
Many patients are thrilled to report a liberated feeling of no longer having
to wear heavy or camouflaging make-up. Results continue to improve over a three-
month period of time. Often one treatment is sufficient to satisfy most patients
however those with greater sun damage or facial scarring and irregularities
may notice continuing improvement with multiple procedures spaced six to eight
weeks apart. The enhanced facial appearance, though comes at a small expense
of downtime. In general the longer the downtime, the greater the energy used
and the better the result. The beneficial aspect of the Erbium Yag laser is
that the energy can be adjusted and therefore the expected amount of downtime
can be predicted so as to meet a schedule. In other words, if a person only
has a weekend available a less aggressive treatment can be performed on a Friday
and a return to a busy schedule can be expected by Monday. But keep in mind
that two or three less aggressive treatment may be required to reach the same
goal as one aggressive treatment. For those individuals who are seeking out
skin rejuvenating benefits that go beyond that achieved with superficial treatments
yet do not desire the downtime, expense or risk of the deeply penetrating treatments
then Erbium Yag laser resurfacing may be the ideal compromise.
