So many skin changes happen with age. There’s a lot going on. You’ll notice that the surface of your skin gets increasingly dry over time, and small fine lines and wrinkles form and slowly become permanent. It gets harder and harder to get enough moisture into your skin. The color of your skin changes too: we develop an uneven skin tone and sun spots appear. What you see when you look at the skin is the surface layer, or epidermis. Throughout your life, the epidermis goes through a lot! When I was a young doctor, I wanted to look older, to garner respect. It seemed like the guys who had a few gray hairs had more gravitas, even when they were junior to me, and knew less. Now in my 50’s (and especially being in the world of aesthetics) I’d prefer to look younger, not older. How do I do that? Skin Resurfacing plays a central role.
When people refer to “skin resurfacing” they are talking about a variety of procedures that can renew the epidermis, and they all do different things. Most doctors are referring to laser resurfacing, but other treatments like chemical peels, IPL and even microdermabrasion can be referred to this way. In this article I’ll explain what these services do, why they help improve the surface of your skin, and ultimately what my recommendations are for skin resurfacing.
Check out the diagram below comparing younger skin to aging skin. You can see that the epidermis (the surface layer of the skin) shows many changes as you age. The goal of resurfacing is to remove, remodel and repair the epidermal layer so that is looks more like the younger skin epidermis. Resurfaced skin will be smoother, with fewer lines and uniform thickness. Any spotty pigment in the epidermis will also be lessened. Any true resurfacing treatment will address the entire thickness of the epidermis.
Resurfacing the skin with fractional lasers has become the gold standard. Laser light can be used to precisely remove a percentage of the skin surface area in a way that allows fast healing in a safe way. These lasers are known for “fractional” resurfacing by eliminating small columns of the skin surface while leaving the adjacent skin intact. The precision of these lasers allows them to remove the full thickness of the epidermis (along with the pigment and wrinkles in them) leaving enough adjacent skin intact to heal quickly. This way anywhere from 20 to 40% of the skin surface can be treated in each session.
There are ablative and non-ablative lasers for this purpose. Ablative lasers are effective but carry a higher risk profile than non-ablative lasers. Ablative lasers (like C02 and Erbium) vaporize the skin and require 1-2 weeks of downtime. Non-ablative lasers (like LaseMD) provide precise controlled damage (without vaporization) to the skin, triggering the skin to shed the damaged bits over a period of a few days. This is much safer and has minimal downtime compared with ablative lasers. With current technology, the best non-ablative laser for this is a 1927nm Thulium laser like the LaseMD. For resurfacing, I recommend a series of 3 of these treatments. Specific laser recommendations are in the summary below.
There are a variety of acids which, when applied to the skin surface, trigger the skin to peel. The vast majority of these are light or medium depth peels, which involves only the very surface layer of dead cells. These do not get to the entire epidermal thickness, the way lasers do. However, they are very effective at treating unwanted pigment like sun spots and melasma. There are deep peels as well, which penetrate down all the way to the dermis. Before lasers, these deep peels were the best way to resurface the skin and even stimulate new collagen formation in the dermis. However, these deep peels have a much higher risk of scarring and hypopigmentation, and are not safe on darker skin types. For this reason, chemical peels are not the best tool for skin resurfacing. I recommend light and medium depth chemical peels for exfoliation in addition to treating various skin conditions such as acne and melasma.
Some people think of IPL as a resurfacing tool, but this is incorrect. IPL is an excellent tool to decrease brown and red spots. It may cause some sloughing in areas of pigmentation, but it does not resurface the skin. One brand of IPL is called Broad Band Light or BBL, so you may have heard of BBL rather than IPL. For all intents and purposes, these are the same tool. IPL devices are similar to lasers but they are not one wavelength– instead, they are a band of wavelengths of visible light. And, yes, it is intense. When the IPL energy hits an area of pigment, the pigment gets darker right away and sloughs off over 1-2 weeks. This works well for people with light skin who want to treat sun spots. But IPL is unsafe on darker skin.
IPL is also used to treat redness and dilated blood vessels. When treated with IPL, blood vessels shrink. Often with a series of IPL, redness and rosacea markedly improves. But as you can see, IPL is a great tool for red and brown color changes, but it does not do much at all for resurfacing. Despite this, some aesthetics clinics sell IPL as though it does this. Always ask– what kind of resurfacing laser is being used? If you’re expecting resurfacing and they answer IPL or BBL, I would take your skin (and money) elsewhere.
Decades ago, along with chemical peels, dermabrasion was performed to resurface the skin, especially for scarring. Dermabrasion involved removing the entire epidermal layer with a physical exfoliation with an aggressive abrasion device. This is a mechanical version of a deep chemical peel, in the sense that you are removing the entire epidermis down to the dermis. This has been since replaced with more modern procedures. But over time, microdermabrasion was developed. Microdermabrasion involves a suction wand with a rough tip that scrapes the surface cells off the skin. The original devices used a crystal surface, but now most machines use a diamond tip. The dead cells are essentially rubbed off and vacuumed up. While microdermabrasion is an excellent exfoliation tool, it does not really resurface the skin.
Hydrafacial is a device that infuses various cleansers, peels and serums into the skin and then suctions them away. Hydrafacials exfoliate, but they also allow deep cleansing of the skin and pores and can be used to infuse various serums to treat skin conditions like acne, rosacea and pigment. Hydrafacial is just one brand of this device, though there are several that are similar. If microdermabrasion is like shop vac for your skin, think of hydrafacial as a wet vac. It is really good at exfoliating and cleaning dirt and debris out of the pores. But like microdermabrasion, it cannot resurface the skin.
A series of non-ablative fractional laser treatments is effective and safe for resurfacing the skin. At Glow Medispa, we use the LaseMD Ultra 1927nm Thulium laser for this purpose with great success. Usually a series of 3 is performed, since each procedure treats 20-40% of the skin.
Schedule your consultation today and find out if laser skin resurfacing is right for you!
Web design and development by Thrive Design