Skin resurfacing is what some surgeons have called “nonsurgical facelifts”.  This is because the results in some patients are so dramatic that it does indeed appear as if the patient has had a facelift.  The procedure is designed to take away the damage caused by years of sun exposure, wrinkles caused by repetitive facial motions (such as smoking) and any discoloration.  Patients that benefit most from these procedures are those who have severe sun damage, fine lines and wrinkles and scars such as acne scars.  Most people have heard bits and pieces about skin resurfacing but do not truly understand the entire process that is involved.  The skin is divided into two layers: a superficial layer and a deep layer.  In resurfacing, the superficial layer of skin is removed from the deeper layer of skin.  In so doing, the aged skin is literally removed and the deeper layer forms entirely new skin.  This new skin has little to no memory of the wrinkles, scars and discolorations that characterized the old skin. The more severe the preoperative skin condition, the more dramatic will the results be.

There are three different types of skin resurfacing.  Lasers, chemical peels and dermabrasion are all used to resurface skin.  During your consultation, all of these will be discussed with you and then depending on your skin type, your expectations and desires, one of these will be recommended.  Some skin conditions do better with laser while others do better with dermabrasion or chemical peel.

Most patients are familiar with a variant of dermabrasion, microdermabrasion.  Microdermabrasion, as the name implies, is a more superficial variant of dermabrasion and is performed by aestheticians.  This procedure polishes the skin and should be repeated frequently for best results.  Dermabrasion is a deeper version and is performed by the physician.  The top layer of skin  is stripped away. The recovery time is much longer but the results are more dramatic as well as long lasting.

There are multitudes of peels that vary from medium to deep penetration.  The deeper the penetration of the chemical peel, the more dramatic the results will be.

The third technique is laser resurfacing.  Again, the laser may be set to produce anywhere from light to deep resurfacing levels.  All of these procedures cause the skin to have a more youthful appearance by replacing the old wrinkles with new skin.  A resurfacing procedure may be combined with a facelift as a “finishing touch.”  The facelift removes excess skin, droops and sags, while the resurfacing takes care of the wrinkles and fine lines.  Some patients undergo full face resurfacing while others only resurface specific areas.  Patients who smoke typically have fine wrinkles around their mouth and will undergo resurfacing around the mouth only.  Younger patients, who are only affected by crow’s feet, will undergo resurfacing only around the eyelid skin.

Resurfacing is considered a surgical procedure and must be performed under anesthetic sedation.   It is extremely important that you vigorously follow the postoperative instructions in resurfacing.  Because you will have new baby-like skin, it is imperative that you treat the new skin like baby skin.  We encourage you to avoid sun exposure and irritants until the skin has time to mature.   Skin resurfacing requires lots of “hand holding” and careful attention to postoperative care instructions, but the results are some of the most dramatic results in all of what we do!


How Do I Know Which Resurfacing Procedure is Best For Me?

With the choices of laser, chemical peel or dermabrasion, patients may feel confused about which procedure is the best skin resurfacing?  During your consultation, Dr. Blackledge will discuss the pros and cons of each procedure with you, and then decide which is best for you.  This decision is based primarily on your skin type.  We will do a thorough skin evaluation during your consultation and explain how your skin will respond to each type of skin resurfacing.


The Resurfacing Procedure

The key to a successful outcome and satisfied patient actually starts well before the day of the resurfacing procedure.  During your consultation, we will discuss the components to a thorough preoperative evaluation.  We will begin by reviewing your past medical history and discussing your current medicines.  This includes any vitamins or herbals because some of these can have an effect on bleeding.  We want to assure that you are in optimal health for the procedure.  It is during this time that we will recommend an herbal vitamin to take starting a week prior to the procedure to reduce bruising.  You will also get all of your prescriptions so that you can have them filled prior to the procedure.  Attention to every detail makes for a much smoother recovery period.  The majority of our resurfacing procedures are performed under “twilight anesthesia.”  Most patients are relieved when they find out that they have the option of not undergoing general anesthesia.

The resurfacing procedure may be done to the entire face or just to different sections of the face.  Some patients may only opt to address fine lines and wrinkles around the mouth area or the lower eyelids.  Other patients may want their entire face resurfaced.  Those decisions are made during the consultation based on how much skin damage you may have.  During the resurfacing procedure, the top layers of skin are removed either by the laser, peel, or dermabrasion and an occlusive ointment is then applied to the skin to keep it moist and to help it heal.


What to Expect during the Recovery

Even though the recovery period technically starts immediately after surgery, there are several things that you can do before your procedure day to make the recovery period smoother.  During your consultation, we will talk to you about the importance of being physically and mentally prepared for resurfacing to ensure that we get the best results possible.   Now back to the recovery period.  Immediately after the procedure, an ointment is placed over your face to facilitate the healing process.   You will be able to return home or to the bed and breakfast overnight facility for your first night after the procedure.  You will be reapplying the ointment every day for the next 7 days.  Most patients sleep the remainder of the day and night after the procedure.   The first day after the procedure is strictly a “bed rest” day.  Most patients feel better than expected, so the temptation is to “over do” it on this first day.  However, patients have less bruising and swelling if they rest with their head elevated on the first day.  Swelling is typically mild to moderate reaching its maximum on the third postoperative day, and then it starts to decline. Most people are presentable to the general public (with camouflage makeup) by day ten.  Of course, this varies with the individual healing process.  All of the “do’s and don’ts” for resurfacing will be given to you separately.


Bruising

Bruising is expected after any kind of surgery.  The amount that you bruise is extremely individualized – some people will bruise more than others.  However, with every patient,  we can expect a reduction in the amount that you bruise by taking Bromelane during the preoperative and postoperative period.  We encourage you to drink at least 8 glasses of water each day during your recovery period to flush the bruising out of your system.  Our experience with resurfacing is that the combination of Bromelane and water intake will reduce the amount of bruising that you normally would have had.
During the recovery period, you will notice that your bruising changes colors.  All bruises initially appear red and change to a purplish hue.  By day five, the majority of your bruises will have changed to a green and then yellow color.  Once you have reached the yellow stage, you are almost “bruise free.”


Swelling

Just like bruising, expect swelling.  The day after the procedure, swelling will actually increase over the next day.  Typically, swelling begins to decrease on the third day after surgery.  We often get the question, “what can I do to reduce swelling?”  The most effective treatment for reducing swelling is keeping your head elevated during the recovery period.


Sleeping

It is best to sleep in an upright position with your head at least above the level of your heart for the first two weeks after the procedure.  This helps to reduced swelling and also bruising.   The best beds are usually either a recliner or an incline pillow.  Both of these keep the head and shoulders in a natural position.  If you try to sleep with your head elevated with pillows, you wind  up sleeping in an unnatural position and develop muscle spasms in your shoulders.


Exercise

You may begin light walking on the seventh day after the procedure.  In fact, we usually encourage this because it helps to improve your circulation, which in turn gets rid of bruising and swelling quicker.  You can gradually increase the intensity of your walking over the next few days as your body tolerates it.  Your body will tell you how much exercise is enough.  We usually recommend that you refrain from any competitive sports such as tennis or golf for at least two weeks.  When it comes to exercise, don’t pull against any tight sensations that you may have.  Also, we will encourage you to be almost paranoid about sun exposure during the weeks following your procedure.  Remember, this is brand new skin…..you should treat it exactly like you would treat a baby’s skin!


Pain

A popular question is “how much pain will I have after a resurfacing procedure?”  Most patients will tell you that they had little to no pain after the procedure.  The common response is that everything felt “tight.”  This is usually due to swelling and the tight sensation begins to subside after about 2 – 3 weeks.  Patients are given prescriptions prior to surgery for pain medicine and are encouraged to take theme as directed for discomfort.  However, most patients switch to Tylenol soon after surgery.


When will I look presentable?

Obviously, this is a very individualized answer.  The average patient is able to go back in public without being obviously swollen or bruised by about 10 – 14 days.   You will have a pink color to your skin that will require camouflage makeup for usually up to 6 weeks.