Skin resurfacing refers to a group of techniques used to improve a variety of imperfections on the face by removing layers of skin so that new, healthier-looking skin will appear.
At UCSF Health, our facial plastic surgeons offer a variety of skin resurfacing techniques, including laser resurfacing. Although a very new approach, it has been shown that in some cases laser resurfacing causes less bleeding, bruising and postoperative discomfort than is typically experienced with other resurfacing methods. Our team also offers more traditional skin resurfacing approaches, such as chemical peels, dermabrasion and dermaplaning.
It is important to note that because skin resurfacing has become so common, it may be offered in a nonmedical setting and performed by people who are not adequately trained. It is highly recommended that you receive treatment from an experienced, board-certified facial plastic surgeon. Be sure to check the plastic surgery qualifications and background of the provider before undergoing any skin resurfacing procedure.
Skin resurfacing may treat:
- Wrinkled or sun-damaged facial skin
- Vertical wrinkles around your mouth, such as those that cause lipstick "bleed"
- "Crow's feet" lines around your eyes
- Loose skin in your lower eyelid area
- Fine wrinkling of your upper eyelids
- Brown spots or blotchy skin coloring
- Certain precancerous skin growths
- Scars from acne or chicken pox
- Superficial facial scars from a past injury
It is important to note that although skin resurfacing can improve the conditions listed above, it cannot completely erase facial flaws or stop the effects of aging.
If you are considering skin resurfacing, you will first meet with a facial plastic surgeon for a consultation. Please bring information about your medical history, including previous surgeries, present and past health problems, and any medications, vitamins or nutritional supplements you are taking or have taken. Be sure to tell your plastic surgeon if you have ever had X-ray treatments of your facial skin, such as those used in acne treatment, or if you have had a prior chemical peeling procedure. You should also tell your surgeon about current or past use of Accutane, Retin-A and other topical skin preparations.
Your surgeon will ask you to point out the areas of your skin that you would like improved. He or she will then carefully examine your skin type and the extent of skin damage to determine which type of skin resurfacing technique will best meet your needs. In some cases, your surgeon may recommend having other procedures performed at the same time, such as eyelid surgery or a facelift.
If you decide to undergo skin resurfacing and your surgeon thinks that you are a good candidate, he or she will explain the techniques and anesthesia that will be used, the type of facility where the surgery will be performed, and the risks and costs involved. Be sure to ask your surgeon any questions you may have and also to express your concerns and expectations related to the surgery.
Health insurance typically does not cover skin resurfacing procedures because they are considered cosmetic. However, in some cases, if your procedure is being performed to treat precancerous skin conditions or improve certain scars, your health insurance may provide partial or full coverage. Be sure to check your insurance plan or call your insurance carrier to determine whether you can receive any coverage for your procedure.
Although very infrequent, skin resurfacing may cause:
- Infection or abnormal healing
- Activation of herpes virus infections ("cold sores") and sometimes other types of infections, especially in people who are prone to them
- Burns or other injuries from the heat used during laser resurfacing
- Obvious lightening or darkening of the treated skin
- Formation of raised or thickened scars
- Unanticipated skin color changes or skin blotchiness
You can help minimize certain risks by choosing an experienced, board-certified plastic surgeon, and following his or her specific instructions on how to prepare for your procedure. Your plastic surgeon will provide you with guidelines on drinking, smoking, and taking and avoiding certain medications and vitamins. If you smoke, it is highly recommended that you stop smoking for a period of time before and after your procedure.
Our team of plastic surgeons specializes in a wide range of skin resurfacing techniques, including chemcial peels, dermabrasion and laser resurfacing. Based on your cosmetic goals, characteristics of your skin, and the extent of damage to your skin, your surgeon will choose the method that best meets your needs.
Chemical peels are typically performed in your facial plastic surgeon's office without the use of anesthesia. There are different kinds of chemical peels, which vary depending on their strength and ingredients. Also, in some cases, one single treatment of chemical peel will give your skin a fresher, healthier appearance, while repeated treatments may be recommended to further improve the texture of your skin.
During a chemical peel, your surgeon will use a sponge, cotton pad or cotton swab to apply the solution to either your entire face or to just specific, targeted areas. The depth of the solution's peeling action is determined by how long your surgeon leaves the chemical peel on your face, and whether it was applied lightly or rubbed onto the skin. After applying the chemical peel, your surgeon will observe your skin for changes, to determine how long the solution should remain on your face. Some chemical peels become inactive on their own after a certain period of time.
Types of chemical peels include:
- Chemical peels using alpha hydroxy acids (AHAs), such as glycolic acid. AHA peels are used to reduce the effects of aging and sun damage, including fine wrinkling and brown spots.
- A trichloracetic acid (TCA) peel is often used for the treatment of wrinkles, pigmentary changes and skin blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck and other parts of the body that have been exposed to the sun.
- A phenol peel is sometimes recommended for treating particularly rough and sun-damaged facial skin, and is effective in reducing the appearance of wrinkles ranging from fine lines to deeper creases. It can also correct pigment problems, such as blotchiness or age-related brown spots, and may be used in the treatment of precancerous skin conditions.
Dermabrasion and Dermaplaning
Dermabrasion and dermaplaning use a method of controlled surgical scraping to smooth the skin's top layers, resulting in a healthier, restored appearance. The procedures are fairly short, taking anywhere from a few minutes to an hour and a half, depending on the size of the area of the skin. The procedures can also be performed more than once, or in stages, depending on the extent of the skin's damage and the size of the area of skin to be treated.
Dermabrasion is typically used to improve the appearance of facial skin scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It's also sometimes used to remove precancerous growths called keratoses.
During this procedure, your surgeon will scrape away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, which is attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.
Dermaplaning is often used to treat deep facial scars caused by acne or other conditions, such as chicken pox. During this procedure, your surgeon will use a hand-held instrument that resembles an electric razor, called a dermatome. The dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.
In some instances, laser resurfacing, also known as laser peel, offers a number of advantages compared to other resurfacing techniques. These include a higher degree of precision, less bleeding and reduced postoperative discomfort.
Laser resurfacing is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes. However, it is also effective in treating facial scars or areas of uneven pigmentation. The procedure may be performed on the whole face or in specific regions.
Laser resurfacing uses a carbon dioxide (CO2) laser to remove areas of damaged or wrinkled skin, layer by layer. During the procedure, the laser is carefully passed back and forth over the skin until the surgeon reaches the level that will make the wrinkle or scar less visible.
In most cases, laser resurfacing is performed on an outpatient basis in an outpatient surgery center or surgeon's office-based facility. However, for more extensive procedures, or for those that are being performed in conjunction with other surgical procedures, they may be performed in a hospital, where you may stay for one or two nights.
Laser resurfacing is most commonly performed under local anesthesia with sedation, especially when it's used to treat localized areas of the face. You'll be awake but relaxed, and will feel minimal discomfort. For more extensive resurfacing, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.
Recovery will differ for each patient, and the healing process occurs in stages.
After your procedure, your surgeon may apply protective creams or ointments to your resurfaced skin until healing is complete. Your surgeon will advise you about cleansing your skin, as well as when to apply ointments or creams. It is essential to follow your surgeon's instructions so your skin heals properly. In some cases, a bandage will be applied over the treated skin for five to 10 days following surgery.
Redness and swelling are to be expected if you have had a deeper chemical peel, dermabrasion or laser skin resurfacing. About seven to 10 days after your skin resurfacing procedure, new skin will begin to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but your plastic surgeon will advise you.
Although you will gradually see improvements, it may take months for all of your skin's pinkness to subside and the final results of your procedure to become apparent. Once the skin heals completely, most patients are very happy with the results of their skin resurfacing.
Resuming Normal Activities
Your surgeon will provide you with specific instructions and guidelines for resuming your regular daily routine. It is very important to follow your surgeon's instructions to make sure your skin heals properly.
During the week following your procedure, it is recommended that you avoid any straining, bending and lifting. In most cases, you should be able to return to work within a week or two. Exercise or other strenuous activities may need to be delayed a few weeks longer.
Your surgeon will schedule frequent follow-up visits in the months after your procedure to check on your progress. If you have any unusual symptoms between visits or any questions or concerns, please don't hesitate to call your surgeon's office.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
William Y. Hoffman
MDPlastic and reconstructive surgeon
P. Daniel Knott
MD, FACSFacial plastic, aesthetic and reconstructive surgeon
Mary H. McGrath
MD, MPHPlastic and reconstructive surgeon
Jason H. Pomerantz
MDPlastic and reconstructive surgeon
MDFacial plastic, aesthetic and reconstructive surgeon