Skin

1. Smooth skin without pigmentation changes.
2. No scars, depressions or elevations.
3. No fine wrinkles.
4. Any scars that are present are flat and smooth. 

COMMENT:  The ravages of age appear most distinctly on the skin of our face.  Men especially neglect skin care.  Sun damage is often the worst offender. Freckles and uneven skin pigment, blotchiness, reflects sun damage and neglect.

1. Check your face for: 
     a. Areas of fine wrinkles. 
     b. Moles, freckles, other spots. 
     c. scars, depressions, uneven areas
2. Before you see the doctor, try some moisturizing cream at night before you go to bed. Stay out of the sun for the same week.  See what happens. 

1. Virtually everything.
2. Even deep acne scars can be repaired by a new technique.
3. Scar revisions can often eliminate or greatly improve scars.

1. Scar Revision

2. Benign Skin Lesions

3. Wrinkle Treatment

Years of sun damage and face movements age the skin of the face.  The finer wrinkles can be treated by a host of methods. Certainly cleansing is important to prevent the build up of bacteria, debris, etc.  Most routine skin care medicines are designed to remove the surface layers of skin and allow fresh skin to grow in.  They also moisturize the skin which allows it to retain water. 

The treatment of these usually involves the removal of the upper layers of skin through some destructive process that allows the re-growth of new skin that is thicker with more collagen to fill in the wrinkles. 

1. PEELING AGENTS (CHEMICAL RESURFACING) 
2. DERMABRASION (MECHANICAL RESURFACING)
3. LASER PEELING (MECHANICAL RESURFACING)

The difference from one peel to the next has mostly to do with the acid that is used. RETINO A is an example of a light acid peel.  Whether the material specifically causes fresh collagen to grow is still an issue.

The lightest peels are routinely performed with alpha-hydroxyl acids also known as FRUIT ACIDS.  These can be used on almost a daily basis to remove the outer layers of skin and gradually over time promote deep collagen growth.  Saloons often apply a 10 percent solution of GLYCOLIC ACID, one of the fruit acids.

Through a physician's office, stronger peels can be performed, usually between 30 and 70%.  We recommend a series of these peels for fine wrinkles with increasing concentrations.  This allows us to observe the overall skin reaction and benefit.

The medium strength is usually performed with trichloroacetic acid (TCA) usually in concentrations between 35 and 50%.  The deepest peels are produced with phenol, often in combination with croton oil in a formula known as Baker's solution.

Again, the difference has to do with the pH of the acid applied to the face.  The stronger the acid the deeper the peel. Also, the deeper the peel, the greater the benefits, but also the greater the risk of an undesirable skin reaction.

For fine wrinkles, a series of light peels with maintenance on some sort of light acid cream are highly recommended.  There is some feeling that most of the benefit in wrinkles that follows the use of Retino A results from it being an acid more than anything specific about the material itself.  Therefore, we generally recommend glycolic acids for light maintenance because there are less other materials of concern in the preparation.

Almost every dermatologist and plastic surgeon has their own recommendations and potions for the treatment of wrinkles. Most are very beneficial.

Patients with light complexion are far and away the best candidates for peeling because they have very little skin pigment that might cause the disturbing alterations that follow peeling.  Also be aware that some bleaching affect of the skin occurs so that the skin is lighter.  This has reversed the sun damaging affect that causes freckles and fine wrinkles.

If there is an issue of a skin pigment problem, the physician will usually initiate therapy with a light strength peel, then increase the concentrations.

Routinely treatment for acne scars falls into two categories.  One are the destructive procedures such as dermabrasion, chemical peels and laser treatments.  Secondly are the filler procedures in which bovine collagen or fat are used to fill the defects.

1. DERMABRASION: Dermabrasion works by sanding the outer surface of the skin with a high speed motor and a diamond drill bit to remove the outer layers.  The recovery can be slow and the skin surface red for weeks or even months.  This can be very effective in some regions of the face.

2. LASER PEELING: The laser is another tool to remove the outer surface of the skin.  As with the other techniques, all of the risks of scarring and pigment changes still exist.

1. PERSISTENT WRINKLES AND SCARS

2. PIGMENT CHANGES: The skin can get lighter or darker or blotchy in areas.  This may be improved afterwards with bleaching creams or steroids.  It may take a long time for this to resolve.

3. SCARRING: Deep peeling or dermabrasion may damage the deep skin and cause further scarring.  In patients who get cold sores (Herpes) a breakout may occur that causes ulceration.  Many doctors give Zovirax to prevent this.
4. INFECTION: The skin is open and must be kept clean to protect it from infection.