Facial Resurfacing | Beverly Hills & Mission Viejo
Taylor R. Pollei, MD
Fellowship Trained Facial Plastic Surgeon offers facial resurfacing in Beverly Hills and Mission Viejo CA
How Does Skin Age?
Pollei Plastic Surgery will help you restore a more youthful look by offering facial resurfacing at our Beverly Hills & Mission Viejo locations. Our skin definitely changes with age and these skin changes can be accelerated with increased sun exposure, worsened by smoking, and definitely have a genetic component. Unfortunately, by the time most patients are interested in pursuing treatment to improve skin quality and the appearance, much of the damage is often done. Even patients who take the best care of their skin will still notice that it thins, loses its elasticity, and develops discolorations and texture changes. Additionally, fine lines or heavier wrinkles occur, pores can enlarge, and small blood vessels often become more visible.
Any skin aging is exacerbated by the descent of facial soft tissues and bone loss. These changes all go hand in hand to make the face appear more aged and worn out. Fortunately, there are multiple different methods to resurface facial skin, from less aggressive office-based procedures to more aggressive procedures requiring sedation and anesthetic.
What Can Facial Resurfacing Do For Me?
There are different ways to view resurfacing techniques including laser resurfacing, chemical peels, dermabrasion, or even MicroNeedling. The value of one versus another treatment really comes down to the desired effect, as well as what specific concerns the patient wants to address.
Laser resurfacing (typically with a carbon dioxide, or CO2 laser) is meant to address specific issues like acne, scarring, abnormal skin texture, or even generic age-related changes like fine lines, more deep wrinkles, or sun exposure damage. Laser resurfacing can be done in a fractionated manner, which results in less downtime, but often a series of treatments are needed. More aggressive, ablative laser resurfacing has a much more profound benefit, but it does require a greater downtime with more healing.
Chemical peels are designed to utilize a controlled concentration of a known acid to create a superficial trauma to the skin. This burn results in the exfoliation of superficial skin layers. This can include the epidermis which is treated with a superficial chemical peel or entering deeper into the dermis with a moderate or deep chemical peel. The depth of peel totally depends on the goal of treatment, expectations, and the acceptable downtime. Typically with an increase in chemical peel concentration, the more aggressive the peel, the greater the effect, greater potential discomfort, and a greater degree of recovery is required.
Dermabrasion is really just a controlled superficial abrasion of the skin. Although it can be done in a greater surface area like the entire face, is typically used for spot treatment in areas of need. These include acne scars, post-surgical incisions, trauma scars, etc. Depending on the depth of treatment the recovery can be quite simple or more pronounced.
Most of my patients undergoing resurfacing procedures are looking to improve specific facial concerns, including: acne, rosacea, fine lines, abnormal skin texture, pigmentation or sunspots, deep wrinkles, aged appearing skin, or simply want more youthful appearing and smoother skin.
Who Are Good Candidates For a Facial Resurfacing?
The best candidates for resurfacing have a primary goal in mind. This could be a younger patient with acne scarring, a specific traumatic scar they’ve had since childhood, rosacea, or bumpy or abnormal textured skin they want to minimize. Similarly, a middle-aged or older patient looking for improvement in fine lines, large pores, more etched in heavy lines, or just a more youthful appearing facial skin. Expectations need to be appropriate since any surgical or nonsurgical resurfacing procedure will improve your appearance, but what to expect depends on your individual situation.All skin types benefit from resurfacing, with some treatment options been better for darker skinned versus very fair-skinned patients. The best way to figure out which if any resurfacing option is best for you is to sit down and discuss your situation, and what you could expect to achieve.
How Is Facial Resurfacing Performed?
For laser resurfacing, chemical peels, and dermabrasion… where and how the procedures performed depends on how aggressive and deep the anticipated treatment is.
In-Office Treatments: Fractionated laser resurfacing, superficial to moderate death chemical peels, and spot treatment superficial dermabrasion can be done in the office with a topical anesthetic, or local anesthetic injection for pinpoint areas. In these cases, a short office visit includes discussion and reviewing the anticipated procedure, placement of topical anesthetic, and resurfacing treatment. Minimal redness or a tight feeling face can occur, but typically aggressive peeling or exfoliation does not occur immediately rather slowly develops over the next several days. With chemical peels, the acid used may vary but TCA is very customizable, reliable and well tolerated. In addition to the peel substance in itself, other active serums such as growth factors, hyaluronic acid, retinoic acid, etc. can be applied. To complete the peel, moisturizer and high SPF sunscreen are applied. Most patients are able to return to normal routine that day, or the next day comfortably.
Operating Room & Sedation Anesthetic Treatments: Ablative CO2 laser resurfacing, deep chemical peels, or larger surface area dermabrasion are ideally performed in the operating room with a sedation anesthetic. Typically with these procedures, there is a greater downtime, the face can be very tender and pink for days to weeks, depending on the treatment. Although the recovery time required is greater, many patients find this tolerable because a greater treatment effect is achieved. With each type of procedure, the area to be treated is assessed, and depending on the skin color, the thickness of skin, the degree of skin moisture/greasiness, the skin is treated. Immediate exfoliation occurs, and at the termination of the procedure, the moisturizing ointment is placed, with the instructions for aggressive skin care.
What is involved in the initial Office Visit and what is the Recovery Process?
Once you decide which type of facial resurfacing is the best option for you, an appointment for roughly one hour is scheduled. This allows time for additional questions and a detailed discussion of the post-treatment game plan. The peel or treatment itself is not too uncomfortable, but there definitely is some activity or mild warmth to the face with the application/use of the acid or laser. By the time you leave the office, your face will feel close to normal, but you may feel like you have a mild sunburn, or the face skin feels slightly tight. Typically there is not significant exfoliation, bruising, etc. at the time of the procedure.
That evening, I want you to wash your face with a gentle cleanser, and reapply specific treatments such as growth factors and moisturizing serums. There usually is not any exfoliation, flaking, or skin slough the first day afterward, but on day two the more active areas of the face (specifically around the mouth and around the eyes) start to exfoliate, flake, or peel. This is typically not a large sheet of skin that sloughs all at the time but occurs in small areas. The exfoliation will continue on day three and up to day four, but even during this time, the appearance of exfoliation can be well concealed with an application of moisturizer. Most people are back to work or their regular routines without needing any downtime.
The only restrictions are to avoid sun exposure for 5-7 days post-treatment and to avoid swimming and strenuous activity for the first 48 hours.
How Long Do The Effects Last?
The effects of chemical peels, dermabrasion, and laser resurfacing are permanent.
Having said that, your face will continue to age regardless, and the more you take care of your skin the more you can prevent additional damage. Conditions like acne, rosacea, and sun-related hyperpigmentation are all very individual so the degree to which you will notice improvement all depends on your specific situation. This is something we will discuss in detail prior to undertaking any treatment.Many of the in-office treatments are performed in a series of three to four treatments. The goal of this is to decrease discomfort and downtime. Depending on the severity of your concerns, more treatments may prove beneficial.
What Are The Risks?
Risks of a superficial resurfacing procedure are minimal, the worst part is typically the discomfort present for a few minutes during the treatment, some redness, or pink skin afterward, dryness, itching, or at the sensation of tightness of the facial skin. Depending on your skin type, there is a low risk of hyperpigmentation, which increases with treatment aggressiveness. This risk of hyperpigmentation can be decreased by avoiding aggressive post-treatment exercise. Seen typically only with extremely deep treatments using laser, dermabrasion or chemical peels, there is a risk of bleaching or hypopigmentation.
If you are prone to develop fever blisters or cold sores, they can pop up after any depth of treatment. These are easily treated with oral Valtrex for several days. Bacterial infections and fungal infections are incredibly rare although they can be seen with extremely deep layer peels/laser treatments.
Contact our practice to learn more about facial resurfacing where we serve the Beverly Hills, Mission Viejo, and South Orange County areas.