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The removal of the outer layers of the skin may be achieved by three modalities of treatment. These include:
  1. Dermabrasion
  2. Chemabrasion (chemical peel)
  3. Laser resurfacing

Facial skin resurfacing:
This procedure is designed to improve fine wrinkles and moderate laxity of the facial skin. The purpose of the procedure of resurfacing is to remove the outer layers of the skin by various means so that, in the process of healing, the skin will become tighter and smoother.

  1. Dermabrasion involves the use of a wire brush or other abrasive device to physically remove layers of the skin. This creates a wound, which is the equivalent of a burn, which then heals over a period of five to seven days leaving the skin shiny, smooth and very pink.
    N.B. The pinkness lasts for approximately eight weeks irrespective of which modality of treatment is used and may be covered by using base.

  2. Chemabrasion creates the same effect by causing a chemical burn of the skin. The operation is usually carried out under general anaesthesia unless the area being treated is very small. As the wound created is a burn, a certain amount of pain must be expected for 24-48 hours after the operation although this is minimized by the use of suitable analgesics.

    Care of the treated area involves regular application of Vaseline, which keeps the wound moist and prevents drying and cracking which would be very painful. Healing takes place within seven - ten days after which the skin is bright pink and smooth. The pinkness lasts for 6-8- weeks and may be disguised with cosmetics.

  3. Laser skin resurfacing has become very popular in the last five years. While the end result is very much the same as is obtained with the above two techniques, the laser is computer controlled and therefore the depth of skin vaporization is more accurately determined. Healing takes seven to ten days during which period there is significant swelling and weeping of the face which is kept moist by means of liberal applications of Vaseline. Recently, the long-term results of laser resurfacing have been questioned in terms of pigmentation changes and skin tone and the indications for laser skin resurfacing have been severely curtailed. The Erbium Yag laser, which is now available, is less severe in its action and is currently the method of choice as far as lasers are concerned.

    All forms of skin resurfacing are nothing other than reasonably well controlled burns of the skin and they all carry the risk of pigmentation changes in the skin treated. These changes can be either increased or decreased pigmentation of the skin, creating either brownish patches or areas which are lighter than the surrounding skin. In order to avoid these complications it is important for the surgeon to assess the patient's skin type and also to take into consideration whether the patient has developed pigmentation of the skin in the past, either from pregnancy, from taking the contraceptive pill or from sun exposure. The latter is the most likely cause of increased pigmentation after this type of treatment and must be avoided at all costs for at least six months after the treatment during which time the patient should make daily use of a sun screen with the strongest sun protection factor available.