As a triple board-certified plastic surgeon, Dr. William H. Beeson is proficient in providing skin treatments. If you are interested in having skin treatments in Indianapolis, please read this post.
Introduction
Skin rejuvenation procedures improve the overall appearance of the skin by achieving a refreshed skin appearance and restoring elasticity. While they do not have the same effect as surgery, they can often prolong the time until a facelift is needed. To clarify, surgery takes away “sags and bags,” while skin rejuvenation takes away “wrinkles.” Today there are a wide variety of techniques available that allow us to tailor a skin rejuvenation program specifically designed for you— one to match your skin type, lifestyle, and desires. In customizing a skin rejuvenation program to meet an individual’s needs, many factors must be considered. Among these are: skin type, general health, and lifestyle. Each type of skin rejuvenation technique has its own required length of recovery time, as well as its own frequency with which the treatment needs to be repeated.
Aging Process
In order to understand how skin rejuvenation techniques work, it is essential to understand the aging process.
As we age, a number of things happen. Our skin loses moisture and elasticity. Fat redistributes itself, muscles and skin become more lax, and bones actually start to resorb. Wrinkles [rhytids] are the first signs of this aging process. Skin folds or “bags” are the more advanced signs.
Aging Skin Changes
During the aging process, the stratum corneum (the top layer of the skin comprised of dead skin cells) builds up and thickens. When this happens, our skin can develop a sallow look and small “expression lines” can develop. In addition, there is a gradual breakdown of the collagen and elastic fibers in the deeper layers of the skin. Sun exposure or “photoaging” can dramatically increase the breakdown of elastic tissues and lead to increased skin wrinkling.
Skin Rejuvenation Techniques
Essentially, skin rejuvenation treatments can be divided into two types: medium and deep. Skin rejuvenation techniques may include the use of topical creams called peeling agents, which are of various strengths and types. The difference in strength and type allows for penetration to different levels or layers of the skin. The dermis of the skin is the building block layer, which is made up mainly of collagen. It is divided into two parts – the more superficial “papillary” dermis and the deeper “reticular” dermis.
If wrinkles or aging changes are confined to the top layers of the skin, they can be totally removed through these skin rejuvenation techniques. If they extend down into the deeper dermal layers, we cannot completely remove them; only obtain improvement. That being said, this improvement can often be dramatic. Obviously, the deeper into the dermis the aging changes extend, the deeper the skin rejuvenation treatments need to go. And that means a longer recovery or convalescent process.
Another type of skin rejuvenation technique involves the use of lasers. Recent technological advancements have resulted in the development of special high-energy carbon dioxide lasers and erbium lasers, which use light energy instead of chemicals to stimulate changes in the upper skin layers.
Medium peels are used to remove mild to moderate skin textural and pigmentation changes. They may also be helpful in reducing minor acne scars and stimulating increased collagen formation in the upper dermal layers. The advantage of medium depth chemical peels is that they have minimal chances of changing our overall skin pigmentation.
Medium-Depth Chemical Peel
Medium depth chemical peels usually require mild sedation and are performed on an outpatient basis. Patients are able to return home immediately following the procedure and experience very little (if any) discomfort. However, one needs to refrain from wearing makeup for one week and apply a moist dressing (Vaseline) to the peeled areas daily for one week. At the end of the week, the skin will be rejuvenated and have a pleasing red glow. Most individuals are able to apply makeup and resume a normal work/social schedule at this time. Medium peels are used to treat degenerative skin, mild acne, and moderate aging/environmental changes to the skin. The results last two to five years for most individuals.
Deep treatments involve the use of carbon dioxide lasers and phenol-based chemexfoliation. These procedures provide the most optimal skin rejuvenation possible. They remove the top layer of the skin and stimulate increased collagen formation in the deeper layers of the skin, over the following nine to twelve months. Frequent patients not only see a refreshening new layer of the skin, but also find an approximately twenty percent tightening effect to the skin over nine to twelve months. Again, results will vary from individual to individual and no one can guarantee the results. However, most patients find that carbon dioxide laser treatments and deep phenol chemical peels provide dramatic results in eliminating both facial wrinkling and pigmentation changes, as well as improving skin elasticity. However, these treatments can be associated with some pigmentation changes. Phenol-based chemical peels are used to “lighten” areas of increased pigmentation, such as with patients that have melasma (the so called “mask of pregnancy”). Patients who undergo a phenol-based chemical peel need to accept the fact that their skin may become lightened to the extent that they need to use make up and cover the treated areas. Despite this, the phenol peel is very popular, because it provides the most dramatic reduction in facial wrinkling, as well as the most improvement in skin elasticity of any facial rejuvenation procedure.
Carbon dioxide laser resurfacing, as well as phenol chemical peels, require minor sedation. Procedures are done on an outpatient basis, and patients are able to return home immediately following the procedure. Similar to the medium peel, there is very little (if any) discomfort associated with these procedures. As with the medium chemical peel, a moist dressing technique is used following the treatment. Vaseline is applied to all treated areas four to six times a day for seven days. While these procedures can be repeated, we find that most individuals respond very favorably to just a single carbon dioxide laser resurfacing or phenol-based chemical peel treatment. These procedures are intended for severe acne scarring, patients with recurrent skin cancers, deep facial wrinkling such as “smoker’s lines” and more advanced pigmentation/skin textural changes.
Deep Rejuvenation Techniques
Phenol-based Chemical Peels
Phenol-based chemical peels are considered “deep” peels. They are the strongest type of peel and produce the most dramatic changes. They are used to treat deep wrinkles (or “smokers’ lines”) and pigmentation changes. In addition, they provide tightening and rejuvenation to the skin. Deep chemical peels usually provide significant improvement with only one treatment.
One of the disadvantages of the deep phenol-based chemical peel is that it tends to “lighten” the skin. It is important to understand this because there may always be a need to cover these areas with some type of makeup. This lightening of the skin would be seen in the color difference between peeled and non-peeled areas. For this reason, the best candidates for this type of peel are women with light skin. Less appropriate candidates are men and those with darker or black skin.
The procedure is usually done under “twilight” anesthesia, if the full face is treated. It is done under local infiltration, if regional areas such as the lower eyelids or perioral area are treated. The peel solution is applied to the area with a cotton-tipped applicator. Following treatment of the area, a moist dressing technique is utilized. A thick layer of Vaseline is applied to the peeled area. The patient is then taken to recovery and later released. A mild burning sensation may be noted for the first three to four hours following the procedure, but it can easily be controlled with oral medications. There is moderate to significant swelling that can accompany phenol-based chemical peeling. Individuals apply Vaseline and shower three to four times a day to minimize crusting and to facilitate epithelial rejuvenation. The skin surface is usually completely reepithelized within seven to ten days. At that time, the skin has a reddened appearance; makeup can usually be applied. The skin may continue to be red for six to eight weeks. During this time, the redness is usually covered easily with makeup. The skin then gradually fades back to the normal skin color or potentially a lighter color.
The phenol-based chemical peel is particularly beneficial for treating individuals who have areas of hyperpigmentation around the eyelid area. It can provide an aesthetically favorable lightening effect and remove fine wrinkles, providing a “tightening” of the skin. This peel is commonly performed in conjunction with blepharoplasty surgery.
It is important for patients to realize that not all wrinkles can be removed. Some individuals can obtain dramatic improvement, but results can vary from individual to individual.
Laser Skin Resurfacing
Laser resurfacing is a relatively new technique, in which light energy is used to remove the most superficial layer of skin [epidermis], and actually stimulate increased collagen in the deeper layers of the skin [dermis]. The primary lasers used for skin resurfacing are high-energy carbon dioxide lasers and erbium lasers. The wound healing mechanism and recovery time is very similar, whether laser resurfacing or traditional phenol-based chemical peeling is performed. In one case, light energy is used; in the other case, various chemicals are utilized to achieve rejuvenation of the skin.
Laser resurfacing is usually done on individuals who are concerned with deep wrinkling around the mouth or eyelid area, as well as general photoaging and degenerative skin changes over the entire face. While not all wrinkles can be removed, significant and dramatic improvement can be obtained in selected individuals. The advantage of the laser over the phenol-based chemical peel is that there is less chance of pigmentation changes to the skin, and the degree of redness following surgery may be significantly less.
Laser resurfacing is also frequently used to treat scars. Laser resurfacing performed at four to eight weeks after a facial laceration can stimulate wound healing and, in many cases, dramatically improve the aesthetic appearance of the area. Laser resurfacing may provide significant improvements in older, depressed scars in selected patients.
Laser Technique
With the erbium laser, a topical anesthetic cream is applied to the skin twenty to thirty minutes prior to the procedure. Laser resurfacing is then performed over selected areas. The patient applies Vaseline over the area and washes the area four to six times a day for the next three to five days. Most patients find that, by the third to fifth day, they are able to apply makeup over the reddened skin. The redness usually fades away within the next week. The advantage to this technique is that the patient recovers more quickly, and can resume normal social/work activities in approximately one-third the time of traditional chemical peels or laser resurfacing techniques. The disadvantage is that one to three treatments are usually required, spaced at one-to-three-month intervals, in order to obtain the maximum improvement for the deepest wrinkles. There is virtually no pain associated with this technique, and minimal if any pigmentation changes to the skin are noted, in contrast to other rejuvenation techniques. This makes the procedure very desirable for men, as well as those with busy schedules and limited recovery time.
The carbon dioxide laser scanner is used for facial rejuvenation. With this technique, a topical anesthetic cream is also applied to the skin approximately twenty to thirty minutes before treatment. Because the treatment is more intense, local anesthetic is frequently needed to anesthetize the areas to be treated. This procedure can be done with a minimal amount of discomfort. Some individuals prefer to have “twilight” anesthesia. If the full-face area is treated, “twilight” anesthesia is usually utilized. Following the procedure, the patient applies Vaseline to the treated areas and washes their face four to six times a day. There is slightly more swelling and crusting than with the erbium laser. Most individuals find that they can begin to cover the reddened areas with makeup at seven days following treatment. Redness may persist for several weeks following surgery, but can usually be concealed with makeup. While there is a longer recovery time and slightly more erythema [redness] associated with this procedure, the carbon dioxide laser usually requires only one, possibly two, treatments to obtain the desired result, in contrast to multiple treatments with the erbium laser. In contrast to phenol-based chemical peels, there is minimal (if any) coloration change to the skin following carbon dioxide laser treatment.
As with any skin rejuvenation technique, it is important for patients to avoid increased sun exposure for the first several months following their procedure. We recommend that individuals apply a sunscreen for the first three to four months following any skin rejuvenation procedure, whether it is a chemical peel or laser resurfacing technique.
ALA Photodynamic Therapy
ALA photodynamic therapy – aminolevulinic acid [ALA] is a topical chemical that photosensitizes your skin. The ALA is then photo activated by the pulsed dye laser in a process called “photodynamic therapy”. ALA treatments may be added to the skin rejuvenation process to optimize the inflammatory response and accelerate the aesthetic outcome. It is an important part of the overall skin rejuvenation program. ALA photodynamic therapy treatments help to increase stimulation of collagen and are also used to decrease pre-cancer lesions in patients. They have also been shown to be very effective in treating severe acne in many of our younger patients, and are an alternative to Accutane therapy for many. We use ALA photodynamic treatments for the cosmetic effect of improving skin texture/tone, as well as reducing fine wrinkles, similar to that of a medium depth chemical peel (but without the expense or one week of “down time”).
These treatments are performed on an outpatient basis, and you are able to drive yourself to and from the procedure, since only topical anesthesia is necessary. You wash your face with a special antibiotic soap. The ALA is then applied to your face (and any other areas that require treatment) with a small applicator stick. Occasionally, there may be a slight tingling sensation, but there is no discomfort associated with the application. Following this, a topical anesthetic cream is applied, so that the laser activation is not uncomfortable. Lights are then dimmed in order to decrease any photo activation, and the topical lotion is allowed to gently penetrate into the skin for the next forty-five to sixty minutes (your time may vary according to specific skin types and conditions being treated). The lotions are then washed from your face, and the pulsed dye laser is used to “activate” the ALA. A lotion is then applied to the treated areas. This entire process takes approximately ten minutes. Following treatment, patients need to avoid sunlight and strong indoor lighting for the next forty-eight to seventy-two hours, and keep the treated areas moist with lotions or creams as directed. Your skin may become swollen and reddened like a moderately severe sunburn. There is usually minimal discomfort. However, extra strength Tylenol, or prescription analgesics, can be used if necessary. Recovery times can vary, but most individuals can apply makeup and resume their normal activities within three to four days.
Conclusion
Advances in modern skin rejuvenation have made both chemical peels and laser treatments safer, more comfortable, and more effective than ever before. Today, patients experience far less swelling, bruising, and discomfort, along with a quicker return to normal daily and social activities than was once expected. These improvements, combined with individualized care and gentle anesthesia options, have opened the door for more people to enjoy the benefits of youthful, refreshed skin.
In today’s visually focused world, an ever-growing number of people are choosing minimally invasive treatments to help them look rested, energetic, and vibrant. The best treatment is never “one size fits all”—it depends on your unique goals, the areas you’d like to improve, how long you’d like results to last, and how much recovery time you are comfortable with. Yet, almost everyone can benefit from skin rejuvenation procedures. For most, the outcome is not just smoother, healthier skin, but a refreshed, natural appearance that reflects vitality rather than surgery.
Perhaps more than any other aesthetic treatment, skin rejuvenation improves skin texture, tone, and radiance—the very qualities that most strongly signal youth and health. Beyond cosmetic benefits, these treatments also encourage new collagen production, improve skin elasticity, and may reduce the risk of certain skin cancers by removing damaged cells. By correcting sun spots, uneven pigmentation, and roughness, skin rejuvenation helps reveal skin that looks clear, polished, and luminous.
Considering the minimal discomfort, quick healing, and straightforward aftercare, skin rejuvenation offers tremendous value. It not only enhances your appearance on its own but also complements and highlights the results of other aesthetic procedures—like putting the final polish on a beautiful surface.
Ultimately, skin rejuvenation is about more than looking younger. It is about feeling renewed, confident, and comfortable in your own skin. With the guidance of your medical professional, you can choose a treatment path that fits your lifestyle and goals—helping you look as vibrant and healthy on the outside as you feel on the inside.
