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INTRODUCTION

Nonsurgical skin care is a feasible alternative for patients who are looking to delay or avoid surgical interventions and treat unwanted hair. The wide array of options available and minimal recovery time make these procedures very attractive.

The growing trend toward nonsurgical skin care has been confirmed in the latest data from the American Society of Plastic Surgeons, which shows that from 2007 to 2008 minimally invasive cosmetic procedures jumped 5% to 10.4 million procedures. The top five procedures performed in 2008 were Botox therapy, hyaluronic acid fillers (Restylane, Hylaform, and Hylaform plus), chemical peel, laser hair removal, and microdermabrasion.

Fortunately, several skin conditions, including acne and acne scarring, age spots (senile keratosis), hyperpigmentation, rosacea, actinic keratosis, sun damage, wrinkles, and hair removal, can all be treated without surgery. The addition of a medical grade skin care regimen can act to complement these procedures and often reverse sun damage. Several medical grade regimens exist, including the Obagi line of products, LaRoche-Pasay by Biomedics, Method Physioderme, SkinMedica, and Jurlique.

Most nonsurgical procedures are performed in the doctor’s office with minimal recovery time. The procedure begins with a complete analysis of the patient’s skin, including a complete history of sun exposure, prior procedures and surgery, and the determination of the patient’s skin type. The most commonly used classification is the Fitzpatrick typing, which divides patients into six types based on color and response to sunlight. This classification helps determine a patient’s risk for post-procedural hyperpigmentation.

A new tool in the plastic surgeon’s armamentarium is Visia, which evaluates the skin for porphyrins, sun damage, pore size, and the texture of the skin, brown spots, and wrinkles. This painless analysis is done in the doctor’s office and provides a comparison of the patient to their age-matched group. The information gathered from this analysis helps determine the appropriate treatment plan for the patient.

CHEMICAL PEELS

PATIENT EVALUATION & SELECTION

Patient desiring chemical peels are evaluated with a thorough history and clinical examination of the skin. Chemical peels are used to treat patients with photoaging- actinic keratosis, solar elastosis, solar lentigo, superficial rhytids, pigmentary disturbances (eg, melasma, postinflammatory pigmentation), acne, acne scarring, and rosacea. The type of chemical peel selected depends on the patient’s desires (rejuvenation of the skin or treatment of a specific condition), skin type (as determined by the Fitzpatrick classification), condition of the skin, (thin vs thick, oily vs dry), and the amount of recovery time available.

Patient desiring superficial epidermal peels are best treated with low concentrations of trichloroacetic acid (TCA) (20%), glycolic acid, lactic acids, or combination peels (Vitalize peels). Patients desiring complete epidermal resurfacing are treated with higher concentration TCA, up to 50%. Phenol, the strongest chemical peel, was used in the past to treat coarse facial wrinkles, areas of sun-damaged skin, and a precancerous growth. ...

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