Skin Resurfacing
Q:
I want to have microdermabrasion. However, I have Diabetes Mellitus and have read that people with this condition may be poor candidates for the procedure. What are the dangers of microdermabrasion for people with diabetes and if precautions are taken, would it be safe to have this done?
A:
An individual with diabetes may certainly undergo microdermabrasion as long as the person performing the procedure is an experienced aesthetician who performs microdermabrasion in the office of, or under the auspices of, a board-certified plastic surgeon. An individual who is a member of the Society of Plastic Surgical Skin Care Specialists would be such a person. This individual has the training and experience to treat a person with diabetes in a safe and effective manner. While persons with diabetes may have poor wound healing abilities, this should not be a factor in a well-performed microdermabrasion procedure. No specific precautions need be taken as the procedure is limited in its scope to the epidermis - the most superficial layer of the skin.
Q:
I am a 35-year-old woman who has been battling with acne breakouts and cystic acne since I was a teenager. Recently I have noticed several fine lines in addition to my large pores, especially on my forehead and nose. I am interested in microdermabrasion. Can I have microdermabrasion treatments over my areas of inflamed breakouts?
A:
The most important aspect of your treatment is control of your acne. Good skin care, topical antibiotics, glycolic acid treatments at home, and possibly microdermabrasion are good options for you. Not all individuals respond to each of these treatments, and it is a matter of tailoring the treatments to your response. Strict sun avoidance is also essential.
Q:
I have damaged skin on my face because of serious acne that left scars on my cheekbones a few years ago. I went for laser dermabrasion 6 months ago, but I am not very satisfied with the results. The scars are not very deep but still visible. I am interested in any way to even the skin surface. Which method is the best, or maybe face lifting would help?
A:
There is no technique to completely eliminate the acne scars. Some larger and deeper scars can be excised and sutured to be turned to a small line along natural expression lines of face; then CO2 laser or dermabrasion may further improve it.
Q:
I'm a dark skinned African-American male. I am considering having the microdermabrasion procedure. But all of the information that I have been told so far has been negative. I was told that the results are unpredictable. I have also read that this procedure can be used on all types of skin. I have a problem with acne scarring and would like to have it corrected. Please advise.
A:
Acne scars are a problem for people of all skin types.. With dark-skinned African-Americans, acne scars are an even more difficult problem. Microdermabrasion for these scars would be ineffective. The procedure only removes the top dead layer of the skin (the keratin layer). Acne scars are deeper than that. In order to improve the scars which extend into the dermis under the more superficial layer, the epidermis (including the pigment cells) and a part of the dermis needs to be removed. This is done with a laser or full dermabrasion. Although both can be done in African-Americans, they have to be done very carefully by someone with significant experience and with a three-month preparatory skin care regimen in order to prevent depigmentation (loss of skin color) or hyperpigmentation (darkening of the skin). One other option is individual excision of the worst scars with care to prevent pigmentary problems postoperatively.
Q:
I am 40 years old and I think I'm still too young for plastic surgery at this time. I am looking for an alternative to this so that the lines on my forehead and between my eyes and the crow's feet will go away or be dramatically reduced in appearance. They have been caused by overexposure to the sun. What do you recommend?
A:
Injections of botulinum toxin (BTX, also called by the brand names Botox and Myobloc®) by a qualified plastic surgeon are the best nonsurgical method for improvement of these types of wrinkles, which are related to over-activity of certain facial muscles. BTX temporarily deactivates these muscles so the forehead and crow's feet areas appear smoother. Injections must be repeated to maintain results. At age 40, however, there are often enough visible signs of aging around the eyes that surgery can be of significant benefit. Consultation with an ASAPS-member plastic surgeon should give you an accurate idea of your options.
Q:
Is there a skin resurfacing procedure with no down time? Someone mentioned to me that radio frequency coblation does not require the recovery time that lasers do. Is this true?
A:
Coblation, or radio frequency electrosurgical ablation, resurfaces the skin more superficially than a laser and at a much lower surface temperature. That's why recovery from this procedure is shorter than from carbon dioxide laser resurfacing. However, it still may require 5 to 7 days following the procedure for the skin to heal. Coblation is currently available only on a limited basis for clinical studies. It requires special training and there are not many physicians who have experience with it. Studies are needed to assess its effectiveness and safety. For now, there are other more widely used treatments including light chemical peels and microdermabrasion that can help you achieve a smoother, fresher complexion with little or no down time. I suggest you consult with an ASAPS-member surgeon to determine what treatments can benefit you.
Q:
Can you tell me if the NLite is effective?
A:
Wrinkles can be the result of many factors which can include sun damage, aging, smoking, alcohol, and hormonal changes. Basically, these changes result in the loss of collagen from the skin with subsequent loss of the smooth stability of youthful skin. Carbon dioxide and erbium lasers ablate the outer layers of skin and heat the deeper skin which results in tightening
of the underlying dermis. A pink glow to the area treated is common as it is a healing wound.
The NLite laser works by causing this inflammation only to the deeper skin (dermis) without removing the outer layer of skin. Healing substances are released following the laser treatment which stimulate new collagen production and resultant smoother skin. The advantage is limited downtime, however the long term results are still being evaluated. Your surgeon will discuss the advantages of the different treatments.
Q:
I am considering a photo-facial. I have mild sun damage with sunspots and some minor discoloration. I also have dark circles under my eyes. What is your opinion?
A:
A photo-facial can give improvement in fine lines and some pigmentation changes related to sun exposure. The dark circles under the eyes, however, may require other types of treatment. If you are in need of, or are looking for, more substantial improvement, then other treatments such as chemical peels or laser resurfacing might be better.
Q:
Being of Indian origin with olive skin color, is there anything I could do in terms of skin resurfacing which would give me more than just a glow for a few days? I have fine lines and wrinkles, but find it impossible to find a procedure to remove them.
A:
In order to treat fine lines and wrinkles, a plastic surgeon must first evaluate where the wrinkles are and whether they are there all the time or only when you make certain expressions. This helps to determine the best treatment for those wrinkles. Wrinkles around the eyes (crow's feet) can be treated very well with Botox injections into the muscles that cause these dynamic wrinkles in the skin. This treatment will last 3 to 6 months and works for all skin types. Deeper, more permanent furrows or static wrinkles can be treated by the placement of filler substances into the dermis to help plump out the wrinkles. Materials such as collagen and fat have been successfully used for years, and there are numerous new materials available or soon to be available to help treat deeper and more static wrinkles. New nonablative lasers can be used to soften fine wrinkles by stimulating the formation of collagen and plumping out these wrinkles. Because this type of laser does not affect the outer layer of skin, it can be used for all skin types as well.
The topical use of Vitamin A (Retin-A) or its derivatives, alpha hydroxy acids, and many other active agents work by means of the turnover of the outer layer of the skin and through slight edema (swelling) from skin irritation. These effects are temporary and will go away when the
irritation is removed for a prolonged period of time. Deeper resurfacing techniques are numerous and include chemical forces (chemical peels), mechanical forces (dermabrasion), and heat (laser ablation). All of these injure the outer layers of the skin and the response depends upon the depth of injury. The deeper one goes, the longer the recovery, the more collagen is created to heal the wound, and the more improvement one will obtain. The deeper the injury, the more potential that the cells that cause the olive coloration in your skin will be injured. There is not a magical answer to what is the best resurfacing technique for skin of color, but a discussion
of your goal with an experienced ASAPS-member plastic surgeon will allow him or her to help you decide how to best treat your wrinkles.
Q:
I am interested in learning if a facial skin peel will help eliminate and/or reduce acne scars. I have read that fine lines are reduced by this treatment, and I am assuming that not-too-deep acne scars may also be effectively treated. Is this correct?
A:
Skin peels can potentially improve the appearance of acne scars. The result, of course, depends on the depth and severity of the scarring and on the strength (depth) of the peel. More than one peel or a series of peels may be necessary to achieve satisfactory results. However, results will vary and will most often improve, rather than eliminate, the scars.
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