Soft Tissue Fillers

Injectable fillers are generally considered soft tissue augmentation materials. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial ageing (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (e.g. nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure.

Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler “feels”. Generally speaking, very soft fillers (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the nasolabial folds).

You may be a good candidate for skin resurfacing if you have one or more of the following conditions:

  1. Wrinkled or sun-damaged facial skin
  2. Vertical wrinkles around your mouth, such as those that cause lipstick “bleed”
  3. “Crow’s feet” lines around your eyes and perhaps some skin laxity in your lower eyelid area
  4. Fine wrinkling of your upper eyelids
  5. Brown spots or blotchy skin coloring
  6. Certain precancerous skin growths
  7. Acne or chicken pox scars
  8. Superficial facial scars from a past injury

Patients may have their skin resurfaced at almost any age. You may have certain characteristics that make you a better candidate for one technique rather than another. The amount of time you can allow for recovery also may be an important factor in selecting a particular resurfacing method or determining the extent of treatment. All resurfacing techniques can be performed to varying depths.

A more superficial treatment will require less healing time, but you may need to have the procedure repeated more than once to achieve the same results as a deeper treatment. If you are having aesthetic (cosmetic) surgery, such as a facelift or eyelid surgery, you may be able to have a skin resurfacing procedure performed at the same time.

Skin Resurfacing Techniques

Chemical peels, dermabrasion and laser skin resurfacing all achieve results in basically the same way. Layers of your skin are removed and, as the healing process progresses, a new, healthier-looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin’s layers are removed. Chemical peels involve the application of a chemical solution, dermabrasion utilizes high-speed rotary wheel (diamond Brush), and laser resurfacing uses a laser beam.

Chemical Peel

Chemical peel solution may be applied to your entire face or just to certain regions, such as the crow’s feet area around your eyes or the vertical wrinkles around your mouth. Your plastic surgeon will apply the solution using a sponge, a cotton pad or sometimes, for smaller areas, a cotton swab or brush. Your surgeon decides how long to leave the solution on your face by carefully observing any changes in the appearance of your skin. With certain types of chemical peels, the solution may be “neutralized” after an appropriate amount of time has elapsed.

The different types of chemical peels vary according to their specific ingredients and their strength. The depth of their peeling action may also be determined by factors such as how long they remain on the skin and whether they are applied lightly or rubbed more vigorously onto the skin.

Generally, the most superficial peels are those using alpha hydroxy acids (AHAs) such as glycolic acid. Sometimes just a single treatment with an AHA peel will give your skin a fresher, healthier appearance and a radiant glow. Repeated treatments can help to further improve the texture of your skin. AHA peels can reduce the effects of aging and sun damage including fine wrinkling and brown spots. An AHA peel is performed as office procedure. No anesthesia is needed, and you will only feel a tingling or mild stinging sensation when the solution is applied to your face. Immediately after the procedure, you generally will be able to wear makeup, and you can drive yourself home or back to work.

A trichloracetic acid (TCA) peel is often used for the treatment of wrinkles, pigmentary changes and skin blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck and other parts of the body that have been exposed to the sun. For spot peeling of limited areas such as around the mouth or eyes, TCA formulas are often preferred because they have less bleaching effect than solutions containing phenol, another popular peeling agent. For the same reason, some surgeons have found TCA to be effective in treating darker-skinned patients.

Lactic acid peels give instant glow to skin and can be performed 2-3 prior to social commitment for getting glowing face.

Dermabrasion

Dermabrasion is physical removal of outer layer of skin using aluminium oxide crystals or diamond brush. This resurfacing procedure sometimes is selected for the acne scars treatment and often is performed on the cheeks or the entire face. Some machines have facility of vaccum suction along with dermabrasion. Negative pressure sucks away dead skin cells removed during dermabrasion.

Dermabrasion is very effective for any type of skin. It helps to reduce irregularities of surface, reduces pigmentary changes, and causes collagen fiber remoulding in skin. It improves microcirculation so as to produce glowing complexion to facial skin. It can be used on a small area of skin and on patients with somewhat darker complexions.

It is done as office procedure and does not require anaesthesia. Post treatment area should not be exposed to direct sunlight and use of sunscreen is recommended.

Laser Resurfacing

Skin resurfacing with laser can be of two types.

  1. Ablative : using a carbon dioxide (CO2). Its effects are similar to those of chemical peels and dermabrasion, except that the laser removes skin layers by vaporization rather than with chemicals or a sanding device. This however requires anaesthesia and hospitalization.
  2. Non-Ablative : 1320 Nd Yag, 1540 Er Glass. These are newer generation lasers used for photorejuvenation. They are done on office basis and do not require anaesthesia. Use of fractional lens minimizes superfacial skin damage but allows laser beam to penetrate deeper so as to produce excellent results.

Like the other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for laser resurfacing. Some patients may benefit from the laser’s mild “tightening” effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of ageing. The laser beam is directed to water content in the skin. It heats up the skin thus remoulding collagen fibers leading to skin tightening and non surgical face lift.

Risks

Skin resurfacing procedures are generally safe when performed by an experienced plastic surgeon. The various resurfacing techniques discussed above have similar types of risks, although there are some differences, some individuals have a tendency to form raised or thickened scars, and this may be unpredictable. Medications are available to treat such complications, but in rare cases some degree of scarring may be permanent.

Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.

You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions of your plastic surgeon.