Understanding what we can do for the face involves understanding the levels of invasiveness, and this also relates to difficulty of recovery and how much improvement is to be hoped for. A, B, and C below are about the same degree of hassle-factor and effectiveness, but costs are very different. D, E, F and G are increasingly more expensive but typically get increasingly more profound results. D, E, and F can reduce the chance of future skin cancer in some cases: an added benefit.
- Cream treatment such as Obagi, which is pretty irritating but effective, Retin A®, or glycolic creams of various types. You have to be persistent for many months to get good results. Cost: $
- "Non invasive" laser and photo facial treatments, such are described in chapter 3. Cost: $$$
- Glycolic peels and other light peels, slightly heavier than aesthetician peels. Cost: $
- Trichloracetic Acid peels (TCA peel). This can be deep or light, depending on the practitioner and the patient's desires. In 2006 is usually done as intermediate or light depth. Cost: $$.
- Laser peel: predictably produces fine wrinkle removal and freshening, also is very technique dependent, and can be done deeply, but this is less often done in 2006. Cost: $$$.
- Phenol peel: whole-face lightening is a problem, and should probably not be done for darker skin types and people who can't cope with some degree of lightening. Like all peels, can't tighten neck. Very profound results in experienced hands. Cost: $$$.
- Surgical procedures, such as facelift, blepharoplasty (eyelid lift), brow lift, and facial implants; often the whole face is operated on at once and sometimes combined with peels of various types (but rarely with phenol peels). Cost: $$$$. See other chapters.
Some facial surgery involves a hospital stay many use general anesthesia. Facial laser peeling, by contrast, can be done in an afternoon in a doctor's office. Local anesthesia can be used if the doctor is an expert in the use of tumescent anesthesia (see chapter 13 for more information on tumescent anesthesia). The recovery is manageable, though a bit aggravating. Patients desire facial peels for a variety of reasons: most often for wrinkles, discoloration, and other skin imperfections. It is not usually very effective for acne scarring. Some have work done only around the eyes or the mouth. Others will treat the entire face. Either way, if done skillfully, laser peeling can produce remarkable improvements. A light "TCA" peel of the face combined with a laser peel around eyes and mouth is often a well-tolerated and acceptable procedure that, in most cases, blends the result without lines between the treated areas.
Deeper "dermabrasion" and deep "chemical" or "acid" peeling are still used, but they produce more frequent complications, including scarring and/or permanent changes in skin color. Superficial peels, both chemical and laser, are safer. There's a trade-off between depth of any peel and quality of results and risks, of course.
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