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Dermabrasion and Peels

Dermabrasion involves using a tiny electric sander which revolves at a very high speed, and literally "sands" the surface of the skin. A good surgeon can "rub out" wrinkles or acne scars to an even plane, but it requires a lot more skill than the laser, and scarring or uneven results are more common. Dermabrasion also produces a lot of bleeding. It's been said in some medical texts that 50 percent of dermabrasion patients wish they'd never had the procedure. But this may be because dermabrasion is the treatment of choice for "ice-pick" acne scars, which are not amenable to many therapies anyway.

Acid peeling is the chemical version of the same idea. Rather than sanding the skin surface, acid — phenol or trichloracetic (TCA), for example — is applied to produce a deep, hopefully even, injury to the old skin. Phenol usually produces beautiful wrinkle shrinkage, but also produces permanent color loss in most cases. Patients may end up with a white cast to their faces, which will need to be covered up with makeup. This is most acceptable in elderly patients. When enough TCA (40 to 50 percent strength) is applied to produce significant wrinkle shrinkage and deep penetration, there may be a three to five percent chance of scarring (the lighter TCA peels use 15 to 35 percent strength). It's difficult to accurately predict how the more concentrated TCA will penetrate the skin. In my opinion, this makes deep TCA peeling unacceptable.

Superficial TCA peeling, however, is an excellent technique. When 20 percent TCA is placed on the face, skin changes are produced during the application process. These changes are obvious, and different from those resulting from the deep TCA peel. This is good for texture improvement, though deep wrinkles are not improved. Recovery time for this lighter peel may only be four to five days. Fruit acid, such as 40 to 70 percent Glycolic acid, is also being used in a similar fashion as the light (20 to 25 percent) TCA peeling.

The heavily advertised "lunch-time peel" irritates the deep skin in order to produce improvement but does not cause peeling. It is popular because each session is inexpensive and requires no "down time," or time off usual activities. The procedure is performed with new machines which produce light that may not be a single-frequency band like a laser. This peel is similar to very minimal aesthetician peels performed with low acid strength. It is not very effective and requires repeat procedures over time — sometimes as many as 10 to 20. Added up, these sessions may be more expensive than the invasive peels. See chapter 3.

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