Combination skin resurfacing still the best bet

July 1, 2005

Atlanta - Dermatologists have seen an explosion of new nonablative techniques in the past five years. While these procedures minimize downtime, they do not produce results comparable to combination skin resurfacing (CSR), according to Harold Brody, M.D

"The news is that CSR is still the most cost-effective and elegant way to relieve wrinkles, precancers, scarring and pigmentation problems," he says.

Dr. Brody, clinical professor of dermatology at Emory School of Medicine in Atlanta, points out that many doctors think combination means doing two or more procedures, one on top of the other, such as a glycolic acid peel and microdermabrasion. He says CSR is a more conservative approach, using different procedures on different regions of the face.

As a general rule of thumb, he advises dermatologists to treat the unit as a whole when the "defect" constitutes more than 50 percent of a cosmetic unit. If it constitutes less than 50 percent, dermatologists get better results by focusing on the defect.

Take, for example, a patient who presents with severe wrinkles around the mouth, a modicum of deep scarring on the cheeks and minor but widespread photodamage. That calls for laser resurfacing of the mouth as a unit, dermabrasion of the scars, and a superficial peel of the entire face - all in one sitting.

"On the other hand," Dr. Brody says, "if a patient has a lot of acne scarring on the cheeks and a just little photodamage elsewhere, then I'd use dermabrasion on the cheeks followed by a medium-depth chemical peel elsewhere."

Another example would be a deep chemical peel around the eyes to produce contraction and wrinkle removal, with a medium peel on the rest of the face for moderate sun damage.

"It's axiomatic that anyone doing CSR is already on a routine skincare regimen, such as retinoids," he says.

Botulinum toxin and fillers complete the rejuvenation picture, he says.

Tools of CSR Dr. Brody relies primarily on chemical peels, dermabrasion and laser resurfacing to correct sun damage, wrinkles, uneven pigmentation caused by birth control pills or pregnancy, and many types of scarring.

Mild chemical peels, with either glycolic or lactic acid, will improve superficial photodamage with no downtime. Stronger peels flatten scarring, remove wrinkles and improve hyperpigmentation. Some situations call for a single peel uniformly over the entire face and neck, while others demand the use of light, medium and deep peels on the same face to correct different skin problems.

"Mild and moderate peels are called 'freshening peels' because they improve the quality of the skin without altering its normal architecture," Dr. Brody says. "The skin's ability to tan and return to the same color after peeling or sunlight exposure is unaffected."

Microdermabrasion employs aluminum-oxide crystals to sand the skin. This technique eases scars, improves the appearance of blackheads and acne, minimizes wrinkles and reduces splotchy pigmentation. Particularly effective for sensitive skin and darker skin types that are resistant to other resurfacing methods, microdermabrasion may require up to six weekly sessions plus maintenance. No downtime is involved.