Skin resurfacing for perioral rejuvenation

Key Points

Buffalo, N.Y. - The modern dermatologic surgery armamentarium offers enough options to please most patients who desire a brighter, more youthful complexion.

Techniques for treating particular parts of the face or body are also becoming increasingly refined.

David A. Sherris, M.D., professor and chairman, department of otolaryngology, University of Buffalo, discusses methods for rejuvenating the perioral region. Dr. Sherris explains how excellent results can be obtained when using a few specific modalities.

Dr. Sherris favors three resurfacing techniques: chemical peels, dermabrasion and laser.

He says resurfacing is appropriate for patients with texture abnormalities, fine-to-moderate wrinkles and pigment abnormalities or blotchy skin.

"The deeper the resurfacing, the more wrinkles can be removed, which is beneficial to the patient. The down side is that the healing time is longer, and there is a greater risk of complications. These risks include infection, delayed healing, milia or acne reactivation, prolonged erythema, hypo- or hyperpigmentation, as well as hypertrophic scars," Dr. Sherris tells Dermatology Times.

Preparing the skin

Dr. Sherris adds that he prefers to prepare the skin before performing a resurfacing procedure to maximize results.

He advises his patients to use a glycolic acid cleanser and night cream or tretinoin (Renova, OrthoNeutrogena) nightly, beginning a few weeks before the procedure.

When performing medium or deep peels, he gives his patients 400 mg of acyclovir five times daily beginning two days before and ending eight to 10 days after the treatment. Also, he always defats the targeted skin prior to the peeling procedure.

"I like to use 15 percent TCA peels for full-face peels, and prep the skin for approximately six weeks prior to treatment. This peel goes slightly deeper than glycolic acid peels. The patient's skin heals beautifully with no downtime. I advise the patient to avoid sun exposure for one week to two weeks and then repeat the peel approximately two weeks to four weeks following initial treatment," Dr. Sherris explains.

He applies glycolic acid or 15 percent TCA peels using 2x2 gauzes, and though frosting is not common, he advises physicians to always be wary of potential "hot spots" during the peeling procedure. He deactivates the treated areas with cold water-soaked gauzes and then applies moisturizing creams.

Dr. Sherris uses 35 percent TCA peels for the whole face or just the perioral area, and again, he preps the area to be peeled six weeks prior to treatment. The skin here will heal in five to seven days, but the patient must avoid sun exposure for six to eight weeks following procedure.

He recommends repeating this peel twice, four weeks to eight weeks following the initial peel.

"I apply the 35 percent TCA peel in the same fashion as the 15 percent TCA peel, but, here, frosting is expected. The multiple applications will result in a deeper peel. After the treatment, I like to moisturize the area with Aquaphor (Eucerin) or Crisco, but until re-epithelialization has occurred, the patient must avoid applying makeup for optimal cosmetic results," Dr. Sherris says.

Perioral dermabrasion

Dr. Sherris also favors perioral dermabrasion.

He prepares the skin six weeks prior to treatment, but contrary to the peeling procedures, which can be performed in an office setting without anesthesia, he performs his dermabrasions in an operating room.

According to Dr. Sherris, the abraded area will need 10 days to 14 days to heal, but the erythema will last up to three months.

He advises his patients to avoid sun exposure for six weeks to eight weeks following treatment and strongly advises an acyclovir prophylaxis in all patients undergoing this procedure.