Skin resurfacing for cutaneous rejuvenation

[madman]

Evaluating resurfacing modalities in aesthetics (2022)
Shashank Bhargava, MD, Mohamad Goldust, MD, Hannah Singer, MD, Nicole Negbenebor, MD, George Kroumpouzos, MD, PhD


Abstract

Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of non-surgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, micro-needling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additional combination treatments and resurfacing in acne scars, melasma, and skin of color.




Introduction

Nonsurgical resurfacing modalities include laser and light treatments, radiofrequency (RF), micro-needling (MN), and chemical peels.1,2 Laser modalities have become popular owing to their purported ease of use, relatively low-risk profile, and predictable postoperative course.1,3,4 The traditional carbon dioxide (CO2) laser, which is considered the gold standard of resurfacing, is associated with substantial morbidity and extended postoperative healing. This has led to the development of fractional lasers, which offer improved safety, but at the cost of lower efficacy and the need for additional treatment sessions. RF, especially radiofrequency micro-needling (RFM), provides an excellent alternative to fractional lasers, and it has been found to have similar efficacy and safety.5 Medium- and deep-depth peels can also be effective for skin resurfacing by inducing neocollagenesis and improving photoaging.6 MN and platelet-rich plasma (PRP) can be used on various skin types and may be useful in combination treatments.7-11 MN enhances skin tone and improves skin texture, whereas PRP promotes collagen and elastin regeneration. PRP is modestly beneficial for the treatment of aging skin and improving facial skin texture.9 Because PRP enhances healing, it is also great adjuvant therapy for resurfacing modalities,12, especially in combination protocols for acne scars.13,14 The addition of PRP has shown recent promise.15-20 We reviewed and evaluated various skin resurfacing modalities regarding their efficacy, ease of treatment, safety profile, and patient satisfaction.




*Laser therapy
-CO2 lasers
-Erbium:Yttrium-aluminum-garnet lasers
-Non-ablative lasers
-Comparison

*Radiofrequency

*Chemical peels

*Microneedling

*Platelet-rich plasma




*Treatment approaches
-Acne scars
-Melasma
-Skin of color



Conclusions

With the advent of newer minimally invasive treatment options, there is a plethora of resurfacing modalities that can be used for global facial rejuvenation. During a cosmetic consultation, the aesthetic provider should discuss the available options and suggest a management plan that considers the patient’s expectations, efficacy and safety of each modality, the longevity of results, and lifestyle and budget limitations.

Although the fully ablative CO2 laser remains the gold standard of resurfacing by which all other modalities are measured, it is mostly recommended for severe skin aging. For more mild-to-moderate skin aging, newer modalities, such as RF and fractional lasers, are being increasingly used. These treatments offer an improved safety profile and decreased downtime at the cost of more treatments. Other minimally invasive options, such as MN and PRP, are now becoming more popular because they can easily be combined with other treatment modalities.

 

[madman]

Fig. 1 Moderate-to-severe skin aging and photodamage are shown. Left, Before treatment. Right, After three sessions of FR- CO2 laser (FIRE-XEL, Bison Medical, Seoul, Korea). CO2, carbon dioxide. Reproduced with permission from Leslie Ortner, MD

 

[madman]

Fig. 2 Severe atrophic acne scarring, including inflamed rolling and boxcar scars, is shown. Left, Before treatment. Right, After three sessions of FR-Er: YAG laser (Pixel, Alma Lasers, Caesarea, Israel). Er:YAG, erbium:yttrium-aluminum-garnet

 

[madman]

Fig. 3 Moderate atrophic acne scarring is shown. Left, Before treatment. Right, After three sessions of RF micro-needling (Secret RF, Cutera, Brisbane, CA). RF, radiofrequency.

 

[JmarkH]

Thank you madman.
I used the chemical peel this year. At first, I didn't think it was working but towards the end of two weeks, I could see the skin was thinner almost as if it was thinning from the inside out. A month later and new skin regrew over the area. Of the three spots, two completely disappeared and the one is just a small micro spot. I'll see if it grows over time. I did use ghk-cu during the regrowth period to help with rejuvenation. I have no idea if the ghk-cu helped, but my skin did heal.

 

[Partapradip]

Your experience with the chemical peel sounds pretty fascinating, and it's awesome that you saw positive results in the end. I'm actually quite new here and soaking up all the skincare wisdom. Your mention of ghk-cu during the regrowth period caught my attention—I've been curious about it. I recently came across this interesting read on skin rejuvenation—specifically about Pico Laser Treatment in Singapore. There's this clinic I found, Pico laser clinic, that seems to offer some promising insights. Has anyone here tried it? Would love to hear your thoughts!

 

[DorianGray]

Some dermatologists feel chemical peel isn't effective and it has fallen out of use because of the laser hype today. I recall my mother had it done in the '70s. She looked like a skin peeling zombie for about a month. Then when it healed, she looked like she had the facial skin of a 20 year old. I was shocked.

 

[BadassBlues]

I had a series of glycolic acid peels done about 15 years ago. They start with 30% and move up to 70% over 6 treatments. I peeled like a snake for 3 weeks and afterward, my skin looked amazing. I had a lot of tanning booth and sun damage and it worked wonders.