The Return of Resurfacing

Skin resurfacing appears to have originated among the ancient Egyptians who used rough alibaster masks to smooth and beautify their skin. Since then, many other substances including fire, acids, various mineral and plant extracts and sandpaper like materials have been used for a similar effect. Generally it has been observed that the more aggressive procedures were associated with better results but also with a higher risk of side effects.

The milder procedures still exist today as microdermabrasion and the milder chemical peels. They are effective, but mildly so, and their effect tends to be short lived.
In the 20th century wire brush dermabrasion and deeper chemical peels, particularly the phenol peel, were developed an achieved often dramatic and very long lasting improvements in facial lines, wrinkles, discolorations and scars. These approaches still had a very long recovery period and a risk of scarring and permanent loss of pigment that many considered to be too high. The next step was laser resurfacing which achieved popularity with the CO2 laser resurfacing. Again there was a long recovery time but the same side effects were seen, although less often. Most people have stopped using the CO2 laser for full face resurfacing. Subsequently the Erbium YAG laser was introduced, It can achieve results similar to the CO2 laser, but unlike the CO2 laser, it does not heat the skin as part of the process. This led to a significant reduction in side effect frequency and this laser is still used by many physicians today.
The search for less down time and fewer side effects led to the rise of what has been called nonablative resurfacing. These lasers work by heating the deeper tissues while sparing the skin surface. They require a series of treatments and their results have not approached that of resurfacing lasers. The most effective of this group has been the Fraxel Erbium Glass laser (Re:store) which can, at times, produce results similar to the resurfacing lasers without significant down time.
Nevertheless there remained a group of people who were willing to tolerate some downtime in exchange for a single procedure with good, long lasting results. Although the Sciton Erbium Yag laser generally meets these criteria, a new class of fraxellated (treating small spots and leaving small untreated spots in between) CO2 and Erbium YAG lasers have been developed. The primary CO2 lasers in this category are the Reliant Fraxel Re:pair and the Affirm deep FX, although there are a number of copycat, generally less powerful, lasers that are being introduced. The main fraxellated Erbium YAG laser is the Sciton. These lasers are claimed to be safer than the older versions, but some instances of the development of scarring have now been reported.
The role to be played by these newer lasers has yet to be completely worked out.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA