Resurfacing, the Big Gun

Skin resurfacing has been around for a long time. The earliest procedures were performed over 100 years ago, using a variety of acids. Eventually the procedures became somewhat standardized, with the phenol peel becoming recognized as the most effective of the peels. It has fallen from favor because, in the long term, it reliably produced significant loss of pigment (hypopigmentation). The weaker peels, some of which such as the glycolic and trichloroacetic peels, produced less problems but also were less effective and somewhat erratic in their outcomes.

Laser resurfacing, starting with the CO2 laser, replaced phenol peeling, and was quite effective, but still had a side effect profile that many found unacceptable. The primary problem was persisting hypopigmentation, which was seen in about 20% of patients and is thought to be at least partially due to the heating of the skin that occurs with treatment.. To cope with this problem the erbium YAG laser was developed. This is a laser that resurfaces the skin without heating the skin, and while it still can produce occasional hypopigmentation, it does so much less frequently. The results of the erbium YAG laser are frequently very dramatic as illustrated by the before and after photos attached.

 You can see the dramatic improvemt
not only in the skin tone and texture,
but in the fine lines and even in the tightening of the eyelids. All of this
was done without surgery.
Fraxel has introduced the Re:pair
CO2 laser which offers a different approach to the reduction of hypo-
pigmentation. So far there has been
no reported hypopigmentation with the Re:pair laser, but whether it can produce results as dramatic as those seen with the erbium YAG laser remains to be seen.

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