Chemical Peel
None of the above-mentioned procedures improve the very fine wrinkling that can occur on your face, about your eyes and about your mouth. It is not possible to pull the skin tightly enough to pull these fine wrinkles smooth. The proper way of smoothing these fine wrinkles is with dermabrasion, chemical peel or LASER resurfacing. Some surgeons prefer dermabrasion, others prefer a chemical peel and others prefer the LASER. They both have the same risks and, in good hands, seem to have very similar outcomes. My own preference is to use a chemical peel, for I feel this gives the best result and lasts longer. Chemical peel is normally performed in the office, and it consists simply of painting onto your face a solution containing phenol. The phenol burns your skin very much the way the sun would burn your skin, but it burns it more deeply, and when the skin heals, it scars, contracts, and pulls the fine wrinkles smooth. A chemical peel can be very uncomfortable for the first two or three days after it is performed, and very often narcotics are necessary to treat this pain. The procedure is almost always performed under local anesthesia, generally in the clinic. After surgery, you will be given ointment and you can apply this to your face. Some people find this makes their face more comfortable; others prefer not to use it. The face initially will form some crusts and ooze a bit, but beginning around the fifth to seventh day, this superficial crusting should be gone, and the skin takes on a very bright red color. This red color dissipates over the next three to six weeks and beginning a week or two after surgery, can be covered very effectively with makeup. The effect of a chemical peel can be very dramatic, and it is particularly useful for the fine wrinkles that occur about the mouth. The one problem with a chemical peel is that it thins the skin and increases the skin's risk for sun damage. Therefore, chemical peel is generally performed on people older than forty years of age, and is only performed on people who are willing to significantly reduce their sun exposure, wear hats and always use sunscreens when out in the sun. The risks from chemical peeling include changes in the texture of the skin, occasionally scarring and in 5-10% of cases, there can be some change in the color of the skin. It can either become lighter in color, or occasionally even form areas that are pigmented. The risk for these changes is much higher in people whose skin is naturally pigmented and so dermabrasion and chemical peel should only be performed in fair skinned individuals.
New treatments
There are many new treatment modifications for fine wrinkles. Patients can perform their own chemical peelings by placing weak peeling solutions glycolic acid, retenoic acid, alphahydroxy acid and others onto their skin once or twice a day. Some of these peeling solutions require a prescription. Many are available as over the counter cosmetics or medications at cosmetic stores.
Used on a regular basis these are very effective for slow steady improvement of facial wrinkles. Deeper wrinkles and faster cures require stronger chemical peels, be they performed with trichloroacetic acid or in some advanced cases, phenol.
The latest development is the use of LASERs to resurface the skin. The LASER changes the skin similiarly to a chemical peel. Many taught this as superior to chemical peels and it may well be. It will take years to prove that LASER are more effective and that there are no long term risks such as the induction of cancer.
One of the other complaints in aging is the development of pigmented skin. There are a number of bleaching agents currently available which will lighten and even abolish these pigmented spots. The chemicals used are hydroquinones. They can be purchased in weaker concentrations as over the counter medications and in higher concentrations as prescription items.
Results in aging face surgery are variable. The two following case examples demonstrate some of the principles.
The first is a man whose problems focused about this eyes. They were certainly droopy and gave him an older appearance, but in fact had also become a hindrance to his vision. His eyebrows and eyelids drooped so much that when he looked up, it was difficult for him to see things much above his forehead. A blepharoplasty and browlift were performed. You see here pictures be fore surgery and a year after surgery (Figures 12A,B and 13A,B).
The next patient is a woman who desired a facelift. This was performed. In Figures 14A and 14B, you can see pictures before surgery and after surgery. This woman took particularly good care of her skin, and I am sure this contributed significantly to the dramatic improvement in her appearance.