Advanced Skin Rejuvenation

21 Advanced Skin Rejuvenation

The procedures described on the following pages have been called “nonsurgical facelifts.” They are described in much greater detail in a textbook coauthored by me and Dr. Phillip R. Langsdon.1

I developed the following skin rejuvenation classification system:

• Level I: These treatments are often offered by nonsurgeons, frequently in a spa setting. Patients are able to return home or to work or play immediately. Little or no healing time is required. Level I treatments tend to “polish” the skin for a few weeks, but have essentially no long-term benefits. The exception to the above rule is that some topical products (e.g., hydroquinone) can improve dyschromic areas; however, the practitioner should consult the medical literature for recommended concentrations, combinations, and length of use.

• Level II: These skin resurfacing procedures are generally offered by facial surgeons and dermatologists. More layers of damaged and wrinkled skin are removed with these deeper (dermis-level) treatments. Healing generally requires about a week. Level II procedures are generally recommended for patients less than 50 years old or those with minimal to moderate sun damage and wrinkling.

• Level III: These procedures should be performed by experienced facial surgeons or surgically oriented dermatologists. Level III resurfacing procedures are the most effective methods of removing severely sun damaged, blotchy skin and deeper wrinkles. Healing time is longer—generally 2 to 3 weeks. However, results are long lasting and often dramatic. Although in most fullface resurfacing procedures I rely on a combination of chemical peeling and dermabrasion, long-term skin tightening along the jawlines is obtained when the cheek regions are treated with Baker’s formula peel solution.

Different parts of the same face generally require differing levels or depths of treatment. For example, the thin skin of the eyelids may not tolerate the same level of treatment that the thicker skin of the forehead, nose, lips, and chin may require. An experienced surgeon will know how to vary the depth of the treatment to meet the specific needs of each patient.

Fig. 21.1 (a) Prior to chemical peeling and brow lift (b) After chemical peeling and brow lift.

While varying degrees of skin tightening occur with deeper (level II and III) resurfacing procedures, it is my opinion that the term facelift should be reserved for the procedures described in Chapter 20.

Creative formulas and methods of applying exfoliating solutions do not change the fact that the ingredients cause a separation of the upper layer of skin, which “peels” or “sheds” within a few days.

Varying layers of skin are removed by chemical peeling, dermabrasion, and laser resurfacing. Each seems to have unique qualities and benefits. An experienced surgeon must be able to explain to the patient which procedures might be the most advantageous in the patient’s unique set of conditions, and in that surgeon’s hands.

With all skin resurfacing methods, layers of the sun-damaged, wrinkled, or scarred skin are removed. However, only with deeper (level II and III) procedures are new collagen and elastic fibers produced in the deeper layers of skin. As a result, some tightening of facial tissues occurs, but not to the extent that can be accomplished with surgical removal through conventional facelift and eyelid lift techniques (Fig. 21.1, Fig. 21.2).

Superficial (level I) peels do not produce long-term improvement in the quality and texture of the skin and should be viewed as “polishing or pigmentation-lightening agents.” As with any polishing agent, the results are not permanent and must be repeated every several weeks. Level I resurfacing procedures are often helpful as adjuncts to the level II and III methods herein described, but only after healing is complete—said another way, when all pink coloration from a healing level II or level III peel subsides. Most spas offer level I peels, unless a qualified—and properly licensed—medical professional is involved.

■ Treatment for Wrinkles

Neither a facelift, nor eyelid surgery (blepharoplasty), nor a browlift will eliminate wrinkles of weather-beaten skin, the horizontal creases of the forehead, crow’s-feet that occur around the eyes, or the vertical wrinkles of the upper and lower lips. Keep in mind that surgery is designed to improve sags and bulges, while level II and III resurfacing improves wrinkles.