Skin resurfacing utilizes either chemical peels, manual dermabrasion, or laser light to dessicate or remove the outer layers of skin and as skin regenerates from appendages (follicles or glands), it appears rejuvenated with more organized epidermis, dermis, collagen, elastin, and glycosaminoglycans. This translates to reduced wrinkles, increased elasticity, improved wrinkles, removal of dysplastic changes, more regular pigmentation, and improved scarring and inflammatory conditions of the skin (acne, seborrheic dermatitis, rosacea, milia). Skin resurfacing cannot, however, correct the loss of structural support from muscle, bone, or fat that contributes to the changes of aging and create deeper wrinkles and depressions. 

Chemical peels are medical procedures that use a variety of chemicals to either lyse or coagulate the skin, leading to rapid exfoliation of the epidermis and superficial dermis. They are designed to treat the changes that occur with genetic and photo-aging, including irregular pigmentation, reduced elastic fibers, fine wrinkling, and slow cellular turnover. The depth of peel is determined by the expectations, budget, and allowable recuperation time. 

Superficial peels (Glycolic Acid, Salicylic Acid, Jessner’s solution) are nonablative but remove the top layer of the epidermis and stimulate healing, thickening, and hydration. A superficial peel is appropriate for a patient wishing to correct fine wrinkles and mild degrees of hyperpigmentation. 

Medium depth peels (Trichloroacetic acid :TCA) are ablative and reach into the dermis.  Depth of treatment is not only dependent on the concentration but on preparation of skin and the number of applications and can be judged by the frosting that occurs during the procedure. With the increased depth of peel comes significant additional improvements in skin elasticity, hydration, tone, and color, but also increased discomfort and risks of scarring, infection, and altered pigmentation. 

Deep peels (Phenol / Croton Oil) are ablative and extend into the deep dermis, leading to the deposition of new epidermis and dermis with normal elastic fibers, glycosaminoglycans, and collagen. However, this is a deep, painful burn done only under sedation and the patient needs to be monitored and resuscitation equipment should be available. 

Dermabrasion uses a rapidly rotating diamond burr or wire brush to remove the outer layers of skin to smooth scars or correct wrinkles. This is different than micro-dermabrasion which can be performed by untrained personnel who propel crystals to exfoliate the epidermis and improve dilated pores, oily skin, and mild sun damage. If performed on a small area, local anesthesia is sufficient. If larger areas are being treated, intravenous sedation or general anesthesia may be necessary

Resurfacing lasers can be used to apply controlled injury to the skin, prompting regeneration with either a continuous wave or a pulsed-laser light.  This is a significant medical procedure that should be undertaken only by highly qualified physicians who have been trained in the use of resurfacing lasers and sedation is frequently necessary. Blemishes and pigmented spots are removed and wrinkles should be significantly improved. 

Fractionated lasers do not ablate all areas of the skin. These less traumatic techniques minimize procedural pain, down time, and redness. However, the overall benefit is less and multiple treatments are required, typically 5- 10 laser treatments at monthly intervals. 

IPL, or Intense Pulsed Light, is a broad, noncoherent wavelength that can be utilized to treat many dermatological conditions and very fine wrinkles, but its use for resurfacing is limited. 

Erbium:YAG  is a coherent laser light of 2940 nm wavelength that targets water and ablates the epidermis, similar to a superficial peel, but does also target and ablate collagen (3030 nm) augmenting its rejuvenation. 

Nd:YAG is a coherent laser light of 1064 nm wavelength that targets melanin and ablates the dermis and epidermis. 

CO2 laser is a coherent laser light of 10,400 nm wavelength that targets water and ablates the skin deeper with sequential passes. 

All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” .