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Otolaryngology: Cosmetic Surgery - Skin Resurfacing with Facial Peels and Laser Surgery

Treatment Specialists

Gregory H. Branham, M.D.
John Chi, MD

West County Office
Medical Office Building 3, Barnes-Jewish West County Hospital campus
1020 N. Mason Road, Suite 205
Creve Coeur, Missouri 63141


Learn more about facelifts, mini facelifts, facial fillers and BOTOX™ injections, scar revision, nose surgery, eyelid surgery, and other cosmetic surgery procedures by visiting the Facial Plastic Surgery Center web site.

Commonly Asked Questions

In the last fifty years, men and women have had more leisure time to spend outdoors than in previous generations. Prolonged exposure to sunlight has taken its toll on people's skin.

Premature wrinkling is more common now that ever before. Both men and women seek facial plastic surgery to reverse the effects of sun damaged skin. In addition to treating fine lines or wrinkles, resurfacing may also improve the pitted look of acne scars and remove pre-cancerous skin growths called keratoses.

If you've wondered how skin resurfacing with lasers, chemical peeling or dermabrasion could improve the look of your skin, your self-confidence or your health, you need to know how laser resurfacing, chemical peeling and dermabrasion are performed and what you can expect from these procedures.

What are the factors for success ?

  • Good rapport, communication and trust between you and your surgeon are critical for success. A thorough consultation is crucial to both parties understanding of the procedure and outcomes.
  • Surgical skill of the surgeon
  • Realistic expectations of the patient
  • Good general health of the patient
  • Meticulous post-peel care by the patient

Skin resurfacing procedures cannot produce perfect skin; rather, the goal is to improve the appearance of the skin as much as possible. Skin type and color, ethnic background, and age are important factors that should be discussed prior to surgery.

If you have dark skin or problems such as allergies, previous burns, a history of poor scars, radiation exposure, or if you have taken Accutane in the past, you may need special evaluation to determine if you are a candidate for these procedures. If you have had episodes of cold sores and blisters around the mouth, inform your surgeon of this condition.

What is the advantage of consulting a facial plastic surgeon from Washington University?

Facial plastic surgeons in the Department of Otolaryngology (ear, nose and throat), bring patients a unique blend of extensive training and experience in surgery of the head and neck as well as plastic and reconstructive surgery.

This combination provides their patients a thorough understanding of the functions and structures of the mouth, throat, ears and nose, as well as the plastic surgery aspects of facial skin and musculature, scalp and neck.

Well known for success with very complicated reconstructive surgeries due to cancer, trauma and accidents, Dr. Branham also offers a full range of cosmetic procedures.

What is the procedure for evaluation ?

Before deciding on a skin resurfacing procedure, your facial plastic surgeon may recommend a skin care regimen proper to the procedure to enhance the result as well as expedite your recovery. If you have extensive damage from aging or injury, more than one procedure may be necessary. The surgeon will examine your skin to assess factors that could affect your healing and determine which procedure or series of procedures will give you the best result.

After you and your surgeon decide to proceed with laser resurfacing, chemical peel or dermabrasion, all options for the procedure will be discussed along with the risks. You will also receive information relating to each procedure.

Bear in mind that neither chemical peel nor dermabrasion can correct sagging skin or halt the aging process. Furthermore, as some chemical peels lighten skin color, you must make a commitment to use sunblock after surgery or camouflage transition areas with makeup.

Following a thorough medical history, your surgeon will advise you as to anesthesia options, the surgical facility being used, any addition surgery options, and the cost of the procedure. Your surgeon may also suggest other surgery, either before or after your resurfacing procedure, in order to enhance your overall appearance.

What is the surgical process ?

Chemical Peels: The skin is composed of the epidermis and the dermis. Within the dermis are two layers, both of which are constructed of collagen, long fibers that loosen and stretch with age and sun damage. If the deepest layer, the reticular layer, is damaged, scars result, while the upper layer of the dermis, the papillary layer, heals from injuries without scarring. In a facial chemical peel, the surgeon applies on of several chemicals to the skin. Glycolic acid is the mildest. TCA, thrichloroacetic acid, can be used in varying strengths for longer-lasting smoothness. The most common TCA peel is a 35% or medium depth peel.

Before any peel, the face is first thoroughly cleansed with a solution to remove oil and to prepare the skin for deepest penetration. As the chemical is applied, the epidermis is removed, and the chemical penetrates into the first layer of the dermis. You may also be pretreated with a pre-facial peel solution called Jessner's Solin to prepare the skin for the facial peel agent.

Dermabrasion: This is a surgical technique whereby some deeper scars and wrinkles can be smoothed. The surgeon uses a local anesthetic and/or a freezing agent to render the skin numb. Then, using a high speed rotating brush, the surgeon removes the top layer of skin to the appropriate level for the best results. The size and depth of the scars and the degree of wrinkling determine the length of the surgery. Dermabrasion is usually done in the office on localized scars.

Laser surgery: This procedure is used to resurface facial skin with wrinkles caused by excess sun exposure, "crow's feet," and acne scarring. The high energy, amplified light waves of the laser vaporize the top layer of skin instantly, with no bleeding and minimal trauma to the surrounding skin. Laser resurfacing stimulates the collegen growth under the skin, thus smoothing out the top layer with minimal redness or discomfort.

What can I expect after the procedures?

Immediately following laser resurfacing, chemical peel or dermabrasion, the surgeon may apply a dressing to your skin. Swelling and "crusting" of the skin are normal, and ointments to keep the skin supple will be applied for seven to ten days following surgery. The redness of skin that persists after the initial healing phase fades with time and can be covered with makeup once the skin has stopped crusting.

The surgeon often recommends a soft diet, avoidance of extremes in temperature and any activity that would cause stress to healing skin. It is imperative that you follow the post-operative instructions of your surgeon to the letter. Should you experience any increase in redness or itching in the days after surgery, notify your surgeon immediately.

In one to two weeks after surgery, new skin will emerge that is pinkish, finer, and free of many wrinkles. But it may take weeks for all the redness to vanish. Follow-up care involves using sunblock in order to protect to skin while new pigment is created. Patients will notice that the skin remains lighter for a long time after surgery, but that condition will usually subside when the skin's pigment level has been restored.

Facial plastic surgery make is possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.

Is this covered by my insurance ?

Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve major deformities or accidental skin injuries may be reimbursable in whole or in part. If this applies to you, please check with your insurance carrier for information on the degree of coverage.

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Copyright 2015 Washington University School of Medicine
Copyright 2015 Washington University School of Medicine