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- Surface Repairs: Chemical Peel, Dermabrasion, and Retin A
Over the past three decades, plastic surgeons have developed and perfected techniques for smoothing out finely etched wrinkles, as well as refinishing scarred or blemished facial skin. Two of these procedures--chemical peel and dermabrasion--remove the damaged skin; as the skin regenerates itself, a fresh, new, smooth surface appears.
Some people think chemical peel and dermabrasion are mini-facelifts. They are not. Facelifts firm sagging jowls and tidy up double chins. In contrast, chemical peel and dermabrasion work only on the surface, without changing the actual architecture or contour of the face. They are often used in conjunction with a facelift, but they are not a substitute.
These procedures do not prevent aging. This belief is as mistaken as the notion that coloring the hair will keep it from turning gray. Both chemical peel and dermabrasion are treatments for specific conditions and are used only wen there is an obvious need for them. They usually are used on the face, where the rich blood supply helps the skin heal with minimal risk of infection.
Both procedures are very popular and, when carried out by properly trained physicians, they are usually effective and safe.
If you are considering surface repairs on your face, the two main considerations are choosing the best procedure for your needs and selecting a well-qualified surgeon. Similar results can be achieved with both procedures: Fine, cobwebby surface wrinkles are diminished, scars are softened, surface blemishes fade, and general skin texture becomes smoother and firmer. For most people, these results are usually permanent, although the procedures do not prevent the natural effects of aging from causing new wrinkles to form.
Both chemical peel and dermabrasion can be used on the entire face, or they can be limited to a specific area, such as the forehead or upper lip. Both operations are extremely delicate and require the skills of an experienced physician.
The two procedures are also similar in their depth of penetration. Both remove the top layer of skin, called the epidermis. Beneath that is the dermis, which contains connective fibrous tissue. Below that is a layer of fat.
The main differences between the two procedures lie in their method of removing the marred skin. In a chemical peel, sometimes called chemosurgery, a caustic solution containing phenol or trichloracetic acid is applied. New skin forms underneath the treated tissue, which eventually sloughs off. In contrast, dermabrasion is a process in which the superficial, outer layer of skin is ground or scraped away using a hand-held machine. A new layer of skin then forms.
Many plastic surgeons perform both techniques, selecting one or the other, or a combination of the two, to solve a particular problem. As a general rule of thumb, chemical peel is the treatment of choice for fine wrinkles, and dermabrasion is preferred for deeper imperfections, such as acne scars.
Your choice of procedure may depend on which doctor you consult and the procedure with which he has the most experience. Your choice may also involve personal feelings of your own.
Age and sex usually are not important in determining your suitability for either chemical peel or dermabrasion. However, physicians do find that older patients tend to heal more slowly than younger ones, and that women generally heal more quickly than men. More important than age or sex, however, is your skin type and coloring.
The Consultation
It is imperative to find a doctor who is experienced in providing dermabrasion and chemical peel, since these procedures have been offered by inadequately trained practitioners in the past and involve highly visible changes in the part of your body that plays the most significant role in self-image: you face.
During the consultation, the physician should explain the risks and benefits of the procedure you are interested in, and should especially describe in detail the length of the recovery period and the level od discomfort you can expect. If you surgeon prefers one procedure over the other, he should tell you why.
Retin-A for Sun Aged Skin
Doctors have stumbled upon a substance that seems effective in combating the signs of photoaging, or prolonged exposure to the sun. Also known as tretinoin or tetinoic acid, Retin-A is a vitamin A derivative that has been prescribed for the past twenty years as a treatment for acne. Doctors noticed that the skin of young women using the treatment was notably smoother and free of surface wrinkles.
Most exciting to doctors and patients was the evidence that continuing, regular application of Retin-A can improve appearance regardless of the degree of damage. Physicians now often prescribe Retin-A for older patients who wish to soften the superficial signs of aging, such as fine wrinkles and uneven pigmentation. A few doctors also believe Retin-A is useful for younger patients who are eager to prevent lines and age spots.
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Photos-
Our eyes ride in fat-cushioned comfort in the bony sockets of the skull--pockets nature designed to protect them from harm. With age, the skin of the eyelids stretches, muscles weaken, and excess fat gathers over and under our eyelids, regardless of whether our bodies are thin or obese. Sagging eyebrows, drooping upper lids, and bags below can make the energetic appear perpetually sleepy, and the abstemious appear dissipated. Drooping upper eyelids may even interfere with vision.
If droopy, puffy lids run in your genes, you may want eyelid surgery--called blepharoplasty--as a teenager. However, many people begin to feel the desire for this rejuvenating surgery between the ages of thirty-five and fifty. Approximately half of those opting for eyelid surgery do so five to ten years before they need a facelift.
A delicate process requiring great surgical finesse, blepharoplasty is one of the oldest procedures in the cosmetic surgery repertoire. It removes fat from the upper and lower lids, often along with excess skin and muscle. After surgery, patients look refreshed younger, and more alert. Eyelid surgery does not remove crow's feet or other wrinkles (unless they are located in the skin to be removed). It also won't lift your brow, though it's possible to perform a brow lift simultaneously. Eyelid surgery also will not eliminate dark circles that many people complain about under their eyes, though it can remove some of the discolored skin.
Currently, about 16 percent of blepharoplasty patients are men and that proportion is growing. Most men who seek eyelid surgery--which is the second most popular procedure for males--are businessmen who look older and less energetic than they feel and who don't want their appearance to penalize them careerwise.
The Consultation
It's vital to have realistic expectations about what eyelid surgery can and cannot do. You and your doctor should discuss your goals, determine whether to do all four lids (uppers and lowers) or just two, and whether to have this surgery alone or in conjunction with a facelift or browlift.
Health problems that rule out eyelid surgery include two thyroid disorders: hypothyroidism (low glandular activity) and hyperthyroidism (increased activity, called Graves' disease or thyrotoxicosis). The former causes eyelids to become waterlogged--a type of swelling that's not correctable with surgery. In the case of Graves' disease, the lids swell and they eyes my bulge. Attempting surgery would only worsen the bulging and aggravate the "dry eye" symptoms these patients have. In addition, due to the sensitivity of blood vessels in the back of the eye, you should not have eyelid surgery if you have hypertension or other circulatory disorder, cardiovascular disease, or diabetes. Caution is also advised if you have an eye condition such as a detached retina or glaucoma. In these cases, you should consult with your ophthalmologist before having a blepharoplasy, since any irritation or pressure on the optic nerve can lead to complications.
Another condition that could preclude eyelid surgery is a lack of sufficient tears. The cornea (the eye's clear, outer covering) lacks its own blood supply and dries out easily, particularly after lid surgery. Without proper lubrication, the cornea can become ulcerated or permanantly scarred.
Discuss your entire medical history with your plastic surgeon. If you're like most people, you'll be quite well suited to eyelid surgery.
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- The facelift, known as rhytidectomy, can improve loose skin and sagging
muscles around the face, jaws, and neck.
Facelifts have been done for about seventy years, but the last fifteen years or so have brought great improvements in the procedure. In the early days of the operation, a facelift was merely a skin lift. All too often, women emerged from surgery with a higher hairline--nothing more. Their neck continued to sag and their cheeks looked pulled up at the corners, giving a stretched, unnatural look to their face.
Today's facelift is a much more involved procedure that offers better, more long-term results. Plastic surgeons' ability to manipulate the deeper facial tissues now enables them to "clean up" the neck and jaw more effectively. The emphasis is on contouring by suctioning away excess fat, particularly under the chin; tightening underlying muscles; and redraping the skin.
There are three basic problem areas that a facelift can improve; (1) the nasolabial fold, or deep crease between the nose and mouth; (2) a slack, jowly jawline; and (3) folds and fatty deposits around the neck. A facelift may be performed alone or in conjunction with other procedures, suck as a browlift, eyelid surgery, nose reshaping, and chin or cheek implants.
Best Candidates
The best candidate for a facelift is a woman or man who has developed a saggy face or neck and has realistic expectations. There are no strict age limitations. Although it's fairly uncommon for persons in their thirties to show signs of an aging face, occasionally the skin is so fragile or sun damaged that premature sagging occurs. (Note that facelifts should not be used as a preventative tactic.) Octogenarians can be fine candidates as well. Most often, however, a facelift patient is in his or her forties, fifties or sixties.
More important than chronological age is the condition of your skin and underlying bone structure. Your skin should still have some spring in it, and your bone structure should be strong and well defined. Because of its thinness and excellent blood supply, facial skin tends to heal well with almost invisible scars. But certain medical conditions--such as the tendency to form excessive scars, uncontrolled high blood pressure, or blood clotting problems--could rule out surgery.
Both men and women can be good candidates. Men now constitute about 9 percent of all facelift patients.
The Consultation
Your plastic surgeon will evaluate your face as a harmonious whole, including your eyelids and brow. The extent of type of facelift he recommends will depend on your unique anatomy and the particular changes aging has wrought.
To a certain extent, a rhytidectomy can give you back your former face by reversing some of the changes brought on by age. However, the aging process is only set back, not stopped altogether. In addition, physically, you will still be the same age, subject to the same health conditions and other limitations.
If you're counting on having a totally different look, you're setting yourself up for disappointment. If you're hoping to give yourself a psychological boost by looking younger, a facelift my help. Discuss your goals with your surgeon so that your expectations are in line with the surgical reality.
Plastic surgeons hesitate to use words like younger when they describe the results of a facelift. They prefer the word fresher. In fact, a good facelift, along with stylish makeup and hairstyling, will make you look younger. If you understand the goals, accept the risks, and appreciate the fact that recovery will be necessary before you see the final results, you're likely to get what you expect; a healthy, psychological boost. A facelift may give you the confidence to make other positive changes in your life, like improving your diet, starting an excercise routine, or getting out more socially.
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[ Changing Inherited Traits ][ Minimizing the Effects of Aging ]
[ Recontouring the Body ][ Skin Cancer ]
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