Skin Resurfacing

Our skin is a natural barrier protecting us against damage by the environment. It accumulates physical, chemical and solar damage over the course of our lives. Healthy, youthful skin is taut and has an elastic bounce. It has an intrinsic lustre and is devoid of irregular pigmentation. In contrast, aged skin is characterized by wrinkles, appears dull, thin, crepe-like and has irregular pigmentation. Skin resurfacing aimed at reduction of fine wrinkles and scars is a popular request among individuals seeking aesthetic rejuvenation.



How does damaged skin arise?

The skin achieves maximal thickness at around the third decade of life. Thereafter, dermal thickness decreases 6% per decade of life. With advancing age, there is reduced production of collagen, elastic fibers and ground substance (glycosaminoglycans and proteoglycans). The end result is skin thinning, loss of skin elasticity and firmness, and consequent formation of fine wrinkles that gradually progress to become deep wrinkles.

Skin damage is related to the cumulative lifetime exposure to UV light. The UVA light spectrum causes skin aging by activation of the metalloproteinase enzymes that cause degradation of collagen and elastic fibers. The UVB and UVC light spectrum causes direct DNA skin damage and is associated with skin cancer.

Smoking generates oxygen radicals that stimulate metalloproteinase enzymes that are involved in skin aging. In an interesting study of skin aging in twins, where only one twin is a smoker, it was demonstrated that the smoking twin always appears more aged than the non-smoking twin, with every 10 years of smoking leading to a 2.5-year perceived age difference.

Excessive caffeine consumption reduces collagen type I synthesis by up to 15%. This has been demonstrated at a blood concentration of caffeine corresponding with three or more cups of coffee per day.


How do I prevent aging changes in my skin?

The most important measure in maintaining skin health and delaying aging is prevention against UV light exposure. This involves the liberal use of sunblock and protective clothing when outdoors. Smoking cessation is also an important measure. Smoking cessation counselors and use of nicotine patches have been shown to help smokers stop smoking more successfully than self-attempted cessation programs. Sufficient sleep, reduction in caffeine intake, and a sensible diet all contribute to good skin health. Finally, regular use of moisturizing creams and lotions is helpful for those with dry skin to maintain skin hydration and glow.


Attempts at skin resurfacing are as old as the human race itself. Examples include Cleopatra’s fabled baths in donkey milk and the litany of facial masks, peels and serums developed over the many centuries and millenia. A breakthrough in skin resurfacing occurred in the 1990s with the discovery of ablative laser resurfacing. This emerged as an effective non-invasive method of skin rejuvenation. In the early 2000s, fractional laser resurfacing was developed and shown to achieve equivalent rejuvenative effects as ablative resurfacing, while enjoying shorter duration of recovery. The treatment options for skin resurfacing include microdermabrasion, chemical peels and fractional laser resurfacing.


Microdermabrasion method of Skin Resurfacing.


Microdermabrasion is a gentle, non-invasive method of skin resurfacing with minimal discomfort and visible results.

Individuals with good quality skin seeking for minor improvement and minimal recovery time may consider microdermabrasion. Microdermabrasion may be used to treat sun damaged skin and acne scarring.

Microdermabrasion uses a regulated air-blown stream of fine diamond crystals on the skin surface, and the gentle abrasive effect removes the dead skin cells within the epidermis in a controlled manner. It stimulates the inner dermis layers to regenerate and recover, and maintains a fresh, youthful appearance. Treatment sessions normally last for 30 minutes each.

Very minimal redness may be visible following treatment, and the recovery time ranges from 2 to 24 hours. Repeat treatments may be performed at 2- to 3- week intervals for optimal results.

Chemical peels

Chemical peels may be used to exfoliate the superficial layers of the skin together with the melanin pigment contained within it. Picasso Plastic Surgery uses a proprietary formulation for a chemical peel that stimulates this exfoliation. This is a simple treatment consisting of a peel applied in the clinic that is removed 4 to 6 hours later, followed by a daily recovery serum applied for a month following the peel. Chemical peels are an effective and safe method of removing skin pigmentation. Repeat treatments may be performed at 2 monthly intervals for optimal results.


Fractional laser resurfacing

Fractional laser skin resurfacing technology emerged in the early 2000s as an effective method of skin rejuvenation. It strikes an optimal balance between skin rejuvenation and recovery time.

Individuals with good quality skin seeking to improve fine wrinkles and minimal recovery time may consider fractional laser resurfacing. It may be used to treat scars and sun damaged skin.

Fractional laser skin resurfacing induces extrusion of old skin, stimulation of new skin growth and collagen production. Fractional laser treatment delivers high-energy microbeams of laser to the skin surface in a grid configuration. Light energy from the laser is absorbed by water within the skin cells and is converted to heat energy, creating microthermal zones (MTZs) in the skin. The old, defective skin in the MTZs is extruded 1 week after the laser procedure, and new skin is formed originating from stem cells in the surrounding healthy skin. In the skin lying adjacent to the MTZs, a lesser degree of heating occurs. This results in thermal shrinkage of existing collagen fibers and induces new collagen formation by fibroblast cells.

Two main laser technologies have emerged as popular and effective methods of treatment. The CO2 laser utilizes a 10,600-nm wavelength and penetrates to a depth of 200- to 300- micrometers within the skin. The fractional CO2 laser generates good collateral heating around the treated area and induces significant skin tightening from collagen shrinkage. The other prevalent technology is the Erbium YAG laser, which utilizes a 2,940-nm wavelength. The Erbium laser is better absorbed by water and penetrates more superficially. The CO2 laser is capable of deeper skin heating and resurfacing and produces significant improvement. Our clinic utilizes the fractional CO2 laser to deliver the best result to you.

Fractional skin resurfacing is a quick and simple ambulatory procedure. An anesthetic cream is applied to provide analgesia during the procedure. The laser settings are tailored to individual skin characteristic and treatment goals. Successful laser treatment is a fine art that strikes a balance between delivering sufficient laser energy to create good clinical effect yet avoiding prolonged healing and complications.

Mild skin redness is expected over the treated areas, which peaks at 24 hours and settles after about 48 to 72 hours. Skin redness is due to blood vessel dilatation in the skin as a natural response to the laser treatment. Recovery after laser resurfacing is accelerated by the use of a proprietary serum derived from umbilical cord lining stem cell conditioned media for the first 5 days. Skin that has recently undergone laser treatment is normally sensitive to ultraviolet light and will require disciplined use of sunblock after the skin surface is recovered at day 5. Repeat treatments may be performed at 4- to 6- week intervals for optimal results before converting to maintenance treatment.

Fractional Laser Skin Resurfacing.

Other Non-Surgical Skin Treatments