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   Skin Resurfacing:
   Skin resurfacing employs a variety of techniques to change the surface
   texture and appearance of the skin. Common skin resurfacing techniques
   include chemical peels, dermabrasion, and laser resurfacing.







   Antiviral medications should be started several days before the procedure.
   Laser resurfacing is performed under local anesthesia. An oral sedative may
   also be taken. The patient's eyes must be shielded, and the area surrounding
   the face should be shielded with wet drapes or crumpled foil to catch stray
   beams of laser light. The physician will mark the areas to be treated
   before beginning the procedure.




   The skin should be kept moist following laser resurfacing. This promotes more
   rapid healing and reduces the risk of infection. The face is washed with
   plain water and an ointment is reapplied. Healing will take approximately
   two weeks. Pain medications and a steroid to reduce swelling may also be taken.




   Chemical peels employ a variety of caustic chemicals to selectively
   destroy several layers of skin. The peeling solutions are "painted on,"
   area-by-area, to ensure that the entire face is treated.
   After the skin heals, discoloration, wrinkles, and other surface irregularities
   are often eliminated. Chemical peels are divided into three types:
   superficial, medium-depth, and deep. The type of peel depends on the strength
   of the chemical used, and on how deeply it penetrates. Superficial peels are used
   for fine wrinkles, sun damage, acne, and rosacea. The medium-depth peel is used
   for more obvious wrinkles and sun damage. Deep peels are used for the most
   severe wrinkling and sun damage.




   Preparation for the chemical peel begins several weeks before
   the actual procedure. To promote turnover of skin cells, patients use
   a mild glycolic acid lotion or cream in the morning, and the acne cream tretinoin
   in the evening. They also use hydroquinone cream, a bleaching product that
   helps prevent later discoloration. To prevent reappearance of a herpes simplex
   virus infection, antiviral medicine is started a few days before the procedure
   and continues until the skin has healed.




   Patients arrive for the procedure wearing no makeup. The physician "degreases" the patient's face using alcohol or another cleanser. Some degree of pain accompanies all types of peels. For a superficial peel, use of a hand held fan to cool the face during the procedure is often sufficient. For medium-depth peels, the patient may take a sedative or aspirin. During the procedure, cold compresses and a hand-held fan can also reduce pain. Deep peels can be extremely painful. Some physicians prefer general anesthesia, but local anesthetics combined with intravenous sedatives are frequently sufficient to control pain. Within a day or so following a superficial peel, the skin will turn faint pink or brown. Over the next few days, dead skin will peel away. Patients will be instructed to wash their skin frequently with a mild cleanser and cool water, then apply an ointment to the skin to keep it moist. After a medium-depth peel, the skin turns deep red or brown, and crusts may form. Care is similar to that following a superficial peel. Redness may persist for a week or more. Deep-peeled skin will turn brown and crusty. There may also be swelling and some oozing of fluid. Frequent washing and ointments are favored over dressings. The skin typically heals in about two weeks, but redness may persist.

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