Mechanical Peeling

    Dermabrasion

    Dermabrasion has proved successful as a surgical peeling treatment for removing acne scars. For treating facial wrinkles of the older skin, however, dermabrasion is usually not as effective as peeling methods with phenol or TCA. The advantages of dermabrasion are the good controllability of the depth of treatment and the normally low pigmentation disturbances that occur in the skin. A combination of dermabrasion with chemical peeling methods appears a good solution in many cases.

    In dermabrasion, layers of skin are removed mechanically by means of brushes, steel cylinders and diamond fraises (a kind of grinder) rotating at high speeds (60,000 RPM and more). A local anaesthetic is necessary. With the handpiece being constantly moved, very fine layers of skin are removed. To prevent scarring, it is preferable to repeat the treatment several times with only small amounts being removed at each session, rather than to remove too much skin all at once.

    Soft dermabrasion

    A much gentler, though more superficial form of peeling, is the so-called reviderm peeling method, whereby the superficial skin is removed by microfine coridon crystals applied using compressed air. Before the mechanical process, a peeling cream can be applied.

    As with all peeling methods, removal of the outermost layers of skin causes new cells to be formed starting from the basal cell layer. Small wrinkles are smoothed out, and pigment blemishes may become paler.

    Laser therapy (“laser skin resurfacing”)

    In the case of laser treatment, a high-energy, highly concentrated beam of light is aimed at the skin tissue, which contains moisture. In less than two-thousandths of a second, an extremely fine layer of skin – only a few thousandths of a millimetre thick – is evaporated. By repeating this process, it is possible to remove the skin in several layers in a controlled manner. As the energy is released in the form of ultra-short pulses and the movement is controlled by computer, the laser energy and therefore also the depth of treatment can be very well controlled. With the ultra-pulsed CO2 or erbium YAG laser, wrinkles, age spots, haemangiomas and pigment blemishes can be dealt with in just a few sessions. The heat exposure is so brief that the deeper tissue is not affected. As a result of the heat, the surface collagen fibres contract, causing collagen shrinking. Consequently, the skin appears tauter and younger. While erbium YAG laser treatment corresponds more to the effects of surface peeling, the CO2 laser produces heating of the deeper tissue and more marked collagen shrinking. The small wrinkles around the upper lips and the eyes are highly susceptible to treatment with the erbium YAG laser. Deeper wrinkles can only be removed using the CO2 laser.

    Before any peeling, cryo-peeling, dermabrasion or laser therapy, the skin should be treated beforehand for 2 to 4 weeks with a special cream (e.g. 0.1 % tretinoin and 4 % hydrochinon, or possibly also with fruit acids). Patients with a tendency to herpes infections should also take prophylactic treatment against herpes in tablet form for 1 day before and up to 7 days after treatment. Most treatments are performed under local anaesthetic (cream or infiltration), the deep peelings almost always under a light general anaesthetic.

    After treatment, it is essential to protect the skin from moisture loss by the use of lipid ointments (e.g. eye vaseline). For cleaning, it is sufficient to use gentle soaps and syndets. Thicker scabs can be gently released with 3 % H2O2 solution. Itching during the healing process can be lessened with anti-histamines taken orally, or in severe cases by steroid ointments applied locally. This prevents scratching and, as a result, damage to the newly forming epidermis and so the risk of scar formation and pigment changes.

    Follow-up treatment also appears advisable in the form of a tretinoin-hydrochinon cream for a period of at least 4 weeks in order to avoid excessive skin pigmentation. After the treatment, it is essential to protect the skin from sunlight and artificial UV light by using sun blockers with the highest possible sun protection factor. Subsequently, life-long use of sun protection products with a high UVA and UVB filter is strongly advised.