Combined Resurfacing Techniques: A Systematic Approach

Abstract

Many resurfacing techniques are available to the modern facial aesthetic surgeon, and may be broadly grouped as mechanical, chemical, and laser abrasion. Each resurfacing modality has its own inherent strengths and weaknesses that make it suitable for certain defined goals. Understanding the characteristics of each type of resurfacing tool permits the surgeon to combine them effectively to achieve the desired cosmetic outcome. This paper represents the 10year experience and personal philosophy of the senior author (EFW) and reviews how he has implemented combined resurfacing techniques using the CO 2 laser, TCA peel, and wire-brush dermabrasion. Three important guidelines will determine which resurfacing modality is best suited to a particular situation: the facial subunit principle, the depth of the facial pathology (e.g., scar, rhytid, or actinic damage), and the Fitzpatrick classification of the patient's skin. Different resurfacing modalities are discussed, and three clinical scenarios for combined resurfacing are presented: acne scarring, rhinophyma, and facial rejuvenation (rhytids and actinic damage).

Management of the Postpeel and Laser-Resurfaced Patient: A Ten-Year Experience

“…Due to this fact we have limited our CO 2 resurfacing to discrete areas of the face that, in our experience, tend to tolerate laser resurfacing better, such as the lower-lid, glabellar, and perioral regions. (1) Hypopigmentation must be carefully delineated from frank depigmentation. Hypopigmentation may resolve, but true depigmentation is not easily managed.…”

“…Each modality has its own unique characteristic benefits and drawbacks, and at times a combination of these techniques may offer the patient the most favorable means of obtaining the desired objective. (1) Mechanical abrasion may range from the least invasive microdermabrasion to the more aggressive technique of dermasanding to fully ablative dermabrasion. The latter offers precise control of uneven cutaneous contour and texture and is particularly well suited in acne-scarred skin (Fig.…”