Skin Resurfacing Laser or Peel

"Structure and surface should be analyzed separately and then melded into a therapeutic plan for the individual facing you across the consultation room."

Leonard J. Singer

"Since the mid 1990s, laser-assisted skin resurfacing has rapidly replaced chemical peels and physical dermabrasion as the most common means of skin exfoliation. Remarkably this has taken place with alarming rapidity and despite the lack of comparative trials. Evidence-based medicine has taught us the value of comparative trials. Without these we must ask ourselves the fundamental questions, how and why has this happened and is it justified?"

Milton Waner

"The contemporary use of these agents began in the 1960s, and their use has flourished since that time. Well-documented research has shown the beneficial clinical and histologic changes present after the application of various chemical peeling agents."

Devinder S. Mangat

Skin Resurfacing—Laser or Peel

Leonard J. Singer


During the past 5 years, two new industries have made a substantial mark on the cosmetic surgery world: the therapeutic skin care market, and the cosmetic laser market. As with most advances in this field, these new products and services have undergone a baptism by fire of talk-show promotion, infotainment exposé, and faddish mood swings in popularity. At this juncture, it would be useful to review a framework of knowledge and opinion that may help the practicing cosmetic surgeon organize and make sense of these new products and services.

Patients consulting with the cosmetic surgeon for improvement of the appearance of their face represent the broadest range of expression of any presenting problem in the specialty. They range from the preteen struggling with scarring from self-evacuation of acne pustules to the leathery alligatorlike skin of the working outdoorsman; from the society matron who shuns photos of her profile to the 30-year-old manager who simply wants to improve and maintain her skin. An organized, logical approach to these problems will encourage problem-oriented solutions, which should in turn result in improved outcomes and greater patient satisfaction.

When the patient is first seen, it is helpful for the surgeon to determine where the patient's concerns and priorities lie. Is the patient most concerned about problems of structure, i.e., sagging of skin around the brows, nasolabial folds, jaw line, and neck, or is the concern directed more toward skin color and tone, and surface wrinkles or acne scars? The analogy I frequently use in explaining this concept to the patient is that of the old, neglected house being considered for rehabilitation. Clearly, placing a bid without first determining the quality of the supporting structure and the need for structural repair would be foolish. Equally important is the assessment of the surface, such as paint, roof, and landscape. Structure and surface should be analyzed separately and then melded into a therapeutic plan for the individual facing you across the consultation room.

The purpose of this chapter is to address the repair of surface abnormalities specifically by laser resurfacing, but it is important to place the procedure within the context of a logical plan. Only the amateur cosmetic surgeon will address all facial concerns with one modality.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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