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The number of patients consulting for skin aging prevention and skin rejuvenation procedures is growing since the last decade.
We have a lot of possibilities to help this kind of patients and it is not always easy to make the right choice. The first decision to take is to select the most appropriate and the safest procedure for your patients, considering several factors as their skin type and the type of skin damage they are suffering. The most popular techniques today are dermabrasion, microdermabrasion, CO2 and Erbium laser resurfacing, face lift and peeling.

Dermabrasion has been used by several generations of dermatologists and plastic surgeons for many years. This is a very good technique to reach the mid or deep dermis in order to decrease wrinkles or deep acne scars. Nevertheless, great skills are mandatory and very few doctors today are able to safely perform that technique. Complications as hypopigmentation or hypertrophic scars are common. This is a painful procedure which requires light sedation. This is certainly not a beginner's procedure. There are so many other ways today to prevent and treat skin aging that dermabrasion will certainly not be your first choice, except if you are an expert.

The popularity of microdermabrasion has never been very high in Europe, Asia or Latin America where it has been put on the market in the late eighties. Lack of results gave that procedure very limited success in those parts of the world. The technique is very easy to perform although it is difficult to get an even abrasion. Nevertheless, the first microdermabrasion units showed up on the US market a decade ago, helped by a strong market strategy. It has been an attractive method for the practitioners in their first steps to approach photo aging and other inesthetic skin disorders. The industry pushed the technique forward in a wide range of indications covering most of the skin damage we can see on a daily basis during our consultations, such as acne scars, pigmentary disorders, fine lines and wrinkles, striae and others. Since the last few years, this technique is less and less successful. Too many users have been disappointed with the results. We have so many better tools in our possession today that I do not think that the expense of such an unit is justified.

The popularity of CO2 and laser resurfacing is slowing down as well. The results are good but complications such as pigmentary changes and scars are common. The healing process is very long. A post laser resurfacing erythema can persist for six months and up, generating a lot of discomfort in the social life of the patient. On top of that, a laser unit is extremely expensive and, very often, your laser will become obsolete before the end of your lease. You also have to consider that, like a computer, there is little or no second hand market.

Face lift is a great technique that works on muscles laxity but it does not work on skin structure itself. That's why a face lift is not always sufficient to correct skin aging. Other complementary techniques such as peelings will be necessary to obtain a maximal effect.

More and more practitioners have been performing peelings in the past ten years because it works and, if you make the right choice, you will proceed with an optimal safety for your patient. A long time ago, Egyptians were already using various herbs and chemicals in order to rejuvenate their skin and to look younger. At the end of 19th century, Unna, a German dermatologist, was the first to describe peelings in a scientific way. He made the medical community aware of the effects of TCA, phenol, resorcine and salicylic acid on the skin. Several generations of dermatologists updated this knowledge through more than a century. Thanks to them, we have the opportunity today to find a large range of chemicals or chemical mixtures for peeling purpose. The most difficult will be sometimes to make the right choice.

There are some main rules to observe to drive your peel successfully. The most important in my mind is to be able to manage your peel all the time during the procedure. In observing your endpoints, you must be able to know how deep you are at anytime and you must be able to stop it at anytime as well. Do not give unrealistic expectations to your patient and think the indication well before proceeding. Take care of your patient skin type as well. We have so many types of peels today that we can go as superficial or as deep as we want, depending of patient wishes and practitioner skin examination. We can go all the way from a light exfoliation to look better, to deeper peel for scars and wrinkle problems.

It is crucial for anyone of us to be and stay informed on peeling materials and evolution of techniques, by following workshops and attending congresses focused on aesthetic medicine. Today, I think that peeling is the best and safest technique to treat sun damage and skin aging. Make your choice and learn how to do it. Your patients and yourself will be so pleased with the results.