Summary 

Unlike chemical peels and dermabrasion, laser skin resurfacing (LSR) with the CO2 laser generates heat, which results in immediate tightening because of shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, as well as a tightening effect that improves the skin’s overall appearance. The laser continuously stimulates healthy new collagen and elastic fibers in the skin for six months after resurfacing. Therefore, any wrinkles or scars will continue to improve for up to one year. Nonablative or minimal ablative fractional CO2 holds great promise in both treatments of skin textural abnormalities (acne scarring, wrinkles, and skin mottling associated with photoaging) as well as pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia).

Since ancient times, man has practiced removing layers of skin to get a specific cosmetic result. Scarifications have been practiced by primitive people for thousands of years and have survived among some cultures into this century. The definition of skin resurfacing (rejuvenation) is to make the surface smooth again. To smooth out the skin, a vast array of treatment choices varies from topical skin care products to chemicals, abrasive modalities, or lasers that can strip out the surface skin and promote the regeneration of new smooth, younger-looking skin. Non-ablative techniques were designed to combat the effects of aging in a softer, gentler way. It uses a revolutionary process that delivers the laser/light/RF energy through your skin’s surface to gently stimulate collagen production while protecting the outer layer of your skin. The new collagen softens the appearance of aging skin. Unlike ablative techniques, non-ablative technology does not resurface the skin; it simply tightens your skin to diminish the appearance of wrinkles.

Ablative Laser skin resurfacing (LSR) stays the gold standard for treating wrinkles and sun-damaged skin, offering unsurpassable results. Although there are various new technologies touted to be comparable to ablative skin rejuvenation laser peel, no treatment modality to date can replace ablative skin rejuvenation peel concerning the overall improvement of chronically sun-damaged skin. Unlike chemical peels and dermabrasion, laser skin rejuvenation peel with the CO2 laser generates heat, which results in immediate tightening because of shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, as well as a tightening effect that improves the skin’s overall appearance. The laser continuously stimulates healthy new collagen and elastic fibers in the skin for six months after resurfacing. During this time, the surface will continue to improve. It can achieve fifteen to twenty percent of firms.

In most cases, resilience and elasticity are restored, and any wrinkles or scars will continue to improve for over six months. Unfortunately, many traditional ablative laser techniques used to treat aging or scarring present patient discomfort, morbidity, and significant downtime. More people seek skin resurfacing treatments that don’t need many downtimes, recovery time, or discomfort noticed with full ablative skin resurfacing laser systems.

Fractional skin rejuvenation laser peel was developed for laser surgeons to get closer to ablative laser resurfacing clinical outcomes with less patient downtime and fewer overall adverse events. Fractional lasers produce an injury pattern to the skin with skip areas repeated, which, as they heal, promote an improvement in the tone and texture of the skin, in lines and wrinkles, in pigmentary concerns including melasma and scars, especially acne and traumatic scars.

The concept of fractional emission of light into microscopic zones of injury contrasts with traditional ablative skin resurfacing using a CO2 or erbium laser. The repair mechanisms seen in fractional lasers occur through the trans-epidermal delivery of treated necrotic skin through the stratum corneum. This process is known as microscopic epidermal necrotic debris (MENDs). The rapid healing process is made possible through the help of the surrounding “normal” or untreated skin—another process unique to fractional lasers.

Ablative fractional laser systems originally were divided into classifications based on laser type: CO2, Er: YAG, or YSGG, 2790nm. However, different ablative fractional laser systems emit light differently, with penetration depths that may be considered “superficial” and others that it may regard as “deep.” Thus, a new classification system that depends on the degree of skin penetration seems more logical.

Thus, fractional ablative lasers have been classified into “micro-ablative fractional laser systems,” which would include those lasers that produce epidermal and dermal damage to a depth less than 750 microns, and “deep dermal ablative fractional laser systems,” which would include those lasers that produce damage beyond 750 microns in the skin. Based upon these mechanisms of action, non-ablative fractional lasers hold great promise in both treatments of skin textural abnormalities (acne scarring, rhytides, and skin mottling associated with photoaging) as well as pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia). One of the significant advantages of non-ablative FP is the low incidence of adverse side effects.

Fractional skin rejuvenation laser peel action can range from non-ablative to full ablative skin resurfacing effect. Furthermore, it can be combined with a vast number of cosmetic procedures to help cosmetic surgeons in their battle against aging or scarring. The following cosmetic procedures can be combined successfully. Depending upon your skin condition, we mix and match the following:

Microdermabrasion is a technique used to exfoliate the upper epidermis and the stratum corneum to treat a vast range of skin imperfections. Like a light peel, it can improve superficial acne scars, some effects of sun damage, fine lines and wrinkles, superficial pigmentation, enlarged pores, and blackheads and whiteheads. It also acts to stimulate the formation of new collagen and elastin to improve skin texture and elasticity. Although its effects are not as dramatic as dermabrasion, it offers a more conservative choice in managing photoaged skin.

This type of microdermabrasion works with a diamond-tip handpiece that gently abrades and exfoliates dead skin cells. The diamond-tip microdermabrasion is safer to do closer to the eyes and more flexible in sensitive areas or on more sensitive skin. Microdermabrasion may be combined with a light chemical peel to increase the effect. The level of exfoliation achieved depends on many factors, including the skin contact time of the micro-dermabrader and the suction strength of the vacuum. At MSI, we are happy to have the 3rd generation micro-dermabrasion device. It removes this layer of skin by gently exfoliating the skin with natural diamond chips while at the same time vacuuming the dead skin cells away in a sterile and controlled way, leaving your skin smoother and healthier. The procedure is performed on the face but may also be applied to other areas of the body. Micro-dermabrasion should improve the permeation of topical treatment. Prof Moawad may recommend micro-dermabrasion as a standalone treatment or, more commonly, adjunct with other nonablative resurfacing procedures. The diamond peel can be given as a standalone treatment or a first step in skin rejuvenation peel. A typical course of treatment varies between 4-6 sessions at about 2-3-week intervals. It is recommended that you schedule an additional procedure every 1-3 months to keep up your skin condition

Before the peel, Prof. Moawad prescribes MSI skincare production such as bleaching agents, tretinoin, sunblock, and moisturizer at least 4-6 weeks before chemical peel for those patients with pigmentation or dark skin.

Many ablative skin resurfacing techniques are available at MSI, broadly grouped as mechanical, chemical, and laser abrasion. Dermabrasion relies on mechanical ‘cold steel’ injury, acid peels result in a ‘caustic’ injury, and lasers result in a thermal injury. All ablative techniques result in upper to the mid-dermal wound. All ablative resurfacing treatments work the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Superficial or medium resurfacing is limited to the epidermis and papillary dermis. For deeper resurfacing, it can also remove the upper levels of the reticular dermis.

Chemical peeling is often used to treat fine lines under the eyes, mild superficial scarring, sunspots, age spots, freckles, melasma, and dull texture. Generally, fair-skinned and light-haired patients are ideal candidates for chemical peels. Darker skin types may also experience good results depending upon the type of skin problem encountered.

The skin is thoroughly cleansed with an agent that removes excess oils at the treatment time, and the eyes and hair are protected. A chemical solution is applied to the skin that causes it to “blister” and eventually peel off. Prof. Moawad may recommend a superficial or medium chemical peel. He favors the medium-depth peel, the combination peel, and repeated lighter peeling regimens. He will select the proper mix of chemicals such as glycolic acid, salicylic acid, lactic acid, TCA, PCA, Phytic acid, or Jessner’s solution. Prof Moawad will individualize the strength of these chemical agents to match your skin type and degree of sun damage offering his patients more than ten programs.

Most patients experience a warm to the somewhat hot sensation that lasts about five to 10 minutes, followed by a stinging sensation. A deeper peel may need pain medication during or after the procedure.

Depending upon the type of peel, a reaction like a sunburn occurs following a chemical peel. Superficial peeling usually involves redness, followed by scaling that ends within three to seven days. Medium-depth and deep peeling may result in swelling and the presence of water blisters that may break, crust, turn brown and peel off over seven to 14 days.

Following any skin peel, you must avoid any exposure to the sun. Your new skin is susceptible to injury. Prof. Moawad will prescribe a good home skincare treatment program that includes cleansers, moisturizers, and sunscreens with or without anti-aging or bleaching agents to make sure adequate healing and keep up the result of your peel.

Following a chemical peel, your new skin will be tighter, smoother, and maybe slightly lighter than it was before surgery. The results of chemical peels may also be enhanced by new laser/light-based rejuvenation techniques.

Skin color is dependent on melanin pigment. Pigment-forming cells are called melanocytes. Abnormal hyperpigmentation (increased pigment) may result from alteration of the rate of melanin production, or uneven distribution of pigment, or both. Most dark spots result from UV light, skin trauma, pregnancy, hormones, drugs, or chemical compounds. The MSI team of medical professionals will thoroughly assess your condition before determining which energy-based technology is best to treat your disease. We use selective lasers, fractional lasers, fractional radiofrequency, and elos light technology. We mix and match different techniques to give the best possible results. Furthermore, physician skincare products with or without electroporation will help you to achieve the best results.

Removal of vascular skin lesions (red spots) without scarring was unthinkable a few decades ago. In the past thirty years, advances in laser technology have revolutionized the treatment of red skin spots expanded the dermatologist’s therapeutic armamentarium. Based on many thousands of treatment sessions and follow-up evaluations, these red pots can now safely and effectively be treated in infancy, early childhood, or as adults, with virtually little or no pain, textural changes, pigment changes, or scarring, and minimal postoperative wound care. We use selective lasers, fractional lasers, fractional radiofrequency, and elos light technology. We mix and match different technologies to give the best possible results.

You may use a topical anesthetic cream before the treatment to minimize pain. The treated areas result in thermal damage in the deep dermal collagen, stimulating wound healing, dermal remodeling, and new collagen, elastin, and hyaluronic acid formation. Fractional radiofrequency (FRF) deliver energy creates zones of affected skin adjacent to unaffected areas. The unaffected areas serve as a reservoir of cells that promote and accelerate wound healing. FRF improves acne scars and large facial pores, wrinkles, and facial laxity reduction. The most common sequence effects are erythema and edema, which are transient (few days).

In a new approach, Prof Moawad offers his patients a full-face FRF to make tiny holes into the skin to overcome the stratum corneum to enhance PRP and /or nanofat. The results are doubles, and you will enjoy both the rejuvenating effect of the FRF resurfacing system and the regenerative effect of growth factors and stem cells present in PRP and/or nanofat. Recently, we applied FRF before botox treatment of excessive sweating or hyperhidrosis of the axilla.

How Do I Look after Skin Rejuvenation Peel?

Your doctor will prescribe the proper follow-up skincare to reduce the tendency to develop abnormal skin color after peeling. Redness, swelling, or the sensation of having a mild sunburn will help a pass after a few hours. Well-chosen MSI skincare products; a hydrating serum, moisturizer, and sunscreen are essential post-skin rejuvenation peel to ensure a rapid healing process. For redness, a cream that has vitamin K will hasten the resolution. Dark skin people may develop transient hyperpigmentation after the ablative procedure (chemical peel, dermabrasion, or fractional laser) that will fade out using a unique combination of bleaching agents such as Hydroquinone, arbutin, licorice Kojic acid, and Azelaic acid.

Complementary Procedures

Photo-rejuvenation encompasses many procedures using light or laser-based technology to reverse the effects of photoaging. Nonablative photo-rejuvenation refers to the controlled use of thermal energy to carry out skin rejuvenation without disturbing the overlying epidermis and with minimal to no downtime. The primary mechanism of action is thermal injury either by heating the dermis to stimulate fibroblast proliferation or by heating blood vessels for photocoagulation. Currently employed nonablative modalities include primarily intense pulsed light (IPL), visible wavelengths including 585nm pulsed dye laser (PDL), and 532 nm green light (KTP laser). Different infrared wavelengths with water as the target are used for remodeling dermal collagen. Because absorption by melanin is negligible, I can use these devices for all skin types, including 1064, 1320, 1450, and 1540 nm.

The newest way to deliver these wavelengths is by fractionating the dose. The non-thermal mechanism, which represents a fundamental change in thinking, is the theory of photo-modulation. This novel approach to photoaging uses non-thermal light treatments to regulate the activity of cells and not to invoke thermal wound healing mechanisms. Photomodulation uses Light-Emitting Diode (LED) treatments.

Monopolar radiofrequency devices are used to treat periorbital wrinkles, skin laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Monopolar radiofrequency deliver a high-frequency electric current—tissue resistance to electrical current, resulting in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.”

In aesthetic practice, using cosmeceuticals in combination with cosmetic procedures is a new treatment ideal for skin rejuvenation. Pre-treatment with cosmeceuticals can prime the skin for procedures, and post-treatment can reduce complications. Patients with conditions such as rosacea, eczema, seborrhea, and acne require specially selected products that will enhance skin appearance without irritating their underlying conditions.

The skin acts as a natural barrier against foreign substances, including drugs or cosmeceutical, into the dermis. No needle mesotherapy addresses this problem by using electrical currents that help to increase the absorption of any solution into the deeper layers of the skin (transdermal, to be more specific). Compared to iontophoresis, it is 500 times more effective in delivering treatment transdermal. The ingredients mentioned above are not injected into the skin but painlessly pass-through deep layers of the skin with the help of an electric current that creates temporary holes in your skin. These holes allow the passage of active ingredients that help treat pimples, dark spots or rejuvenate your skin. Temporary holes closed immediately after treatment.

The procedure is done by applying a numbing cream to the skin first to be comfortable throughout the procedure. Micro-needling works by applying a device that has multiple fine needles to the surface of the skin. This action induces fine shallow punctures on the skin, and these micro-wounds will promote the healing process. When the needle breaks the healthy skin barrier, blood vessels will be injured, thus releasing many repair cells in the blood. This repairing process will also stimulate collagen and elastin synthesis giving the tightening after effect. The after-effects of the process are redness of the skin with mild swelling that will resolve in several hours. Micro-needling is an excellent treatment to be combined with mesotherapy, electroporation, or PRP for an enhanced effect.

The mesotherapy approach to treat aging, sun-damaged, and wrinkling of the skin involving the face and neck is called Mesolift. Mesolift is a safe, natural alternative to invasive cosmetic procedures such as laser skin treatment. This minimally invasive treatment delivers vitamins, minerals, and amino acids directly into the skin to nourish and rejuvenate, promote the production of collagen and elastin, and stimulate your metabolism. A small amount of local anesthetic cream is applied to the face 20-30 minutes before treatment. Mesolift is then injected into the upper layer of the skin using a very fine micro-needle, resulting in a quick, pain-free procedure. Sometimes we make tiny holes in the skin using a derma roller, derma pen, or fractional laser, or radiofrequency, then paint the treated skin with a brush to decrease the bruises of microinjection or in needle-phobic patients. The number of injections and strength of each medication treatment are determined on an individual basis. Mesolift can be given as standalone or, more commonly, part of our comprehensive skin rejuvenation peel.

Platelets have essential growth factors that, when secreted, handle tissue regeneration and rejuvenation, increase collagen production, recruit other cells to the injury site, and induce cell differentiation and extracellular matrix formation. It has an anti-inflammatory effect that will speed up healing time and ease recovery time after resurfacing procedure. With PRP therapy, we stimulate long-term collagen growth, eliminate skin wrinkles, rejuvenate the skin, improve acne scarring appearance, and hasten the healing process after a facial peel.

Vampire Facelift is a name for a non-surgical cosmetic procedure involving the injection of platelet-rich plasma (PRP) derived from a patient’s blood back into multiple areas of the skin of their face to treat wrinkles and “rejuvenate” the face. Platelets have essential growth factors that, when secreted, handle tissue regeneration and rejuvenation, increase collagen production, recruit other cells to the injury site, induce cell differentiation and extracellular matrix formation. It has an anti-inflammatory effect that will speed up healing time and ease recovery time after resurfacing procedure. In a new approach, Prof uses fractional ablative lasers to overcome the epidermal barrier and increase topical agents’ penetration as laser-assisted drug delivery (LADD). Prof Moawad offers his patients a full-face fractional CO2 laser or fractional radiofrequency (FRF) to make tiny holes into the skin to overcome the stratum corneum to enhance PRP and /or nanofat. The results are doubles. You will enjoy both the rejuvenating effect of fractional skin resurfacing systems and the regenerative effect of growth factors and stem cells present in PRP and/or nanofat.

Botox is the most effective tool in cosmetic medicine and should be used first and most often. Indeed, there is now a greater appreciation that BOTOX-A is one part of overall facial rejuvenation therapy, in which all aspects of aging are addressed in the exact individual BOTOX dosing, and injection points should be based on assessing the patient’s anatomy, goals, preferences, and the physician’s own professional experience with prior treatments. Gender, cultural, and ethnic standards of attractiveness may significantly influence the patient’s preference. Each patient’s treatment should be individualized for the best results. BOTOX also has a synergistic benefit with other aesthetic modalities, such as dermal fillers, laser skin chemical peel, and even face and neck lift surgery.

The two principal categories of temporary fillers approved by the U.S. Food and Drug Administration for facial rejuvenation are hyaluronic acid and calcium hydroxylapatite.

The selection of HA implant is based on the indication and site of placement. For lifting and restoring volume, improving the structural foundations and facial contour, a high-density HA implant is injected deeply into the supraperiosteum. To treat medium-deep depression, we used a mid-density hyaluronic acid filler injected subdermally. For treating the periorbital area and the area around the lip, giving finished facial refinements, a low-density hyaluronic acid filler is selected with a water-like consistency filler.

Dermabrasion is a technique that uses a diamond wheel with rough edges (called fraise) to remove the upper layers of the skin. The fraise rotates rapidly, taking off and leveling (abrading) the top layers of the skin. Dermabrasion, chemical peel, and fractional laser resurfacing are used to improve skin texture and superficial scarring. In general, the choice of technique is based on the site you want to treat, your skin type and condition, the doctor’s experience, your preferences, and other factors.

The term “subcision” denotes a method that involves cutting under a depressed scar, wrinkle, or contour using disposable needles inserted under the skin through a needle puncture. The procedure attempts to raise the base of the defect to the level of the surrounding skin surface. The integrity of the skin surface is compromised minimally, just as with a routine needle puncture. The effectiveness of subcision for correcting various types of skin depressions depends on two distinct phenomena. First, the act of surgically releasing the skin from its attachment to deeper tissues results in skin elevation. Second, the introduction of a controlled trauma initiates wound healing with consequent formation of connective tissue, resulting in augmentation of the depressing site.

Conclusion

Skin rejuvenation peel combines traditional relaxing facials with comprehensive high-tech anti-aging anti-acne scar treatment tailored to your needs and goal. We can keep skin function with skincare products at MSI, relax dynamic wrinkles with Botox, refill atrophic skin and subcutaneous tissue with fillers, tighten the skin, and re-drape it non-surgically with energy-based technologies. We can resurface the skin to improve its texture.

Notes

I can determine the specific risks and the suitability of this procedure for a given person only at the time of consultation. All methods have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Significant complications are rare.

A variety knows fat transfer of names, of which the commonly used are fat transfer, fat injection, and autologous fat grafts. The word autologous means material (fat) is harvested from one area and donated to another in the same individual. Fat transfer has become an increasingly important method of facial rejuvenation both as a standalone procedure and in combination with traditional rejuvenation methods, like face-lifting, brow lifting, and Blepharoplasty. Fat transfer is particularly suited for restructuring the proportion of the face. Typical facial structures can also be aided by adding constructive elements to correct a broad range of perceived facial deficiencies. Nanofat is applicable in a wide range of indications to improve the skin quality; trophic skin changes caused by age and sun damage, pigmentary skin conditions, and scarring Non-facial areas such as the neck, the décolleté area, and the hands can also greatly benefit from the use of nanofat grafting, sometimes in combination with microfat.

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