Put Your Trouble Spots Behind You

We all know that to keep our skin looking young and healthy--and prevent against cancer--we should avoid the sun and diligently apply sunscreen. Unfortunately, for many of us, the damage was done long before we began heeding these messages. But before you start crying in your sunblock, all is not lost. The good news is that there are treatments available that will improve the appearance of photodamaged skin, including the face, chest and arms.

Photodamage can show up in lots of ways: brown spots, blotchiness, rough patches and wrinkles. The neck is often one of the first areas of the skin to show signs of aging. And, because the skin on your chest is so thin, this is another telltale area.

These days, dermatologists are using resurfacing lasers and chemical peels to treat photodamage on both the face and non-facial areas. But before you bare it all for either treatment, here's the lowdown.

Resurfacing Lasers

Resurfacing lasers basically work by stripping layers of skin; the heat from the laser also allows for collagen reformation, resulting in tightening of the skin and a smoother appearance. (Keep in mind: If you opt to go down laser lane for non-facial areas, expect about half the improvement you'd get for similar resurfacing of the face.) The advantage of the laser over chemical peels is that you get immediate results. However, recovery is a week to ten days (more for non-facial areas). Redness can also last anywhere from two to four weeks. Other side effects can include scabbing, temporary increased pigmentation and infection. If you have dark skin, lasers can also remove too much pigment, leaving a light spot behind. (A spot test can be done on a hidden area of skin.)

This type of laser treatment is not generally painful, and there is mild discomfort afterward. Often, only a local anesthesia is required. Post-operative care typically consists of soaking the superficial wound with water and applying ointment to the skin regularly for approximately a week or until skin heals. Multiple treatments may be required for optimal results.

Factors influencing what kind of procedure to get include skin type, pigmentation, the degree of sun damage, and your expectations. There are a lot of different lasers out there, but these are among the most common:

Erbium YAG laser

Best used for superficial or medium depth resurfacing. This laser works by selectively removing the outer layer of the skin, or the upper two layers, with little heat. Side effects are less common with this laser, and recovery is usually faster.

Q-Switched Alexandrite Laser

Best for moderate photodamaged skin. Pigmented photodamaged areas are selectively treated, while preserving the undamaged skin. With repeated treatments, this technology produces a noticeable effect.

Carbon Dioxide Laser

Best for moderate to advanced photodamaged skin, from fine lines to deeper wrinkles. This laser destroys the outer and middle layers of the skin. Since results are more dramatic with this laser, there's usually more downtime, as well as a greater risk for complications. When it comes to deeper facial wrinkles, this type of laser resurfacing is a major procedure requiring anesthesia, recuperation and downtime.

Chemical Peels

With a peel, the upper layers of the skin are removed to unveil younger-looking skin, so there are fewer wrinkles and color is more even. There are three different levels of peels, from very superficial to deep peels. The depth of the peel depends on the level of photodamage. Although these techniques may have less recovery time, often allowing patients to go back to work immediately, the results are not as dramatic or long lasting, as with the laser. Still, if you're under 40 or your lines aren't severe, you're probably better off fighting lines with these. They're less risky (and cheaper, too).

Very superficial chemical peels remove the top layer of cells and stimulate a regeneration of the outer layer of skin. These are best for early aging skin. It usually takes 48-72 hours for skin to heal from peeling and redness. There are a few different kinds:

• Glycolic acid peels, also known the "lunchtime peel."
• At-home peels, like MD Formulations My Personal Peel System, DERMAdoctor Physical Chemistry Facial Microdermabrasion + Multiacid Chemical Peel or MD Skincare Alpha Beta Daily Face Peel - 30 applications are very light (yet very effective) with little or no downtime.
• Trichloacetic Acid (TCA) peels, which can be turned up to produce more dramatic benefits. Recovery may take a few days.

  For moderate photodamage, a medium depth peel can be used. But for non-facial skin, these are typically too aggressive, so you should stick with a superficial peel. Deep peels have been used to remove wrinkles, but because they may cause lightening of the skin, a combination of medium and deep chemical peel may be used. Patients usually need five-to-seven day recuperation.

The Next Big Thing?

Photo rejuvenation is one of the hottest things going right now. A precise amount of light energy targets areas on the skin, stimulating the production of fresh collagen. The result is a reduction in sun-induced brown spots and red blotchiness--with little or no downtime.

While some patient may experience a mild amount of discomfort (think: the gentle snapping of a rubber band on the skin), anesthesia is not required and there is no discomfort after the treatment. Skin may appear a little flushed immediately after, and the capillaries may become more visible. In addition, age spots may appear a bit darker for a few days. All of these fade over a period of no more than a few days, even hours. However, you'll need about six treatments, spaced three to four weeks apart, for best results.

Do-It-Yourself Damage Control

For fine lines and rough skin, products that contain alpha-hydroxy acids can help slough off dry, dead skin. Try: MD Formulations Continuous Renewal Serum and Cellex-C BetaPlex Line Smoother.

For hyperpigmentation and uneven skin tone look for products like DERMAdoctor Immaculate Correction Potent Hydroquinone-Free Skin Brightener and/or Afirm 3X.

With any treatment, remember, you may feel like singing, Let the sun shine! But you still need to wear your SPF.

Anna Roufos
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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