Combined Resurfacing Modalities: A Systematic Approach

“Combined Resurfacing Modalities:  A Systematic Approach”, Williams EF 3rd,
        Samuel M. Lam, M.D., International Journal of Cosmetic Surgery and Aesthetic Dermatology  2002;4:81-88.

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 10-year experience and personal philosophy of the senior author (EFW) and reviews how he has implemented combine resurfacing techniques using the CO2 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).

Many resurfacing modalities are currently available to the facial aesthetic surgeon: mechanical, chemical, and laser abrasion. However, surgeons can fall victim to compartmentalized thinking and undiscriminately use one technique that has served them well for every type of resurfacing situation. We have outlined a rational approach to the treatment of diverse skin conditions using wisely chosen and combined resurfacing techniques based on our clinical experience and personal philosophy.

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