Chemexfoliation and Superficial Skin Resurfacing

Introduction
     
  Core Messages
  • Superficial chemical peeling produces a controlled injury to the epidermis. Downtime and complications are minimal, and it is found to be suitable for any skin type.
  • Medium-depth chemical peeling induces damage to the papillary dermis, thus the preprocedure regimen is essential to avoid postpeel pigmentary alterations.
  • Deep chemical peeling penetrates deeper into the dermis and consequently has a higher risk of postoperative complications and downtime in all skin types.
  • The latest technology used to potentiate rapid epidermal exfoliation in all skin types is microdermabrasion, a process involving superficial abrading of the skin with fine, sharp crystals with a vacuum closed-loop suction device to remove the crystals.
 
     
Chemical and mechanical skin resurfacing has been utilized by humans to improve the overall appearance and well-being of skin. The first chemical peels date back to the Egyptians who used sour milk baths (lactic acid), various chemicals (e.g., alabaster and salt), and sandpaper in order to attain a smoother skin surface [1]. In 1882, P.G.Unna, a German dermatologist, described the properties of salicylic acid, resorcinol, phenol, and trichloroacetic acid (TCA) and used these chemicals as peeling agents [2]. In 1976, Resnik et al. described the utility of TCA peels in various skin conditions [3]. In the late 1980s and the 1990s, α-hydroxy acids (AHAs) became available for superficial peeling agents. For nearly 20 years, a newer technique for superficial skin resurfacing, microdermabrasion, has become a key player in the arena of noninvasive anti-aging medicine.Over the last several decades, the science behind resurfacing procedures has expanded, as has the public’s increasing demand for cosmetic surgery and skin rejuvenation. To date, chemical peeling and microdermabrasion are among the most common procedures performed in dermatologic offices and are an important component of our armamentarium in the management of both cosmetic and noncosmetic skin conditions.