From early on, we learn that having a smooth, clear complexion is an attribute of physical attractiveness.  However, as we age, maintaining that healthy glow becomes difficult.

The face is the most exposed part of the body, vulnerable to the harsh rays of the sun.  The face is also subject to acne, rashes, allergic reactions and injuries that may leave permanent scars.

This discussion will give you a basic understanding of commonly used treatments for managing your skin, treatments that can help, what they involve, and the results you can expect.  It can’t answer all of your questions, since a lot depends upon your individual circumstances.

Be sure to ask if there is anything you don’t understand about any treatment you’re considering.

A number of non-surgical “refinishing” treatments are available for individuals who want to eliminate or soften imperfections on their facial skin and achieve a clearer, fresher look.  These treatments include; glycolic acids (sometimes called “fruity acids”), which are natural fruit substances blended into facial preparations and used to eliminate rough or dried surface skin; and   Retin-A, a vitamin A-enriched cream that changes the cellular metabolism of the skin’s surface used to combat fine facial wrinkles and blotches from sun damage.  Most treatments involve a total skin care regimen such as the iS Clinical product lines and Neostrata, available in our office.

Each of these treatments can be used alone, or are frequently prescribed in conjunction with, an aesthetic surgery procedure such as a facelift or laser resurfacing.


Surface repair treatments can enhance your appearance and give your skin a smoother, fresher look, but they will not remove deep scars or wrinkles or prevent aging.  These treatments should not be thought of as mini-facelifts. Generally speaking, Retin-A and glycolic acid treatments are meant to control the quality of your facial skin and offer less dramatic results than surgical approaches which address the excess amount of skin that may be present.

Before you decide to have a skin rejuvenating treatment of any type, think carefully about your expectations and discuss them with your plastic surgeon.


Whether you’re planning a surgical or nonsurgical skin treatment, it’s important that you find a doctor who has training and experience with all types of skin management techniques.  You’ll want a doctor who can give you the best possible single treatment and/or treatment combination. Look elsewhere if your doctor tells you that he has perfected a single technique that promises unbelievable results.  The choice is yours, but be certain your doctor has experience in all skin treatments.

Some skin treatments, such as a CO2 laser treatment, can be performed at the same time as some surgical procedures, but your plastic surgeon will know best if a procedure to treat your skin surface will interfere with the healing of your surgical procedure.

Facelift patients are out and about after 4-5 days.  However, because laser patients take longer to heal, some patients will choose to do these as two-stage facial procedures, with the laser treatment performed during the winter months.


It is unlikely that you’ll have to spend time in the hospital for your skin treatment unless your treatment is performed in conjunction with a facelift or some other surgical procedure.  Chemical peels such as TCA (TriChloroAcetic) acid alone are usually performed in a doctor’s office.


Retin-A is a “fertilizer” for your skin and is not a treatment.  Most patients should use Retin-A to improve the appearance of any skin, including hands, chest and, of course face.  Retin-A will make your skin look better because it causes your skin cells to absorb water, which will result in the softening of lines and wrinkles.  Although Retin-A is not a treatment, it should be part of your maintenance program.

To actually change the appearance of your skin quality, your skin must be “burned”, either with gentle cosmetic products that contain “acids”, or an in-office chemical peel such as TCA.

For deeply wrinkled skin, deep acid peels such as Phenol are usually recommended.  Phenol peels are performed in some areas that are overly pigmented or spotted because they will cause loss of pigmentation which can be a drawback in “only” wrinkled patients.

Today, the CO2 laser is the Gold Standard, and has been for the past 20 years.  This laser produces a “burn” on the skin, which can be calibrated to allow for the thinner skin of the eyelids, or the thicker skin of a creased upper lip.  The knowledge and experience of your surgeon will determine which laser settings and intensity should be utilized in specific areas to achieve the most desirable results.


Patients who are planning to have a chemical peel treatment or laser resurfacing are instructed to use Retin-A as a preparation treatment.  Retin-A thins the skin’s outer layer, allowing the acid solution used in a peel or laser treatment to penetrate more deeply and evenly.  Retin-A is not recommended for pregnant women or nursing mothers, because its effects on the fetus and nursing infant are still being studied.

Retin-A comes in 3 strengths:  0.025, 0.05, and 0.1.  Patients should start with the weakest (0.025) concentration, applied every 3rd night and try to work up to being able to apply it every night.  Once a patient can comfortably apply the weakest formulation every night, then they should move up to the next strength (0.05), which is twice as strong as the weakest (0.025) formulation of Retin-A.  Once again, apply the Retin-A every 3rd night until you can tolerate applying it every 2nd night and then every night.  Remember, your skin cells grow from the deepest level and migrate to the surface, where they are exfoliated or shed.  This process takes 6 weeks, so you must be patient for your results.  Once you are in the process, don’t quit or you will have to start the process with the weakest strength of Retin-A again.

Reactions/Side Effects

Although no serious medical problems have been associated with Retin-A, it’s possible that its use could result in temporary skin irritation and redness.  If this happens, back off to the milder formulation.

Beginning Treatment

Your initial application of Retin-A will include a lesson on how to continue your skincare routine at home.  After your face has been washed thoroughly, a small amount of Retin-A in either cream or gel form, is rubbed over your face and nose, or any other areas where you do not like the quality of your skin.  The formula (0.025) should be used at the beginning – especially if you are younger or have a fair complexion.  As your skin tolerates Retin-A, you should advance to a stronger formula.

Only a very small amount of Retin-A, a pea-sized dab, is needed to cover the entire face.  You should apply Retin-A every night before you go to bed.  Because Retin-A is drying to the skin, you should apply a moisturizer once or twice a day.  To maintain the benefits of Retin-A, its use should be continued for a lifetime.

After Treatment

It’s normal to experience some redness, irritation, itching, stinging, or skin dryness once you begin to use Retin-A.  However, you can expect these symptoms to gradually disappear as the skin becomes acclimated to the treatment.

The appearance of fine facial wrinkles can be improved with Retin-A® treatment.
Glycolic acid treatment can smoothe rough, sun-damaged skin and fade age spots.