All her life, Joan had “problematic skin.” Problematic, because it had prevented her from ever having a boyfriend and going near small children without scaring them. But now, she was determined to get rid of the acne scars that had plagued her since high school and would do it without consulting a doctor. She knew she wasn’t alone in this. Both Vanessa Williams and Jessica Simpson, among others, had suffered the pain of acne and the scars it left behind. Joan had heard that many people had fixed their scars with chemical peels, and she would do the same.
Twenty-two hours later, Joan parachuted from an Aeroflot jet into the mostly abandoned city of Chernobyl for her very first chemical peel. After she crash-landed on a little shack in the shadow of the nuclear reactor, the city’s only remaining inhabitants emerged—a ninety-nine-year-old babushka and her nine-headed kitten, Ivan. The old woman immediately mistook Joan—who looked like a Russian stacking doll inside her gigantic silver hazmat suit—for a space alien with bad skin. Agents of the former KGB were dispatched, and Joan was hauled off for questioning under fluorescent lights that only made her acne scars look ten times worse. When the interrogation was finally over, she immediately placed a collect call to a dermatologist back home and vowed to come in for a chemical peel just as soon as she was released from the decontamination shower (à la Silk-wood) that she was forced to take.
Go outside, right now, and find a baby.
They tend to hang out at parks and in carriages on the street. Check out her dewy baby skin. It’s perfect, uniform in color, with tiny pores, smooth as glass, and soft to the touch, isn’t it?
Now, apologize to the mother and back away slowly from the stroller.
Okay, now go home, wash your face of all makeup, and look at your own skin. Unless you’ve been a very good girl, worn hats, applied SPF 5,000 on your face every morning, and never had a cigarette, your skin looks a lot different than that baby’s. Or your child’s or grandchild’s.
A woman’s skin should be a blank canvas upon which your husband, date, boss/potential boss, ladies at the club/bitches in the PTA can cast whatever impression they’d like. If the canvas is splotchy, spotted, lined, dotted, and dashed, people will form other ideas about who you are based on the blemishes and imperfections. You could be the first woman astronaut, a professor of marine biology at Harvard, a mother of ten, or the czarina of good deeds for the Bill and Melinda Gates Foundation, but visible acne scars, broken capillaries, age spots, and blemishes will make you look like a syphilitic prostitute from pre-revolution Paris.
As I’m one of those women who would take a punch to the jaw in exchange for perfect skin, what’s a little redness, itching, and crusting when a shiny, smooth face is the reward?
A friend of mine once felt besieged by her freckles, like they were a plague on her face and life ever since she was old enough to say, “lemon juice.” She was so insecure about her spots that she hardly dated and had only a few boyfriends in ten years. After trying everything else, from lemon juice to skin bleach, she got a deep chemical peel.
Her freckles are gone for good.
She doesn’t miss them at all. It’s a new face in the mirror, and she loves it. Men love her, too. They’re responding not only to her beautiful skin but also to her confidence. She thinks she’s hot, and who are her (many) boyfriends to disagree?
Another friend had terrible acne scars. Her face was like the surface of the moon. She’d walk in the room and the game would change from Spin the Bottle to Quick, Let’s Break It! She was self-conscious about it as a teenager and increasingly so as an adult.
She had so many holes on her face, Tiger Woods used to play miniature golf on it.
We all know how easily deep acne scars can shape a person’s self-esteem and world view and make them want to hide. But if you’re always trying to hide yourself, how will you ever get anywhere?
Dating is a problem, too. Men do not like leaning over to kiss a pizza face …or pothole skin. They want a woman whose face, and intentions, are clear and smooth.
Anyway, happy ending to the story, she got laser resurfacing, and now her skin is as smooth as a baby’s tush. She happens to be a well-known socialite who I always thought was way nicer than she should be. I asked her once, “Why are you so nice?” She said, “I was an ugly kid, the butt of a lot of jokes.” Well, now she’s kind and gorgeous, so the peel worked out perfectly.
By the way, with her glorious new skin, she attracted and married an extremely wealthy man. Which might be another reason she’s so damn happy.
Psychologically and literally speaking, fresh new skin is a fresh new start. It’s a do-over …and life doesn’t hand you many of those. So take them when you get the chance.
The best current ways to correct skin problems are, in order of their popularity, chemical peels (burning away layers of bad skin, or chemical exfoliation), microdermabrasion (sanding them away, or mechanical exfoliation), and laser peels (zapping away bad skin on the whole face, or going after just problem spots, or photo exfoliation). And, in a special category, radiothermoplasty, or using radio waves to tighten the skin. Starting with …
As you might expect, a chemical peel involves putting a chemical on your face, which makes the top layers peel off, revealing undamaged and unblemished skin underneath.
In 2007, over a million people had their skin peeled. The treatment comes in three different peel levels: shallow, medium, and deep.
A superficial peel is for women with only minor complaints about small acne scars (not craters), lines (not trenches), some splotches, pimples, or redness. It won’t iron out deep wrinkles. You won’t wake up with the skin of your five-year-old niece. You will get a dewy glow, even out your skin tone, and see fewer lines and holes. Your doctor or dermatologist will recommend the specific chemical concoction based on how your skin looks and feels.
His choices may include: 1) alphahydroxy acids, and 2) beta-hydroxy acids. Alpha always sounds better to me than beta. (Maybe because alpha comes first.)
Alphahydroxy acids (AHA) are made from food, including glycolic acid, which is from sugar cane. Lactic acid is made from sour milk and fermented yogurt. Hey, don’t be too quick to rule it out on disgustingness. Ancient Egyptians—history’s first beauty junkies— took milk baths for good reason.
Betahydroxy acids (BHA) are made of salicylic acid. They’re also found in aspirin and beauty products like skin toners.
These chemicals are so mild, you’ll find them in over-the-counter cleansers and scrubs and masks. What you’ll get at the doctor’s office is a stronger version of the same stuff. The way it works: The acids damage the epidermal layer of skin, which will peel away, revealing new, healthy skin. It also steps up collagen and elastin production in the dermis, making your face clearer, firmer, and springier.
Rx: Most likely, your doctor will have you use a retinoic cream (Retin-A, for example) for a few weeks prior to getting a peel. The retinoic cream acts like a primer before you paint to guarantee that the color (or in this case, the acid) goes on smoothly and uniformly.
What happens at the appointment? When you go in for the peel, your face will be cleaned. No numbing agent is needed; you’ll feel only light stinging or burning. The doctor will sponge the acid all over your face, or just where you want it. The chemicals seep into the epidermis (the top layers of skin) for fifteen minutes, and then it’ll be removed or neutralized. Start to finish, the procedure takes half an hour. You’ll walk out a bit red. You won’t need ointment immediately, but you should use the moisturizer your doctor tells you to—and only that one.
Warning: I had a friend who decided she knew best and added all kinds of holistic moisturizers to her recently acid-peeled skin and ended up with horrible infections and permanent scars.
The peeling part comes next. Over the next two weeks, your skin will flake away. Since the peel didn’t go that deep, the flaking isn’t so bad, no worse than what happens after a mild sunburn.
You won’t frighten small children and no one will scream, “Leper!” at you.
There is no downtime with shallow peels. You can go back immediately to doing whatever it is you do. After three weeks, the peel results are as good as they’re going to be. If you like the glow, but want to see more textural improvement, get another peel. People often have a series of three to five light peels, spaced a month apart, to reach their goals. If you’re pleased, get on with your rejuvenated life.
Just remember to use SPF every day: Peeled skin burns more easily.
$: Shallow office peels start at $100 and go up to $300.
With a medium peel, you’ll iron out deeper wrinkles and acne scars, as well as even out skin tone. If you’re blotchy and have dark spots or patches, a medium peel (or two, or three) might be just the ticket. It also gets rid of pre-cancerous lesions on surface skin. The bad news: There is longer down time, more peeling, and increased pain.
The main acid used for a medium peel is called trichloroacetic acid (TCA). You might be familiar with it as a wart remover. Sometimes TCA is combined with glycolic acid (made from sugar cane) or Jessner’s solution, another mild acid.
After your doctor gets a look at your face, he will decide how strong to mix his peel cocktail, using between 5 and 40 percent TCA. The higher percentage, the deeper the peel (and stronger side effects). This peel does affect pigmentation, so it’s recommended for the fair-skinned. If you’re darker than an olive complexion, this peel might cause hyperpigmentation, aka dark patches.
Rx: You’ll probably have a pre-peel regimen of Retin-A, and possibly antibiotics to prevent infection during the peeling stage. At the appointment, your face will be thoroughly cleaned. Then the doctor sponges the TCA solution on your whole face or just parts as needed. The solution will stay on for fifteen minutes, more or less, penetrating layers deeper than an AHA peel.
The epidermis itself has five layers—the stratum comium, stratum licidum, stratum granulosum, stratum spinosum, and stratum basale—on top of the dermis, or deep layer of skin containing connective tissues, collagen, and elastin. A medium peel can seep through the strata of the epidermis, all the way into the upper part of the dermis, aka the papillary dermis. The damage is so profound that the skin on top will frost, or turn white. Your doctor will watch the frosting process. When you’re white enough, he’ll remove or neutralize the peel.
You’ll continue to frost, though, for about half an hour. Just don’t look in the mirror! When the whiteness fades, you’ll turn red. Really red, like a bad burn. You might also swell and feel painfully raw. The doctor will spread some protective gel on your skin, give you a pain pill prescription, and send you home.
During the healing stage, keep your skin moist and stay indoors. No sun exposure at all! If you must leave the house during daylight hours, wear doctor-approved SPF 30 lotion, wear a big hat, carry an umbrella, or wear a veil.
You probably won’t want to go outside anyway. You’ll be really red, and then you’ll peel, crust, and flake. Whatever you do, do not pick! Let it slough off on its own.
After ten days, the damaged skin will be gone, and your new skin will shine through. It’ll stay reddish for a month, but nothing a little foundation and/or powder won’t hide. All that ravaging of the dermis will stimulate new collagen and elastic growth, so you’ll see a new firmness, too, over time, to go with the uniform tone, smooth surface, and radiant glow.
$$: Often, one medium peel is enough. Just as often, peelers go back for more. Each round will cost from $500 to $1,200.
Phenol peels go deep. As deep as you can go, actually, seeping into the mid-dermis. These peels are for seriously sun-damaged or scarred people only! According to New York-based dermatologist Dr. Shilesh Iyer, “Phenol peels aren’t done very much these days. It’s a very aggressive approach but with big risks.”
For example, after you have a deep peel, your skin will lose its ability to tan. It’ll be paler than the skin of your neck and the results are permanent. You will always have a moon goddess glow. For this reason, dark-skinned people are not candidates for phenol peels.
The appeal of deep peels? If you can find a well-trained doctor with a lot of experience, a deep peel will smooth your skin perfectly in one shot. Not only will you kiss freckles and age spots goodbye, you’ll peel away decades of wrinkles and lines, as well as pre-cancerous lesions that aren’t even visible on the surface of the skin yet. It’s the U-bomb of peels.
You will destroy everything, and there’s no going back.
Phenol is also an acid, formerly known as carbolic acid. In other forms, it’s an antiseptic, an herbicide, and a synthetic resin. It’s toxic in high doses. Fortunately, your board-certified dermatologist or plastic surgeon is well aware of the proper concentration for his mixture. Usually, phenol isn’t taken straight up or neat. It’s mixed with water, olive oil, or croton oil for better seepage into the skin.
Rx: You won’t pre-treat with Retin-A this time, although you will probably go on antibiotics and antiviral medications before the peel and keep taking them for the early stages of healing. You’ll arrive at the appointed hour at the doc’s office. He’ll clean your skin, apply a topical or local anesthetic. You’ll need it. The burning and stinging sensation is intense with a deep peel.
If you are offered sedation, take it. I’d take it for a manicure, and you definitely want it for a major peel.
The doctor will paint on the phenol solution. Then, it sinks through five layers of epidermis, through the papillary dermis and into the lower or reticular dermis. But just remember: no pain, no gain, and all that trauma means significant regeneration of new cells and peeling away layers of sun-damaged and wrinkled skin. It is as close as you can get to a total skin do-over.
After several minutes, you’ll start frosting, or turning white. Keeping a close watch, the doctor will wait until you’ve frosted sufficiently, and then he’ll remove or neutralize the peel.
It could be up to half an hour. You’ll continue to frost for an hour, even after the peel is cleaned off. After the white stage, you’ll swell and turn red. The doctor will slather you with gel or Vaseline. You’ll be bandaged, loaded up on pain meds, and sent home with the escort of your choice.
After a deep peel, you shouldn’t walk out by yourself. You’ve been sedated, and you have a bright red face that will stop traffic. The peeling and crusting will begin in a day, and it’ll keep going for about nine more. You’ll have all the discomfort you would if you had a bad, bad sunburn—which is exactly what you’ve had. Once all the skin has sloughed off, you’ll still be red, decreasingly so, for up to six months. By that time, you’ll have smooth skin, new firmness, and even tone due to the massive cell regeneration, collagen growth, and pigment bleaching.
As I said, with deep peels, the results are permanent. So are the changes in your lifestyle. You can never again leave the house without SPF 15 thickly applied to your face. If so, you will sizzle.
$$$: The phenol peel is riskier and therefore pricier. Expect to pay between $800 and $1,500. Unlike the shallow and medium peels, however, a deep peel is a one-time expense.
After chemical peels, microdermabrasion, or mechanical exfoliation, is the second most popular method of skin resurfacing. Almost 900,000 people had it done in 2007 to improve the overall texture of their skin.
To understand how it works, imagine a seventeen-year-old idiot got drunk on Budweiser and spray-painted the word “balls” on the school wall. The next day, the janitor erased the offending graffiti with a sandblaster, a high-pressure hose that sprays a mix of sand and water, blasting the paint off the concrete wall.
If your skin were that wall, microdermabrasion gets the “balls” off your face. Only, the procedure doesn’t use a hose, but a wand. And the abrasive element isn’t sand, but crystals or, for fancypants, diamonds.
Used on the face and neck to blast away acne, age spots, shallow wrinkles, embossed or raised scars (as opposed to depressed acne marks), microdermabrasion can also reduce the size of your pores. Pores are funnel-shaped. The wide part of the funnel, what you’re looking into when you inspect your pores, is blasted down to a narrower circumference, making pores appear smaller.
Microdermabrasion would give you the equivalent results of a superficial chemical peel. You would choose one over the other based on a combination of factors to discuss with your doctor, including acne, redness, skin pigmentation, and texture.
“There are nuances that require a doctor’s evaluation,” warned Iyer. “Choosing the right technology for the right person and condition isn’t only a science. It’s an art.” You might read this description and have your heart set on mechanical exfoliation, but if a doctor recommends another approach for your individual case, be flexible. Unless you’ve been to medical school, your doctor knows better than you which method is right.
Rx: At your treatment (and, be warned, you might want to have a series of them), the doctor will clean your face, put some goggles over your eyes, and then pass a wand over your skin that pelts the outmost layer of epidermis, the stratum corneum, with a pressurized shower of fine crystals. The wand also has suction power, vacuuming away spent crystals, along with the dislodged layer of dead skin. It’s machine-assisted, hard-core exfoliation.
It’ll take only half an hour, forty-five minutes tops. No anesthesia needed. I’d describe the sensation as painless, even pleasant. And when it’s all over, you’ll have a smooth, clear glow.
You’ll be red, like you fell asleep on the porch in the sun. That can be your explanation if you need one. Resume normal activity immediately. It’s no different—recovery- and risk-wise—than getting a facial. Moisturizers and creams are a must during recovery. Although you’ll be red for a few days, you won’t flake and crust as you would after a chemical peel.
What’s the rub with microdermabrasion? It’s a longtime commitment. You’ll need multiple treatments, at increasingly spaced intervals, to maintain the soft texture and even tone you’ve become accustomed to.
It’s skin-treatment crack: feels good, gives you an immediate rush, and then you have to go back again and again.
$$: A single treatment will cost you between $75 and $200. Once a month for a year? Make that between $900 and $2,400.
This is the third most popular way to get smooth, spotless skin. Nearly 350,000 people had laser skin resurfacing in 2007. The process, in a flash, is all about light and heat. The laser is a light beam that heats the surface skin, as well as the deep layers. When the surface is heated, the top layers of skin flake away. When the laser light is absorbed by the deeper layers of skin, the heated dermis goes into collagen production overdrive.
As you know, a chemical peel also flakes away layers of damaged skin on top, and stimulates collagen growth in the dermis. So what’s the main advantage of using lasers vs. getting a peel? It’s that the doctor has better control. A hand-held wand device is easier to manage than a painted-on solution.
Rx: First of all, which laser to use? There are literally dozens out there to treat skin. The gold standard for resurfacing is the carbon dioxide laser. “It’s a long recovery period of two weeks, and you need a really skilled physician to treat you,” said Dr. Iyer.
“You could use non-ablative lasers like SmoothBeam that don’t heat the surface of your skin but do stimulate the collagen underneath. It’s less effective on acne scars than it is on acne, although people use it for both. Somewhere in between are fractional lasers like Fraxel. It treats the skin in microscopic columns, leaving unaffected areas. That speeds up healing. The downtime with Fraxel lasers is minimal compared to CO2 lasers, and shows fairly good improvement.”
For sun damage, a good laser choice is the intense pulsed light laser, or IPL, which has a full spectrum of laser length and targets both brown spots as well as diffuse redness.
The process takes between a few minutes and up to an hour and a half, depending on how much skin is zapped. You’ll probably take antibiotics and antiviral drugs beforehand and during recovery. If you’re doing acres of skin, you’ll get local anesthesia and maybe a sedative, too. Once you’re relaxed and numb, the doctor will position the laser wand over your skin, and give it a pulse of light. You might feel a tweak, like a rubber band snapping on your skin, but you won’t care (thank you, Valium). When the lasering is over, you’ll be covered in ointment, bandaged, and sent home with pain meds and a friend. Let her drive.
In short order—a few days—the top layers of your skin will flake, crust, and peel, exposing the new, fresh, unwrinkled layers below. You’ll definitely have pain and swelling for a week and won’t want to leave the house during the leper stage for up to ten days. The treatment area will stay red, decreasingly so, for up to nine … months. Meanwhile, your dermis is busy making new collagen, which doesn’t happen overnight. Once your color returns to normal, you’ll be fresh, smooth, evened out, and glowing for up to two …years.
Since the recovery period is so long, why choose a laser resurfacing over a chemical peel? “Well, you can stay red for a long time after a peel, too,” said Dr. Iyer. “A laser resurfacing and a chemical peel can give you approximately the same result. In choosing which way to go, it’s a question of individual needs.”
$$$: Laser goodness ain’t cheap. For one whole face treatment with the gold standard carbon dioxide laser, you’ll pay up to $2,500. Only fair-skinned people can do it. If you’re medium or dark, the laser could cause hyperpigmentation, making your skin darker in patches.
A least popular method of overall resurfacing is called radiothermoplasty, otherwise known as Thermalift, Thermage, or Thermacool. The treatment uses high-frequency radio waves to heat up the collagen deep inside the dermis layer of your skin, while at the same time, cooling the surface skin, or epidermis. The heated dermis contracts, tightens, and spurs the growth of new collagen for extra snap.
Rx: The radio waves are delivered via a hand-held device that is passed over your skin in a matter of minutes.
The big advantage of Thermage is that, unlike peels and laser resurfacing, there’s no downtime at all. The cooled epidermis doesn’t burn, change pigment, or peel, although you will probably have temporary redness. Also, during the entire treatment, you feel zero pain. The big disadvantage? It takes time for new collagen to grow. A long time. You’ll have to wait up to six months to see tighter skin. “Some people have nice improvement,” said Dr. Iyer. “Some show modest results. I can’t say who will benefit more.”
$$: The price for Thermage is $1,500 per session. If you are one of the lucky ones, your new smooth skin will be long-lasting, up to two years.
Often, total facial resurfacing isn’t necessary. Considering the downtime of chemical and laser peels, women without major sun damage, lots of wrinkles, or severe acne scars are better candidates for a targeted approach to treat the small spots and splotches. Say, for example, you have a few age spots but otherwise decent skin. Why pay $2,000 for overall laser resurfacing, when you can, instead, pay $200 to get rid of the dots?
Since it’s tricky to use a chemical peel on a tiny area, doctors use targeted lasers to treat smaller problems. “There are so many types of lasers. A qualified dermatologist or plastic surgeon knows the best way to treat different problems,” said New York City dermatologist Dr. Shilesh Iyer. “The laser machinery is really big and expensive. What happens sometimes is that a doctor will just use whatever machine he’s got. You have to trust the doctor to use the right machine for the specific problem. You can hedge your bets, though, if you do research on your own.” Here’s a crib sheet:
For age spots or anything brown, Dr. Iyer likes a pigmented laser such as the Nd:YAG laser or the Alexandrite laser. “We use these for zapping brown age spots, precancerous spots, anything that’s dark,” he said. “You zap the skin over the discrete brown spot. The skin will get crusty, and then it’ll peel off. The laser feels warm, but it doesn’t hurt.” The process takes only fifteen minutes with no anesthetic. For a handful of zaps, Dr. Iyer would charge $200 per session. You might need several.
If you have port wine stains, spider veins, rosacea, or broken capillaries, Dr. Iyer recommends a pulsed dye laser called V-beam. “It’s for all vascular lesions and diffuse redness,” he said. This laser works on any pigment that’s red or blood-related. “The results are permanent in that the redness is reduced,” he said, “but if it’s the nature of your skin to have rosacea, it’ll come back in time. Also, you’ll need a series of treatments, once a month for three to five months, and then touch-ups once a year.” Expect to pay $300 to $500 per treatment.