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 more 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 skin-when they can help, what they involve, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances.

Ask your doctor anything you don't understand about the 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 are 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 and is used to combat fine facial wrinkles and blotches from sun damage. Some treatments involve a total skin care program such as Obagi or IS Clinical skin care.

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

WHAT TO EXPECT FROM SKIN-SURFACE TREATMENTS

"Surface-repair" treatments can enhance your appearance and give your skin a smoother, fresher look, but they won't remove deep scars and flaws or prevent aging. These treatments should not be thought of as mini-facelifts. Generally speaking, Retin-A® and glycolic acid treatments offer less dramatic results than surgical approaches like dermaplaning, dermabrasion, chemical peels or lasers.

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

PLANNING FOR TREATMENT

Whether you're planning a surgical or nonsurgical skin treatment, it's important that you find a doctor who has training and experience with a variety of skin-management techniques. You'll want a doctor who can give you the best possible single treatment or treatment combination. Look elsewhere if your doctor tells you that he or she has perfected a single technique that promises unbelievable results. The choice is yours, but be certain your doctor is qualified to prescribe such treatments. After all, these treatments involve the most visible part of your body - your face.

In your initial consultation, be open in discussing your treatment goals with your doctor and don't hesitate to ask any questions or express any concerns you may have. Your surgeon should be equally open with you and explain the factors that could influence your choice of treatment options such as age, skin condition, and previous plastic surgeries.

The surgeon will ask about your medical history and conduct a routine examination. If you're having a surgical procedure in conjunction with your skin treatment, your doctor should explain the process in detail, including the risks and benefits, the recovery period, and the costs. Insurance usually doesn't cover aesthetic procedures.

WHERE YOUR TREATMENT WILL BE PERFORMED

It is unlikely that you'll have to spend time in the hospital for your skin treatment unless the treatment is performed in conjunction with a facelift or some other more complex procedure. Your initial application of a glycolic acid peel will probably be performed in a doctor's office or an outpatient facility.

THE TREATMENTS

Retin-A®
In general, Retin-A® is most effective in older patients who have some fine facial wrinkles, or blotchy pigmented areas caused by sun damage. However, Retin-A® is often prescribed to younger, active individuals who want to combat the aging effects of sun exposure. Patients who are planning to have a chemical peel treatment or laser resurfacing are often instructed by their doctors to use Retin-A® as a preparation treatment; Retin-A® thins the skin's outer layer, allowing the acid solution used in a peel 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.

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, your doctor may recommend a milder formulation.

As late as 1993, Retin-A® had not received approval for use as an anti-aging treatment from the Food and Drug Administration (FDA). It has received FDA approval as an acne treatment, and doctors have been safely using it for this purpose for more than two decades. However, the full scope of Retin-A®'s effects and potential benefits continues to investigated.

Beginning treatment. Your initial application of Retin-A® will include a lesson on how to continue your skin-care 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. It's likely that a very gentle formula will be used at the beginning - especially if you are younger or have a fair complexion. You may be switched to a stronger formula after your skin becomes accustomed to treatment.

Only a very small amount of Retin-A® - a pea-sized dab - is needed to cover the entire face. You will be instructed to apply Retin-A® every night before you go to bed. Because Retin-A® is drying to the skin, your doctor may also recommend that you apply a moisturizer once or twice a day. This routine is usually continued for about eight months to a year, after which you'll be switched to a less-frequent schedule of maintenance, with Retin-A® applications only two or three times per week. At periodic follow-up visits, your doctor may adjust the strength of your prescription or its frequency of use. To maintain the benefits of Retin-A®, its use must 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.

Caring for your new skin. Because Retin-A® thins out the skin's outer layer, you will need to consistently use a sun-block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics on your face.

Though the degree of change varies from person to person, with continued use of Retin-A®, you will begin to see subtle improvements in the texture and tone of your skin. Retin-A® users notice a rosy glow during the beginning months of use, followed by the disappearance of fine lines and the shrinking of large pores. After about six months, many Retin-A® users report that wrinkles are barely visible and that age spots have faded.

Glycolic acid treatments
Best candidates. Glycolic or "fruity acid" treatments can offer smoother skin to people of all ages. This type of treatment seems to work best on patients who have rough, sun-damaged skin. Glycolic acids are sometimes formulated with bleaching chemicals to correct areas of uneven pigmentation.

Reactions/side-effects. It's important to remember that side-effects may occur even with non-surgical treatments. No serious medical problems have been associated with glycolic acids, but their use may cause temporary skin irritation and redness. Switching to a milder formula may remedy the problem.

Beginning treatment. Your initial application of glycolic acid cream will include a lesson on how to continue your skin-care routine at home. The way in which glycolic acid is applied to the face depends upon what form it's in.

Two common forms are cream or facial wash. Both forms contain about 12 percent glycolic acid, which helps slough away dry, sun-damaged skin on the face's surface. Each also contains a special moisturizer and, if needed, a bleaching agent. In most cases, the acid is applied to the face twice daily, either by smoothing on the cream or using the facial wash. Your doctor may adjust the strength of the acid formulation or the frequency of its use after evaluating your skin's condition in follow-up visits.

After treatment. It's normal to experience some redness, irritation, itching, stinging, or skin dryness once you begin to use glycolic acid. However, you can expect these symptoms to gradually disappear as the skin adjusts to the treatment.

Caring for your new skin. Because glycolic acid thins the skin's outer layer, you will need to consistently use a sun-block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics on you face.

Though the degree of change varies from person to person, with continued use of glycolic acid preparations, you will begin to see subtle improvements in the texture and tone of your skin. In most cases, glycolic acid users notice an overall freshness and smoothness. After a while, pigmented blotches fade or disappear as the bleaching effect begins to work. The time necessary for visible results depends on the degree of pigmentation and individual circumstances. Some patients see results in as little as six weeks.

YOUR NEW ROUTINE

Most people find that maintaining their new look is easier than expected. Using the cream or facial wash will become a natural part of your morning or evening routine - and the difference you'll see will be worth the extra effort.

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