BOTOX® Injections
The cosmetic form of botulinum toxin, often referred to by its product name BOTOX®, is a popular non-surgical injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance.

Studies have also suggested that BOTOX is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.

Dermabrasion and Dermaplaning
These in-office procedures help to "refinish" the skin's top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.

Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It's also sometimes used to remove the pre-cancerous growths called keratoses.

Dermaplaning is commonly used to treat deep acne scars. Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone, or in conjunction with other procedures such as facelift, scar removal or revision, or chemical peel. If you're considering surgery to refinish the skin,

If you're planning "surface repairs" on your face, you may also be considering chemical peel, an alternative method of surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to remove the affected skin layers, while chemical peel uses a caustic solution.

Many plastic surgeons perform all three procedures, selecting one or a combination of procedures to suit the individual patient and the problem. Others prefer one technique for all surface repairs. In general, chemical peel is used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes and contrasts in skin color. 

Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. The procedures can produce a softer, more refreshed and feminine appearance in Transwomen, particularly those who are older, have had heavy beards, acne, and/or enlarged pores.

Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment.

People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area. In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.

Dermabrasion and dermaplaning are normally very safe when they're performed by a qualified, experienced physician. The most common risk is a change in skin pigmentation. Permanent darkening of the skin, usually caused by exposure to the sun in the days or months following surgery, may occur in some patients. On the other hand, some patients find the treated skin remains a little lighter or blotchy in appearance.

Some people may develop tiny whiteheads after surgery. These usually disappear on their own, or with the use of an abrasive pad or soap; occasionally, the surgeon may have to remove them. You may also develop enlarged skin pores; these usually shrink to near normal size once the swelling has subsided.

While infection and scarring are rare with skin-refinishing treatments, they are possible. Some individuals develop excessive scar tissue (keloid or hypertrophic scars); 

These procedures are most often performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. However, if you're undergoing extensive work, you may be admitted to the hospital.

Dermabrasion and dermaplaning may be performed under local anesthesia, which numbs the area, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort. Sometimes a numbing spray, such a freon, is used along with or instead of local anesthesia. Or, in more severe cases, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.

Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to an hour and a half, depending on how large an area of skin is involved. It's not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.

In dermabrasion, the surgeon scrapes away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.

In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.

The surgeon may then treat the skin in a number of ways, including ointment, a wet or waxy dressing, dry treatment, or some combination of these. After Your Surgery Right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You'll probably feel some tingling, burning, or aching; this may be controlled with pain medication from your doctor. The swelling subsides within a few days to a week.

If you remember the scrapes you got when you fell down as a child, you'll have an idea of what to expect from this type of surgery. A scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no scab will form. In any case, you surgeon will give you detailed instructions to care for your skin after surgery. This will include delaying shaving for a while, then using an electric razor at first.

Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin gradually resuming your normal activities. You can expect to be back at work in about two weeks. Your surgeon will probably advise your to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks.

You must protect your skin from the sun until the pigment has completely returned to your skin- as long as six to twelve months. Skin Refinishing treatments can offer dramatic improvements in the surface of your skin, but it will take some time before you see the final results. The pinkness of your skin will take about three months to fade. In the meantime, you'll probably want to wear non-allergenic makeup when you go out.  When your new skin is fully repigmented, the color should closely match the surrounding skin, making the procedure virtually undetectable.

Chemical Peel
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation.

Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery. 

Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed.

Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne.

Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.

 AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside. With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin. With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken. It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes.Certain modified phenol peels are gentler and may be preferred in some circumstances.

Peel Formulas at a Glance
Alphahydroxy acids (AHAs)
Uses:
*Smooths rough, dry skin Improves texture of sun-damaged skin
*Aids in control of acne
*Can be mixed with bleaching agent to correct pigment problems
*Can be used as TCA pre-treatment

Considerations:
*A series of peels may be needed
*As with most peel treatments, sunblock use is recommended

Trichloroacetic acid (TCA)
Uses:
*Smooths out fine surface wrinkles
*Removes superficial blemishes
*Corrects pigment problems

Considerations:
*Can be used on neck or other body areas
*May require pre-treatment with Retin-A or AHA creams
*Treatment takes only 10-15 minutes
*Preferred for darker-skinned patients
*Peel depth can be adjusted
*Repeat treatment may be needed to maintain results
*Sunblock must be used for several months
*Healing is usually quick, much quicker than with a phenol peel

Phenol
Uses:
*Corrects blotches caused by: sun exposure, birth-control pills, aging
*Smooths out coarse wrinkles
*Removes pre-cancerous growths

Considerations:
*Used on the face only
*Not recommended for dark-skinned individuals
*Procedure may pose risk for patients with heart problems
*Full-face treatment may take one hour or more
*Recovery may be slow - Complete healing may take several months
*May permanently remove facial freckles
*Sun protection, including sunblock, must always be used
*Results are dramatic and long-lasting
*Permanent skin lightening and lines of demarcation may occur 

In some states, no medical degree is required to perform a chemical peel - even the strongest phenol peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply.

Be warned that phenol and TCA peels have been offered by inadequately trained practitioners.
It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your plastic surgeon may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.

If you have a history of herpes, you should inform your physician prior to the procedure.

Your plastic surgeon will instruct you on how to prepare for your peel treatment. Sometimes Retin A - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems.

You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel. You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. No extra assistance is needed if you're having an AHA peel or superficial TCA peel.

Where Your Peel Will Be Performed
Most chemical peels may be safely performed in a plastic surgeon's office, office-based surgical facility or outpatient surgical center. Your plastic surgeon may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously. 

Anesthesia
Anesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.

No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
The Procedure
AHA peels/treatments:
Your doctor will apply the AHA solution to your cleansed facial skin, a process usually taking no more than 10 minutes. No "after-peel" ointment or covering is required. Depending on the strength of the peel, periodic follow-up treatments may be necessary until the desired effects are achieved.

For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your plastic surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule.

After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment.

Phenol and TCA peels:
Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.

A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month.

If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary. A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.

After Your Treatment
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment.

After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your doctor's specific post-operative instructions.

A TCA peel may also cause significant swelling, depending on the strength of the peel used. If you've had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery. Getting Back to Normal With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments.

Protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock with adequate UVA and UVB protection and use it every day. It is best to avoid sun exposure unless you are adequately protected.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. 

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result. About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup. 

Your New Look Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.

The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking. If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.

Microdermabrasion
Microdermabrasion is a skin-freshening technique that helps repair facial skin that takes a beating from the sun and the effects of aging. The plastic surgeon or esthetician uses a device like a fine sandblaster to spray tiny crystals across the face, mixing gentle abrasion with suction to remove the dead, outer layer of skin. As with other skin rejuvenation techniques, more than one treatment may be needed to reduce or remove fine wrinkles and unwanted pigmentation.

Permanent Makeup
Permanent makeup is possible through a procedure called micropigmentation in which an organic pigment is embedded beneath the skin to add permanent color. The procedure involves the use of a hand-held device that punctures the skin hundreds of times per minute with a very thin needle and pushes the pigment into the desired location. In addition to defining the eyes, micropigmentation is used to enhance eyebrows and lips and can permanently create the look of blush and eye shadow.