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    'Do I Need a Peel, Microdermabrasion, or Laser?'


    Confusion reigns for many women and men on peels, microdermabrasion, and lasers. Which are the right tools for the right problem? Below are some basic guidelines to consider.

    If your problem is:

    Oily skin and acne. Generally, microdermabrasion is best for this problem because the exfoliating tip (one patient described it as feeling like a cat tongue) will clean off dead skin cells instantly. And the vacuum-like suction helps to clean out pores and remove plugs (comedones) better than a peel or a laser. It also helps to reduce oil temporarily. Another plus: it’s much safer than a peel on darker skin types. Don’t do microdermabrasion without a doctor’s approval if you have cystic acne or are very inflamed.

    Peels are less predictable –they may be fine if you are used to them. But they may cause more downtime than a microdermabrasion. Peels can cause brown spots and blotches on darker skin types if not done correctly or if post-care instructions aren’t followed carefully.

    Lasers, in my opinion, are still not great for acne, although there are some in development (but not FDA approved yet) that look promising.

    Sun damage. This usually looks like small, brown spots (lentigoes), fine lines and wrinkles. With a lot of sun damage, skin looks leathery and blotchy. Using a high zinc sunscreen (7-20%) every day of your life is the best way to prevent sun damage.

    A series of light alpha (usually glycolic) or beta hydroxy peels or microdermabrasion may be helpful if you are under 40 and don’t have much sun damage. Otherwise, lasers are hands-down better at reversing sun damage changes. Always look for an office where there is a board-certified dermatologist or plastic surgeon on site (not just coming by once a month).

    For mild sun damage, also consider a series of IPL/photorejuvenation treatments – usually 2-5. Just be aware that spas and aestheticians often use lower powered machines that may not be very effective. IPLs help create clearer, even toned skin by removing brown spots, small red veins, and blotches. They also build some collagen. There is usually no downtime with IPLs.

    For more moderate sun damage, consider a laser that goes a little deeper like a Fraxel Dual treatment. It usually requires 3-7 days downtime, depending on the settings of the laser. For severe sun damage with deep wrinkles, consider a fractionated carbon dioxide laser. It will require some downtime (usually about 5-7 days), but will also give better results.

    Red veins, flushing and rosacea. If you’re concerned that you might have rosacea, it’s important to see your doctor before trying to treat it on your own. There’s no point spending time or money on a laser treatment if you have uncontrolled rosacea. There are many topical prescription creams, lotions, or gels that can help control it in 8-10 weeks. Sometimes prescription oral antibiotics are still needed. Generally, good treatment will help prevent the progression of this skin disease but won’t remove existing redness.

    After rosacea is under control, there are two lasers that are effective: the pulsed dye laser (like a VBeam) for smaller areas with larger veins like around the nose, or an adequately-powered IPL system for more generalized redness and flushing with some veins.


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