Combined Resurfacing Techniques: A Systematic Approach

Abstract

Many resurfacing techniques are available to the modern facial aesthetic surgeon, and may be broadly grouped as mechanical, chemical, and laser abrasion. Each resurfacing modality has its own inherent strengths and weaknesses that make it suitable for certain defined goals. Understanding the characteristics of each type of resurfacing tool permits the surgeon to combine them effectively to achieve the desired cosmetic outcome. This paper represents the 10-year experience and personal philosophy of the senior author (EFW) and reviews how he has implemented combined resurfacing techniques using the CO₂ laser, TCA peel, and wire-brush dermabrasion. Three important guidelines will determine which resurfacing modality is best suited to a particular situation: the facial subunit principle, the depth of the facial pathology (e.g., scar, rhytid, or actinic damage), and the Fitzpatrick classification of the patient's skin. Different resurfacing modalities are discussed, and three clinical scenarios for combined resurfacing are presented: acne scarring, rhinophyma, and facial rejuvenation (rhytids and actinic damage).