There are a host of reasons to consider a treatment to rejuvenate aging skin. Or, to rejuvenate skin that looks as if it’s aging faster than normal because of acne scars or other defects. Some reasons are personal. Some are professional.

When you are considering a skin rejuvenation procedure, consult with a dermatologist or dermatologic surgeon, you have one thing in common—to determine if your objective and subjective needs can be satisfied with a skin rejuvenation treatment or procedure. Beginning at that point, you and the dermatologist have to begin building mutual understanding regarding:

Your objective and subjective perceptions of yourself and how you want to look after skin rejuvenation; and,

The dermatologist’s objective evaluation of what can be accomplished technically and esthetically.

The bridge of understanding is built by full and frank two-way communication:

Your wishes for what you want skin rejuvenation to accomplish.

After a medical, physical and skin examination, the dermatologist discusses with you what can be accomplished. In some instances the dermatologist may give you a choice of options for surgical, nonsurgical or combined surgical-nonsurgical treatments.

You and the dermatologist review the options; you need to ask all the questions necessary to understand the treatments, their risks and side effects, costs, and anticipated outcomes.

You and the dermatologist agree on a treatment plan, and on the outcome you may reasonably anticipate in your individual case.

Let’s look at each of these steps.

You discuss with the dermatologist why you want skin rejuvenation and what you want skin rejuvenation to accomplish in improving your appearance. Skin restoration may be only a part of your perceptions of self-image. Thinning or lost hair, for example, may be a consideration that influences your image of yourself and the image you want to present to others. Your wishes regarding skin rejuvenation should be discussed in the context of your overall wishes—e.g., to "look and feel younger," "be more comfortable around other people," etc. A 30-year-old man with acne scars and photoaging (sun-damaged skin) may also look older than his years because of a receding hairline. A 50-year-old woman who is concerned about photoaging may also have gravitational "sags" in facial and neck skin that detract from her preferred self-image of a well-exercised person who looks younger than her years. The best way to get the most out of skin rejuvenation is to help the dermatologist understand exactly what you want.

After the dermatologist takes your medical history and conducts a medical, physical and skin examination, options for skin rejuvenation can be discussed. In rare cases a patient’s medical history and/or examination indicates that the patient is not a candidate for certain treatments or that options for treatment are limited.

On the basis of mutual understanding the dermatologist can describe and recommend the treatment most likely to meet your needs—for example, chemical peeling to improve photoaged skin, injection of botulinum toxin to smooth skin, laser resurfacing of skin. A combination of surgical and nonsurgical treatments may turn out to be the best approach to your needs—for example, chemical peeling and botulinum toxin injections around the eyelids to correct "droopiness." If the treatment is to include surgical remodeling of the face, the dermatologic surgeon usually has a collection of illustrative photos or sketches that you can use to identify the "look" you want to achieve. The dermatologist will describe the treatment in detail, but be sure to ask all the questions necessary to be sure you fully understand the treatment.

You should discuss with the dermatologist the costs of the various treatment options in dollar amounts. Avoid imprecise terms like "expensive," "less expensive," " more" and "less." If you have health insurance, find out if the treatment you choose is covered wholly or partially by your insurance plan.

Before proceeding to agreement on a treatment plan, be sure you understand the treatment, its benefits, risks, side effects, cost, and the outcome that can reasonably be expected. Most skin rejuvenation treatment leaves the patient fully satisfied.

The American Academy of Dermatology recommends that patients ask the following questions before they decide if a cosmetic surgery procedure and the doctor are right for them:

The education and training for dermatologists and dermatologic surgeons involves at least four years of postgraduate residency training in a program accredited by the Accreditation Council for Graduate Medical Education. The first year involves a broad-based, clinical emphasis that is similar to that of all medical specialties. This year is followed by three years of intensive training in dermatology including dermatopathology and dermatologic surgery. Dermatologic surgeons also participate in post-graduate surgical fellowships lasting one to two years. Beyond this, dermatologists and dermatologic surgeons engage in continuing medical education (CME) throughout their careers (in fact, almost every state requires a minimum number of CME hours per year for relicensure).

Dermatologic surgeons have, in fact, developed many of the advances in cosmetic surgery. For example, tumescent liposuction was developed by a dermatologic surgeon to improve patient safety while preserving the highest standards of care. Procedures such as hair transplants, dermabrasion, and chemical peels were dermatologic innovations. Dermatologists were also quick to appreciate the power and utility of the laser and developed most of the cosmetic laser procedures including its use in tattoo removal and skin resurfacing.

With any cosmetic surgery, the results achieved largely depend not only on the skill and experience of the physician, but also on a patient’s age, general health, overall skin texture, healing capacity, and the specific skin problem. A patient’s realistic expectations also help contribute to a positive outcome.

What are the risks?

The risks involved in most cosmetic surgery procedures are minimal. However, there are inherent risks associated with any type of surgery, and these should be discussed with your physician.

Because most cosmetic dermatologic procedures do not require general anesthesia, cosmetic surgery procedures are most often effectively and efficiently performed safely in the surgeon’s office, surgical suite, or outpatient surgical center. This offers a safe, cost-saving alternative to the hospital. Under special circumstances, treatment may be delivered in a hospital operating room.

As with any medical procedure, the cost will vary depending on the nature of the treatment. It is important that you ask up front how much the procedure will cost and how payment is required.

When you seek skin rejuvenation, you have some goals in mind as to what skin rejuvenation should accomplish. You need to share those goals with your dermatologist or dermatologic surgeon and make the dermatologist your partner in achieving them.

References

AAD Guidelines for Care for Chemical Peeling

AAD Guidelines of Care for Photoaging/Photodamage