Topical retinoids have been shown to reverse some of the changes due to photo-aging, i.e. sun damage. If used long term, they may reduce some fine wrinkles, freckles, whiteheads and blackheads, and solar keratoses.

They may also be used along with bleaching creams to reduce pigmentation in melasma.

Topical retinoids can be applied to any area but are most often used on the face, the neck and the back of hands. They work by laying down a new layer of collagen in the skin and increasing cell turnover. This pushes the damaged collagen down, and allows newer healthier skin cells to be brought up to the surface.

Retinoids can irritate the skin, especially when they are first used. This is more likely in those with sensitive skin, resulting in stinging. Excessive use results in redness and peeling in treated areas. They may cause or aggravate eczema or atopic dermatitis. The side effects can often be managed with emollients, and less frequent applications.

A chemical peel is a technique used to improve and smooth the texture of skin using a chemical solution that causes the outer layers of skin to peel. The regenerated skin is usually smoother, less wrinkled, and less pigmented than the old skin.
The most common uses of chemical peels are to aid in the reduction of wrinkles, reduce uneven pigmentation and brown spots, aid in the control of acne and improve texture of skin.

ALPHA HYDROXY ACIDS (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice, and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids 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.

BETA HYDROXY ACID: It is becoming common for beta hydroxy acid (BHA) peels to be used instead of alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA. Studies show that BHA peels control oil, as well as acne and removes dead skin cells to a certain extent better than AHAs due to AHAs only working on the surface of the skin.

JESSNER’S PEEL: Jessner's peel solution is 14% salicylic acid, combined with lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

RETINOIC ACID PEEL: Retinoic acid is derived from retinoids; which is denatured vitamin A. It is chemically similar to Retin-A. This is a deeper peel than the Beta Acid peel and is used to reduce the appearance of scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with another peel which is done first in order to open up the skin so the retinoic can penetrate on a deeper level.

TRICHLOROACETIC ACID PEEL (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular or upper dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.

The brand of peel that is most often used at Associates in Dermatology is the Skin Medica line of peels.

ILLUMINIZE PEEL™ is non-invasive very superficial chemical peel utilizing a novel approach to chemical peeling with a newer generation of alpha-hy`droxy acids (mandelic acid and malic acid) in combination with phytic acid and commonly used peeling agents (salicylic acid and resorcinol) to maximize skin rejuvenating effects with low irritation. Illuminize peels increase skin glow and radiance, tighten the skin and restore a more youthful appearance, improve clarity, color and skin texture. Patients achieve enhancement of skin appearance with minimal downtime and discomfort. These peels are appropriate for first-time chemical peel patients or patients looking for a gentle, very superficial peel. They may be performed on Skin types I- VI with little or no visible peeling

VITALIZE PEEL™ helps fight the effects of time, sun damage, and environmental assaults. This powerful yet non-damaging peel can take years off aging skin. Vitalize peels address various skin conditions, such as pigmentation abnormalities, post-inflammatory hyperpigmentation, melasma, and photodamage, and achieve visible improvement after one treatment. Significant results may be seen after a series of treatments. They may be performed on Skin types I- VI with little or no or down time.
Vitalize peels combined with Retinoic acid creates more exfoliation than other chemical peels and is well tolerated.

REJUVENIZE PEEL™ are an advanced formulation of peeling agents, with a built-in anti-irritant and penetration enhancer that provides controlled exfoliation of the uppermost damaged layers of the skin to reveal fresher and healthier skin. It provides predictable results with minimal down time and is effective for use on skin with sun damage, melasma, pigmentary changes and acne scarring. Recommended for Skin types I-VI and can be used on skin types V-VI after the patient has established tolerability to Vitalize Peel, or with physician consent.
A novel synthetic surfactant, Isoceteth-20, creates more uniform peeling while controlling penetration of salicylic acid, and therefore reduces skin irritation associated with the stronger chemical peels without diminishing peeling effect

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Brown spots and patches such as sun damage and melasma as well as freckles, liver or age spots, moles and even some types of birthmarks may be treated with the GentleMax laser resulting in a more gentle and natural lightening of brown spots.

During the treatment you will feel a warm to hot stinging sensation. It is normal for the treated area to feel warm and stingy or sensitive for approximately one hour after the procedure.

The brown spots will darken slightly and, over the next 5 to 7 days, lightly scab and peel. Treatment on areas other than the face may take slightly longer to heal. Makeup can be applied immediately after treatment and during the healing phase.

Often improvement is seen after just one treatment, but more than one treatment may be required to more completely remove brown spots, particularly melasma. Brown spots will likely recur or you will get new ones, thus repeat treatments are required to maintain the results achieved. Repeat treatment may be required as soon as 4 months after your last treatment or just once yearly. A good skin care regimen that includes a broad spectrum sunblock such as zinc (which blocks UVA) and sun avoidance will help keep your skin looking its best.

Brown, blotchy spots will be lightened to reveal a more even skin tone. Not every single brown spot will be removed completely, but all will be lighter giving your skin an enhanced appearance. Most patients also notice a slightly improved skin texture. Skin texture improvements are increased with more than one treatment.

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Pearl Rejuvenation Treatment is A safe, effective treatment for restoring the skin’s natural growth,  renewing your skin’s surface and minimize wrinkles, uneven texture and discoloration in only one or two treatments. The Pearl procedure combines the impact of resurfacing lasers with the gentleness and safety of non-invasive procedures to treat aging and sun damaged skin. Pearl reduces wrinkles, uneven texture and solar damage with fewer treatments and less overall recovery than other technologies to give your skin a healthy glow.

During the procedure, the top layer of skin is treated with pulses of light in a pre selected pattern. The laser simultaneously sends heat to the deeper layers of skin to provide longer-term benefits. After treatment, the skin will look and feel mildly sunburned. You will apply ointment on the skin for 3 – 4 days. Since you cannot wear sunscreen during this time, you will need to wear protective clothing & limit sun exposure for a few days after treatment. You can continue your normal daily activities. However, you may not wish to attend important social events because your face will appear pink/red for 3 – 4 days. Results are noticeable by day 3 or 4 when the superficial tissue has peeled off, revealing fresh, bright, healthy skin underneath. Make-up may be applied at this time.

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