Chemical peels, mechanical abrasion, and more recently laser and electrosurgical devices are used to resurface eyelid and facial skin. The common feature in these techniques is the denaturation or removal of the skin surface. These techniques typically help to hide skin changes related to sun exposure and aging by evening the skin tone, decreasing dyschromia, and diminishing wrinkles. These techniques all require careful case selection and patient preparation with appropriate treatment and postoperative care. Recent interest has focused on less invasive therapy with techniques that leave the epithelium largely intact, shortening healing time and reducing the risk of complications. Aging and sun damage induce a number of changes in skin, including wrinkling, the development of muscle- or gravity-related folds, irregular pigment or dyschromia, and the growth of benign and malignant skin lesions. Scars from acne, trauma, or surgery can also be indications for skin resurfacing. Potential benefit in all of these techniques must be balanced against risks and expected healing time. A medical history must be obtained, looking for a history of immune dysfunction, prior acne, or a history of herpes simplex outbreaks. Prior treatment with radiation or isotretinoin (Accutane) may diminish the pilosebaceous units required for healing. Acne rosacea and cutaneous telangiectasia may be aggravated by skin resurfacing. Cutaneous history must focus on scarring tendencies such as keloid formation, skin type, and ancestry. In particular, one must determine the patient’s skin type, most commonly by assigning a Fitzpatrick’s skin type. Patients with skin type III require careful topical preparation for skin resurfacing treatment in most cases, and patients with skin type IV or higher are more prone to scarring and pigment issues and are not treated with medium depth to deep skin resurfacing techniques by most clinicians. Wrinkles may be graded by the Glogau classification scheme. This scale from “fine wrinkles” (type 1) to “only wrinkles” (type IV) will help to define the amount and type of treatment needed. These loose recommendations will generally hold true in determining effective therapy. The deeper and more invasive the treatment, the more important the role of skin preparation and prophylaxis.
Fitzpatrick Skin Type IV
