Skin resurfacing is the removal of skin layers by chemical acid peeling, abrasive dermabrasion or laser. When the skin regrows, the skin may appear smoother. Numerous medical studies have shown that resurfacing can potentially reduce the appearance of wrinkles, remove benign discolorations, improve skin texture, and improve some scars.

See for example "A Clinical and Histologic Evaluation of Two Medium-Depth Peels: Glycolic Acid Versus Jessner's Trichloroacetic Acid," Dermatological Surgery, 22(9), 781-786, 1996 Sep; "Manual Resurfacing and Trichloroacetic Acid for the Treatment of Patients with Widespread Actinic Damage: Clinical and Histologic Observations," Dermatological Surgery, 23(5), 373-379, 1997 May; "Salicylic Acid Peels for the Treatment of Photoaging," Dermatological Surgery, 24(3), 325-828, 1998 Mar; and "Histologic Effects of the High-Energy Pulsed CO2 Laser On Photoaged Facial Skin," Plastic and Reconstructive Surgery, 99(7), 2036-2055, 1997 Jun (abstracts available on Medline).

Light resurfacing removes only part of the epidermis and can improve skin texture and very fine lines in much the same way as long-term use of cosmetic acids. Medium resurfacing penetrates through the epidermis to the upper dermis. This stimulates new collagen growth in the upper dermis, eliminating fine lines and reducing wrinkles.

Even though the epidermis is removed in medium resurfacing, the face has the remarkable ability to regenerate the epidermis with cells migrating from inside the pores and sweat gland openings. With medium resurfacing, the potential for improvement is much greater than using topical treatments like tretinoin or cosmetic acids. Deep resurfacing extends further into the dermis. It can remove more wrinkles, but it is done less often due to the high risk of scarring and loss of skin pigment. (This FAQ doesn't cover deep resurfacing.)

Risks of Resurfacing 

Light resurfacing is usually safe, but medium resurfacing has increased risk of scarring, pigmentation changes, and pore enlargement. Even though the potential effect is not nearly as great, it is far safer to have one or more light resurfacing procedures rather than one medium procedure.

Net reviews of light resurfacing are generally positive, but the effects are modest. Net reviews of medium resurfacing vary widely with results ranging from great improvement to permanent disfigurement. You can see many before-and-after pictures of resurfacing at dermatology and plastic surgery websites.

(Remember though, that they don't post pictures of the complications.) Unfortunately, there have been a number of news reports about lawsuits against doctors for causing permanent facial scarring from resurfacing that penetrated too far into the skin. (As in any profession, most doctors are skilled, but some are incompetent.)

The effect of medium resurfacing on pore appearance is highly variable, with some people reporting improvement, but many reporting no change or permanent enlargement. Medium resurfacing should not be used as a treatment primarily for large pores because it can sometimes make them worse (see below).

Before you consider either light or medium resurfacing, you may want to try the combination strategy of alternating tretinoin and cosmetic acid for about a year to see if get the improvement you want. Although it obviously takes much longer, it will often produce better results than light resurfacing alone due to tretinoin's ability to penetrate the dermis and improve collagen. It is also less expensive and involves almost no risk. Many people with light or moderate photoaging who have used this combination treatment are very satisfied and have avoided the expense of resurfacing.