To understand the risks of medium skin resurfacing, you should think of the procedure as a controlled surgical wound, not as a "spa treatment." For it to be successful, penetration must be carefully controlled, and then the skin must heal well.

Excessive penetration into the dermis in an effort to remove deep wrinkles can cause uneven, scarred skin. If this happens, the resulting scars are similar to those caused by second-degree thermal burns. Infection following the procedure can cause scarring.

Pigment cells can also be affected by medium resurfacing, producing uneven skin color or permanent lightening. Complications of medium resurfacing are routinely reported in medical journals and mentioned in patient consent forms, but are often minimized in consumer information.

See for example "Thermal Injuries As a Result of CO2 Laser Resurfacing, "Plastic and Reconstructive Surgery, 102(4), 1247-1252, 1998 Sep (abstract available online on Medline). People who have taken the oral acne drug Accutane should not have medium resurfacing done for at least a year, since it reduces the ability of the skin to heal and can cause scarring. Pregnant women should also not have medium resurfacing performed due to the risk of complications, especially infection.

Excessive penetration is the major cause of medium resurfacing complications. Because of the risks, many doctors now prefer resurfacing with the newer erbium YAG lasers because they allow much more precise control of penetration depth than most carbon dioxide (CO2) lasers.

See for example "Achieving Superior Results with the Erbium:YAG Laser," Archives of Facial Plastic Surgery, 4(4), 262-266, 2002 Oct-Dec (abstract available on Medline.)("Erbium YAG" means erbium, yttrium, aluminum, and garnet - the laser's material components.) However, some doctors still feel that C02 lasers are more effective on deep wrinkles than erbium YAG lasers. (You can discuss the different types of lasers with the doctors you consult.)

Dermabrasion is traditionally done using motor-driven instruments with abrasive heads. However, many doctors now do dermabrasion manually with sterilized, fine-grit silicon carbide sandpaper. While this is much slower, it allows penetration depth to be carefully controlled by observing signs that the lower epidermis or upper dermis has been reached.

However, with either technique, dermabrasion is a rather bloody procedure, so most doctors prefer using a laser, if it is available. (Lasers produce much less bleeding and reduce the possibility of infection because the heat of the laser coagulates tissue and blood.) Medium chemical peels are the most difficult procedure to control, because the doctor must judge penetration depth using acid concentration, application time and skin appearance.

Another Risk with Resurfacing

There is another little-publicized, but significant risk with medium resurfacing. Even if penetration is not excessive, in some people, particularly those with large pores and oily skin, the epidermis may not regenerate well, resulting in a much worse surface texture than before the procedure. This is due to variations in the way new epidermal cells grow from around the pores and sweat gland openings.

Even though wrinkles may be reduced, up close the resulting skin may have an uneven orange peel appearance. The pore openings may appear larger than before with tiny fissures around them, particularly in the center of the face. Loss of pigment can also make large pores appear more prominent.

If you have any healed abrasions or chemical and thermal burns you may see a similar difference in texture compared to your normal skin. Long-term use of tretinoin may help this problem somewhat, but the skin texture may never look smooth up close.

This risk of rough texture and enlarged pores is mentioned in some patient consent forms and journal articles on resurfacing, but it is not often covered in consumer information. See for example "The Prevention and Management of Postdermabrasion Complications, "Journal of Dermatological Surgery and Oncology, 17(5), 431-437, 1991 May (abstract available on Medline).

This is a significant risk of medium resurfacing, and is another reason why single or multiple light resurfacing procedures are much safer. With light resurfacing, any problems with epidermal healing will be much less noticeable. It may be wise for those with oily skin and large pores to forego medium resurfacing, at least in the center of the face where the pores are larger and generally produce more skin oil. (Or find a doctor who uses a "nonablative" laser that doesn't burn off the epidermis - see below.)

If your main skin problem is large pores and oily skin rather than sun damage, you should not have medium resurfacing; rather you should use tretinoin and other medical treatments to reduce skin oil (see below).