If you decide to have medium resurfacing, you can minimize the risk of scarring, loss of pigment, and healing problems by having the doctor resurface a small test area first to see how your skin responds. (A test area on the side of your face will be least noticeable.) A test area is recommended because there is a wide variation in people's skin thickness and healing ability.

Medical textbooks on resurfacing say a test area is required for people with darker skin, since medium resurfacing can also destroy some pigment cells; this can cause an unsightly spotted or mottled appearance. People with large pores and oily skin must also do a test area because of the risk of developing an orange peel texture, as discussed here.

You will have to wear a small bandage on the test area for at least 10 days. Allow the area to heal for about six weeks. It should be smooth and only slightly lighter in color than your other skin. If the pores look larger or the surface is uneven or discolored, medium resurfacing is not appropriate, and you should only have light resurfacing done. If a doctor will not do a test area, go to another doctor.

Some doctors will assure you that using the electronic power settings on lasers eliminates the need for test areas. This is definitely not true of CO2 lasers, and questionable even with the more precise erbium YAG lasers. While erbium YAG lasers allow very precise control of penetration depth, the doctor still ultimately determines how deep the resurfacing will go. Don't risk permanent scarring of your face.

With medium resurfacing, you can minimize risk and cost by resurfacing only the areas where you have wrinkles or benign skin discolorations. However, the doctor must blend the resurfaced areas with the untouched areas or you may have a visible border between the two. Some doctors prefer to do the whole face, and adjust the penetration depth as needed for different areas.

For wrinkles, the areas with the best results seem to be the sides of the eyes, forehead, rear cheek area, and around the mouth. Note that dynamic wrinkles in these areas, due to both facial expressions and photoaging, will usually return in the future. Results seem to be variable directly under the eyes and may be dependent on whether the wrinkles there are largely dynamic or due only to photoaging; the skin in this area is also delicate and can scar easily if penetration is excessive. (If you have large bags under the eyes, they usually must be treated with plastic surgery.)

Because everyone's skin has more oil and larger pores on the nose and front cheeks, these areas should only be lightly resurfaced to avoid an orange peel texture after healing. The neck as well is usually only lightly resurfaced because it does not heal as well as the face. These are only general rules, and the depth of resurfacing done on different areas is dependent on your skin type and the amount of sun damage you have. You should obviously discuss all this with your doctor.

Skin Resurfacing Procedures

Depending on the type of procedure, medium resurfacing will require some type of anesthetic during the procedure for pain. You will usually be given topical or local (injected) anesthetic, and possibly a mild sedative.

Someone will probably have to take you home after the procedure because you will have bandages covering your face and any sedative will make you drowsy for a while. If you have a medium chemical peel, be sure the doctor has a large squeeze bottle of water or saline solution nearby in case any acid gets in your eyes. You also don't want to be so heavily sedated that you can't tell the doctor if this happens.

If you do get medium resurfacing, be prepared to look awful for at least 12 days (with swelling, red skin, crusts forming, peeling, etc.). You will need to stay home from work for at least two weeks. You will have to wash the skin very gently and keep it moist with antibiotic ointment. While you may be somewhat presentable after two weeks, the complete healing process can be slow. In light-skinned people, the skin will be pink for a few months. In dark-skinned people, pigmentation may be uneven for a few months.

You must stay out of the bright sun until your skin is fully healed. Ask your doctor when you can resume outdoor activities and what kind of sunblock you should use since some may irritate the new skin (e.g. those with alcohol). In the future you will need to always use sunblock when outside during mid-day because the new skin may be more easily damaged by solar UV radiation.

Results of medium resurfacing will usually last for many years, and if you stay out of the sun, some improvements may be permanent. You can prolong the effects by using tretinoin on the schedule discussed above. To be safe, cosmetic acids should probably not be used at home following medium resurfacing. Continual removal of the upper epidermis with cosmetic acids following medium resurfacing could accelerate some intrinsic aging processes.

Currently, you should also be cautious about repeating medium resurfacing, even after a number of years, until there is more medical information available about the safety of multiple procedures. Multiple procedures within a few years could potentially produce an unnatural surface texture and an unacceptable lightening of the skin.