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From facial thirds (and fifths!) to the infamous golden ratio, pop culture has been seeking facial harmony’s magic formula for millennia. Between the ancient Greeks, Renaissance artists like Leonardo da Vinci, and [today's social media set](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery), there's no shortage of hypotheses about what constitutes a well-balanced countenance. But the whopping number of requests for Kate Middleton’s nose (once deemed to be the “world’s most perfect”) proves that many people still don’t have an accurate grasp of the concept.

In a nutshell, facial harmony is about [ideal proportions, not perfection](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection). “It’s not so much about direct measurement; proportions are way more important,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon and associate clinical professor at UCLA. “When we’re evaluating a face, you’re really looking at that face relative to itself.” In other words, the measurements of individual facial features are less important than the interaction between those features, and we’ve gone straight to the experts to better understand what that means for facial aesthetics.

## **What Is Facial Harmony?**
When we think of facial harmony, most of us think about beauty — but it’s really much more basic (in every sense) than that. “It really comes down to the fact that the most attractive faces are those where everything falls into the average,” Dr. Jason explains. “Philosophically speaking, when one part falls out of the norm, it’s alarming for potential disease.” If a person has a deficient jaw, for example, it’s an indication of certain ailments, he adds.

And, when it comes to attraction, it’s all about survival of the species. “If, in essence, what we’re doing is looking for a partner to mate with, the ideal mating partner is somebody who seems ‘normal’ across the board,” he says. In the most primal sense, we’re programmed to gravitate toward facial symmetry and harmony because they convey good health.

As it relates to aesthetic medicine and plastic surgery, providers have — no surprise here — a very precise understanding of facial proportion. “We mean balance and a subjective sense of normalcy,” explains [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a Nashville-based board certified plastic and reconstructive surgeon and assistant professor of plastic surgery at Vanderbilt University. “If you overly highlight a feature or ignore a feature in the face, it will draw the eye negatively.” 

Sure, a surgery or procedure may focus on one part of the face, but the goal of said treatment is balance. “We aim for improvement in facial aesthetic surgery, but the key to doing it well is understanding facial anatomy and relationships,” Dr. Unger says.

### **Facial Harmony vs. Beauty**
Before we move on, you might be wondering: is facial harmony the same as beauty? According to our experts, the basic tenets of facial harmony have remained largely unchanged. Beauty standards, on the other hand, are infamously ever-changing. “Harmony is less subjective than beauty,” Dr. Unger shares. As he explains it, beauty evolves with the times and trends, but harmony and proportion are less beholden to what is en vogue. “Balance, harmony, and the golden ratio has indicated what is naturally aesthetically pleasing to the human eye and mind since it was first described — and that was thousands of years ago,” he says.

But how do modern beauty trends (think: super plush pouts) fit in with the idea of facial harmony? “There are certain features that you may want to augment compared to average because they have some underlying innuendo with them,” Dr. Jason explains. “But it’s very clear to see that, when it gets too out of proportion, you lose the attractiveness again.” In other words, cosmetic surgery can push certain boundaries to meet beauty standards, but only to the point where the enhancement or augmentation is not disrupting the overall harmony of the face.

## **How Does Plastic Surgery Achieve Facial Harmony?**
“We, as plastic surgeons, must take a holistic approach towards facial beauty and harmony,” Dr. Unger explains. And that often requires a bit of patient education. “We have to make sure we are not just improving the one item that may be the focus for the patient, but explaining how the structures of the face are interrelated,” he continues. As such, candidates must understand that “gentle adjustments in the surrounding areas” may be needed in order to ensure the desired results of more refined shape will look, as he describes, “elegant and balanced.” 

That holistic view ensures facial features remain proportional to each other. “Within a structure like the nose, any expert will explain that just because you don’t like something — a [dorsal hump](https://aedit.com/procedure/nose-bump-solutions), for instance — doesn’t mean that correcting that one issue will look good,” Dr. Unger says. “In fact, it will probably look very unnatural, unbalanced, or not harmonious if you impact one particular concern. This is because everything is interrelated.”

If you’re getting the sense that facial plastic surgery is like aesthetic Tetris, you’re on the right track. “Once you make one move, it may change the proportions and, therefore, you have to make the other move to make the two meld together better,” Dr. Jason says. Essentially, it's all about finding the sweet spot between enhancement (whether it's highlighting or downplaying a feature) and rejuvenation. “This deep understanding of the face is what sets [board certified plastic surgeons](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons) apart from untrained practitioners who do not have deep training or experience in overall facial shape, anatomy, and symmetry,” Dr. Unger adds. That lack of expertise is what leads to “many of the strange looking faces, lips, and cheeks we see walking around all the time,” he says.

The net net: When it comes to finding facial harmony, the whole is indeed much greater than the sum of its parts. Below, we break down some of the most common surgical combos that achieve a more balanced facial appearance:

### **NOSE + CHIN**
Evaluating patients for [rhinoplasty surgery](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs) provides a perfect example of how surgeons consider facial harmony on both a macro level (how a feature relates to all of your other features) and micro level (how a feature’s individual elements relate to each other). “When you fine-tune or reshape a feature that the patient does not like, it will likely require changes to the related parts of the nose or face to ensure everything is balanced and looks appropriate together,” Dr. Unger notes. An example? “A big dorsum, when reduced, will likely expose a too broad nasal tip or too full tip because the relationship will be off,” he says.

Changing the nasal proportions can also [highlight the eyes](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) and make the [chin appear more prominent](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). It may happen naturally — “sometimes, adjustments to the nose alone are sufficient to meet a patient’s aesthetic goals,” Dr. Jason says — or it may require a bit more refinement. “Other times, we also need to perform a [chin augmentation](https://aedit.com/procedure/chin-enhancement-solutions) to get the results they want,” he adds. “A nose looks more or less prominent based on where the facial plane sits relative to it, so bringing the chin forward can also make the nose look less prominent.”

### **EYES + BROWS**
Another common area where proportions are particularly important? The eyes. [Blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) (a.k.a. eyelid surgery) is one of the most popular surgical procedures for both women and men seeking to restore a more youthful, awake appearance. But removing eyelid skin isn’t always the best (or sole) solution. “Some patients who come in thinking they want blepharoplasty don’t actually have much excess eyelid skin,” Dr. Jason explains. “Instead, what they have is a sagging brow that’s making the lids look heavy.” If the surgeon simply cut away the skin without elevating the brow, the results will not be optimal, he says. As a result, [eye rejuvenation](https://aedit.com/procedure/eye-rejuvenation-solutions) often involves pairing eye and brow procedures.

### **UPPER + LOWER FACE**
The term ‘facelift’ can be confusing because the procedure focuses on restoring the lower to midface and jawline (i.e. the dreaded jowls) — not the entire face. [Facelift surgery](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) alone works well for patients whose concerns are relatively isolated to those areas. But, for those who also have significant signs of aging in the upper face (think: above the cheekbones, the eyes, and brows), a facelift by itself may leave them looking unbalanced. 

As Dr. Jason explains, if you’re getting a facelift, a [brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye) often makes sense, too. “You don’t want to make it look piecemeal or unharmonious because you lifted one part and left the rest,” he shares. Patients with a sagging brow, for example, may end up looking, as he describes, “squished in the middle” without the complementary treatment. 

## **Is AI the Future of Evaluating Facial Harmony?**
[Artificial intelligence](https://aedit.com/aedition/study-shows-how-artificial-intelligence-is-bringing-objectivity-to-aesthetics) (read: machine learning) is emerging as a compelling tool for objectively evaluating the elusive trifecta of beauty, youth, and proportion in the human face. But, according to our experts, automated facial analysis still can’t replace the eye of an expertly trained plastic surgeon — and it maybe never will. 

“It is still an analog approach that is honed with education, training, and experience to create shapes and contours that highlight and accentuate without overly stylizing and, thus, looking artificial,” Dr. Unger says. So, while he admits AI may help us better articulate what experts create with their eye and technique, he maintains that we are “likely very far away from a complete algorithmic or pre-planned approach that can be easily enacted on an actual human created from a computerized map.”

At the end of the day, the ‘art’ of plastic surgery cannot be underestimated. “This is what I tell my patients all the time — especially with rhinoplasty — it truly is art, and it doesn’t really matter what anybody else says,” Dr. Jason explains. “At the end of the day, only you can decide what you think looks good.” Regardless of how far the technology comes, honestly portrayed [before and after results](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) are still the most important factor when [choosing the right plastic surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) and, by extension, the right aesthetic for you.

Expert Opinion

Facial harmony is about proportion, not perfection, and we’ve gone straight to the experts to better understand what that means for your next plastic surgery consultation.

Importance Of Facial Harmony And Proportion In Plastic Surgery

The Importance Of Facial Harmony In Aesthetic Medicine

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It’s estimated that around 20 percent of the population has some degree of needle phobia. Known medically as trypanophobia, fear of needles comes in different forms — ranging from a fear of the pointy object itself to anxiety around being injected. For people with trypanophobia, the prospect of getting [Botox®](https://aedit.com/aedition/everything-you-need-to-know-before-getting-botox-for-the-first-time) or [fillers](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time) or even considering a surgery that involves [intravenous (IV)](https://aedit.com/aedition/iv-nutrient-drip-therapy-for-skincare-wellness) medication can be overwhelming. But this doesn’t make the results of these procedures any less attractive, so finding ways to make the thought of treatment less stressful may be helpful. 

Uncertainty around what kind of needles are used, how [painful](https://aedit.com/aedition/how-much-plastic-surgery-really-hurts) a procedure will be, and what to expect during the injection process can all increase anxiety levels for any patient but especially for those with needle phobias. Here at AEDIT, we know that knowledge is power, and we’ve consulted with plastic surgeons and patients alike to better understand the different needles used in aesthetic medicine and how to manage fears.

## **Injectable Needles 101**
When you’re looking into having a cosmetic surgery or treatment, you will come across a lot of procedure-specific medical jargon. As it relates to needles, ‘injectables’ is an umbrella term that refers to procedures that inject a product into the skin or body (think: [neurotoxins](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin), [filler](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers), [Kybella®](https://aedit.com/procedure/kybella), [Qwo™](https://aedit.com/aedition/qwo-cellulite-injectable-treatment-fda-approved), etc.). “There are different types of needles used for cosmetic injectables, and there are different brands, too,” says [Kian Karimi, MD](https://aedit.com/provider/kian-karimi-md-17458), a double board certified facial plastic and reconstructive surgeon in Los Angeles. Below, a quick vocabulary lesson:  

- **Needle**: A hollow, slender, sharply pointed instrument used for injection.
- **Gauge**: A needle’s gauge refers to the size of its opening. The higher the gauge, the smaller the diameter.
- **Syringe**: The syringe is the plastic pump that is attached to a needle to perform an injection. In the case of dermal filler, syringes often come pre-filled and your practitioner will choose which gauge of needle to use depending on your specific needs.
- **Cannula**: A cannula is a thin, flexible tube that is inserted via needle to administer medication or product. When a cannula is placed, the needle used to insert it is removed.

As Dr. Karimi explains, injectables come with needles in an array of sizes (usually ranging from 27-gauge to 30-gauge), and he says some providers will further customize treatment. “Some injectors like to transfer filler into even smaller syringes with 31- or even 32-gauge needles,” he notes. “But it really comes down to the thickness of the filler to determine which needle would be most appropriate.”

Neuromodulators like Botox®, for example, can often be injected with some of the tiniest needles on the market (a 31- or 32-gauge), which minimizes discomfort. Thicker and more viscous fillers (think: Juvéderm® and Restylane®), meanwhile, may require a larger 30-gauge or 27-gauge needle. As such, dermal filler injections are generally considered to be a bit more uncomfortable than neurotoxins.

### **Needle Alternatives**
As defined above, cannulas can serve as an alternative to needles. “Using a microcannula is different from using a needle,” says Dr. Karimi, who specializes in using DermaSculpt microcannulas. “The difference between a needle and a microcannula is that only one poke is made through the skin with a needle, then the blunt-tip microcannula is used to artistically place the filler in different tissue layers.” 

He has been teaching microcannula use for some 10 years now and estimates he has educated thousands of providers. “Overall, there are many advantages to using the microcannula,” he notes. They include less [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox) (a typical side effect of facial fillers) and less chance of injecting into a blood vessel, which can cause serious complications. “Although using a microcannula to inject fillers does not eliminate the risk of complication, it does decrease it to a very significant degree,” Dr. Karimi says. They also allow for a more “artistic” result, he adds.

## **Overcoming a Fear of Needles**
“Fear of needles is completely normal, although in some cases it can be quite extreme,” Dr. Karimi admits. To combat it, he and his team employ a variety of calming tactics — beginning the moment someone enters the practice — to make patients more comfortable. “We use great customer service, hearing the patient’s fears and anxieties, nice music, and friendly injectors,” Dr. Karimi shares. He’s also developed his own line of [CBD wellness](https://broadway.aedit.com/aedition/use-of-cbd-cannabinoids-products-in-wellness-fitness-recovery) products, [HealMD](https://www.healmd.us/), which he says has “significantly reduced anxiety in our patients before the procedure.”

Once it comes time for treatment, Dr. Karimi has a few go-to distraction techniques. “We often recommend patients not look at the needle or think about something else while the injections are being performed,” he says. What’s more? “We use distraction methods such as having an assistant tap the shoulder of our patients while the injections are being performed or other [vibration mechanisms](https://aedit.com/aedition/everything-you-need-to-know-before-getting-botox-for-the-first-time) that can help distract from the discomfort,” he adds.

In the case of more invasive procedures (think: combining filler with a [thread lift](https://aedit.com/procedure/thread-lift) or [laser treatment](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing)), minimal sedation may be offered. “When we are performing more significant combination therapies, we offer nitrous oxide gas inhalation during the procedure, which is a 50-50 mix of nitrous oxide and oxygen,” Dr. Karimi explains. “[It] can really help the patient get through the procedure without any lasting intoxicating effects as the gas wears off in just a few minutes.”

## **Patient Perspective**
Jessica conquered her needle phobia and now has regular appointments to top-off her fillers and Botox®. She tells us how [hypnotherapy](https://aedit.com/aedition/hypnotherapy-for-cosmetic-surgery-sedation-recovery-pain) and exposure therapy helped her to overcome her fear of needles and improved her life for the better.

<Dialogue>
  <Question party={The AEDITION}>
    When did your needle phobia start and how did it affect you?
  </Question>
  <Response party={Jessica}>
    It started when I was a pre-teen. I was having a series of medical tests and went from being a little uneasy about having needles near me — I mean, who isn’t?! —  to having severe panic attacks before having my blood drawn or having any other procedure that involved needles.
  </Response>
  <Question party={The AEDITION}>
    How did you overcome your fear?
  </Question>
  <Response party={Jessica}>
    My motivator for combatting my fear was my desire to become a nurse. Of course, I couldn’t be a nurse who was too scared of needles to be in the same room as anyone having an injection. So, I looked into my options and found an incredible therapist who, over a series of sessions, worked on finding the root of my phobia and practicing hypnosis to help me combat it. As I progressed, I went from being able to hold a needle to being able to give blood without feeling any more than some nerves just as anyone else would. As I’ve gotten older, the shift in my approach has also meant that I have been able to take full advantage of cosmetic injectables to keep my face looking nice and youthful.
  </Response>
  <Question party={The AEDITION}>
    Do you have any advice for anyone who is struggling with the same phobia?
  </Question>
  <Response party={Jessica}>
    For me, the most important step was facing the fact that I needed to do something about the problem. After that, being referred by a friend to a great therapist was nothing short of life-changing. Finding a therapist you connect with and who has experience treating phobias is important. I think having an end goal was key for me. If that end goal is [having your lips done](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time) or getting those frown lines seen to, then more power to you! Injectables are amazing, and I’m so glad I’m able to have them as a happy side effect of working to combat my phobia in the past.
  </Response>
</Dialogue>

## **The Takeaway**
It’s perfectly normal to feel some nerves prior to a cosmetic procedure, but, if you have a fear of needles, this can be exacerbated. Depending on your level of concern, methods ranging from meditation and therapy (talking and/or exposure) to even anxiety medication may be recommended to help manage your fears. Another tact? [Consult with your aesthetic provider](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) — they are often equipped with tips and tools to both educate and empower patients. “All in all, we assess each patient to see what level of anxiety they have about the procedure or procedures and discuss all the options with them,” Dr. Karimi shares.

Aesthetics

About 20 percent of the population has some degree of needle phobia. Since knowledge is power, we’re breaking down the different needles used in aesthetic medicine and how to manage fears.

Guide To Needles And Cannulas Used For Cosmetic Injectables, Botox, Fillers

Needles 101: A Guide To The Tools Used For Cosmetic Injectables

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If you’ve ever read an article about aesthetic procedures on The AEDITION, you know we *always* encourage you to look for or ask to see before and after photos during the research and [consultation process](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation). Why? Because they offer the chance to visualize a provider’s experience and aesthetic, in addition to being a great way to better understand what kind of results are possible. 

With the rise of [social media](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery) (specifically, Instagram and TikTok), images and videos of patients before and after a procedure have become an indispensable educational and marketing tool for aesthetic providers. But how do you know if you can trust what you see? From what to look for to best practices, we’re breaking down everything you need to know about before and after photos in aesthetic medicine.

## **The Value of Before & After Photos in Aesthetic Medicine**
As it turns out, before and after photos are as much for the provider as they are for the patient. “Photos are critical in plastic surgery,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon in Los Angeles. “They show the result in part so we can see it but also so we can be better surgeons.” As he explains, plastic surgery is a “visual art,” and before and afters give providers a chance to critically view their work and their technique across patients. 

And then there is the patient component. The imagery allows patients to get a sense of how often a provider performs the procedure(s) they are interested in, if they operate on people who share similar traits, and what their overall aesthetic is. In some cases, these photos — especially the ones featured on social media or a provider’s website — may serve as the patient’s first impression of the provider. They are looked at during the research and discovery phase (i.e. before a consultation is scheduled). The commercial value of these photos means there could be pressure to make results look as optimal as possible. Balancing business interests with [transparency and ethics](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety) is, needless to say, crucial. 

## **Are Before & After Photos Regulated?**
There are rules that govern patient photos, including before and after images. Firstly, patient confidentiality means that the provider must ask the patient for permission before sharing any photos. The gray space existis in how the photos are taken and where they can be shared once patients sign off.

In a [2018 article](https://journalofethics.ama-assn.org/article/when-advertising-plastic-surgeons-individual-brand-unethical/2018-04) in the *AMA Journal of Ethics*, the authors examine the issues of social media advertising for plastic surgeons in particular. The current lack of regulation surrounding the promotion of before and after photos on social media means that the onus is on the providers to represent their work honestly. In turn, it’s up to patients to look at the images with a level of caution. While there have been varying efforts to regulate the practice, no formal guidelines have been enacted to standardize the practice of taking and sharing before and after photos of cosmetic surgery results.

With that said, many providers take great care to ensure their photos are as accurate as possible. Practicing so-called ‘photographic hygiene’ is a good start. This includes:

- Setting up a dedicated photo space 
- Using a standardized backdrop
- Having controlled lighting 
- Maintaining consistent space between the patient and camera
- Taking and sharing multiple angles 

These steps go a long way toward allowing prospective patients to look at a provider’s work in a more complete manner. 

## **How to Look at Before & After Photos**
If you are wondering whether or not you can trust the before and after photos you see on social media, the answer is not simply yes or no. Instead, you should look at the images critically, and Dr. Roostaeian recommends the following: 

### **1. Be Mindful of Editing**
“As a doctor, you know when people use photoshop,” he says. But how is a patient to know? Try to compare several different photos of the same procedure; it can often help you spot which ones have been manipulated. Natural skin texture is a good indicator, too. If skin appears unnaturally smooth, it could be an indicator that the photo has been edited.

### **2. Look for Multiple Angles**
Best practices indicate that providers will take multiple photos from multiple angles of the same patient. “Look for six angles, including side views,” Dr. Roostaeian notes. “And make sure the photos are taken straight, not crooked.” While providers may only post a single angle on social media, they often feature more on their website. If you are interested in seeing more, message them or call their office.

### **3. Be Wary of the Zoom Effect**
We’re not talking about [the Zoom effect](https://aedit.com/aedition/aedit-survey-reveals-how-2020-altered-aesthetic-landscape) from our increased time on video calls, but rather the impact zooming in or out can have on how the before and after will present. As Dr. Roostaeian explains, using zoom can distort features, making them look bigger. On the flip side, zooming out can make features look smaller. A good rule of thumb is to observe whether all the photos of a particular procedure have been taken from the same distance.

### **4. Value Video**
“Video tends to be lower quality, so it’s more difficult for the patient to see results than in a still photo,” Dr. Roostaeian says. So while videos should not replace before and after photos, they can complement them. Even if you might not be able to see the patient in the same level of detail, you may be able to get a better sense of proportion and perspective. 

### **5. No Makeup Makeup**
Is the patient wearing makeup in some photos but not others? The reality is that it isn’t always possible for providers to get makeup-free before and after photos of every patient (and it may not even be necessary to). It is, however, worth keeping in mind that the results of some procedures may be affected by makeup.

## **The Takeaway**
When viewing before and after photos on social media or on a provider’s website, it’s important to do so with an informed eye. While the imagery is undoubtedly important, there is another important factor to consider when choosing a plastic surgeon or cosmetic dermatologist: [recommendations](https://aedit.com/aedition/category/how-i-found-my-plastic-surgeon). Dr. Roostaeian suggests reaching out to your network for referrals and to hear directly from patients about their experience.

With the rise of social media, before and after images have become indispensable tools for aesthetic providers to attract patients. But how do you know if you can trust what you see?

Importance Of Before And After Photos In Plastic Surgery, Aesthetic Medicine

Everything You Need To Know About Before And After Photos

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Chemical peels are making a comeback. After years of taking a backseat to high-tech, high-priced [lasers](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) and the social media-fueled [microneedling](https://aedit.com/aedition/difference-between-professional-microneedling-at-home-dermarolling) craze, the humble (yet oh so powerful) peel promises a relatively quick, affordable, and versatile alternative for correcting a cadre of complexion woes.

Chemical peels have been around for millennia. An ancient Egyptian medical text known as the Ebers Papyrus (1550 BC) describes the technique, and Cleopatra herself is said to have bathed in sour donkey milk (which contains lactic acid) to smooth her skin. The Greeks and Romans, meanwhile, used corrosive limestone and grapes (tartaric acid) for the task.

From the first use of trichloroacetic acid (TCA) in the 1880s to the fine-tuning of the phenol peel in the early 2000s, peeling techniques have come a long way. In the current climate of [DIY](https://aedit.com/aedition/dangers-of-diy-at-home-dermatology-beauty-treatments) and [discreet downtime](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends), we wanted to explore — yep, layer by layer — the possibilities the modern peel provides.

## **What Is a Chemical Peel?**
Just as it sounds, chemical peeling (a.k.a. chemexfoliation or chemical exfoliation) uses a solution (typically an acid) to strip away the skin’s outer layers in a controlled manner. This destruction to part or all of the epidermis and, sometimes, part of the dermis [stimulates the skin’s regenerative process](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures), including the production of collagen and elastin. Some peels are self-neutralizing, meaning that they lose all their potency on their own, while others require intervention to stop the action of the ingredients. Over time (usually within a week) the skin begins to peel and flake off, revealing smoother skin beneath. 

How deep a peel goes depends upon several factors: 

- Acid type
- Acid concentration
- Application technique 
- Skin thickness
- Sebum production
- Skin barrier health

Generally speaking, the higher the concentration of acid or other active ingredients, the stronger the peel. Similarly, applying more solution to the skin, leaving it on longer (in some cases), and overlapping in certain areas will typically result in more layers of skin cells being removed. Professional chemical peels can be classified into one of three categories depending on their potency:

1. Superficial chemical peels
2. Medium chemical peels
3. Deep chemical peels

Below, we’re breaking down everything you need to know about each type.

### **Superficial Chemical Peels**
Also known as ‘lunchtime peels’ or ‘light peels,’ [superficial chemical peels](https://aedit.com/procedure/superficial-chemical-peels) remove only the layers of the epidermis — you know, those dead skin cells that build up and can make skin look dull. Depending on their makeup, some very superficial peels only remove the stratum corneum of the epidermis, while others go deeper to reach the basal layer. These treatments can be performed by an aesthetician, board certified physician, or [even at home](https://aedit.com/aedition/what-its-like-to-try-a-medical-grade-chemical-peel-at-home) (though it’s best to consult your dermatologist beforehand when going the DIY route).

Superficial peels are used to treat a variety of complexion concerns, including:

- Fine lines
- Acne and acne scarring
- Pigmentation (both hypo and hyper)
- Uneven texture
- Dullness

There are many types of superficial peels. Depending on your [Fitzpatrick skin type](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types) and the concerns you are looking to correct, you may receive one of the following: 

- **[Alpha Hydroxy Acid (AHA)](https://aedit.com/aedition/guide-to-topical-alpha-hydroxy-acids-in-skincare)**: Most commonly lactic or [glycolic acid](https://aedit.com/procedure/glycolic-peel), but also citric, malic, mandelic, and tartaric, concentrations of AHAs vary from 10 to 70 percent. Neutralization with a basic solution is required. Depending on formula and technique, may be suitable for Fitzpatrick types I to VI.
- **[Trichloroacetic Acid (TCA)](https://aedit.com/procedure/tca-peel)**: Used for over 100 years, a concentration of about 6 to 25 percent produces a superficial TCA peel that’s self-neutralizing. Lower potencies are typically suitable for all Fitzpatrick types.
- **[Salicylic Acid](https://aedit.com/procedure/salicylic-acid-peel)**: This [beta hydroxy acid (BHA)](https://aedit.com/aedition/guide-to-beta-hydroxy-acids-salicylic-acid-in-skincare) is often used to treat acne and also has anti-inflammatory properties. Concentrations usually range from 20 to 30 percent and is typically suitable for Fitzpatrick skin types I to VI.
- **[Modified Jessner’s Solution](https://aedit.com/procedure/jessners-peel)**: The first blended acid peel, it originally contained 14 percent lactic acid, 14 percent salicylic acid, and 14 percent resorcinol (later replaced by TCA). The self-neutralizing peel can address a range of concerns — from acne to aging — for Fitzpatrick types I to VI.
- **Blended Acid Peels**: These peels are popular because they combine different acids at lower concentrations to address a myriad of concerns with (potentially) fewer side effects. The makeup of blended peels varies to accomodate a patient’s specific needs and goals.
- **[Retinoids](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare)**: You might not realize it, but these vitamin A compounds — commonly known as retinol (in lower potencies) and tretinoin (prescription-strength) — are considered peeling agents because they induce cell turnover. Though suitable for Fitzpatrick skin types I to VI, higher concentrations can cause irritation and dryness.

With so many options to choose from, consulting with your provider or aesthetician will ensure you receive the best treatment for your needs.

### **Medium Chemical Peels**
[Medium chemical peels](https://aedit.com/procedure/medium-depth-chemical-peels) penetrate the entire epidermal layer to exfoliate cells within the papillary dermis. Though some states allow aestheticians to perform moderate peels, it’s important to consult with a board certified dermatologist or plastic surgeon beforehand to avoid possible complications and unwanted outcomes.

Medium peels produce more noticeable results than light peels, making them well suited for:

- Acne scars
- Fine lines and wrinkles
- Sun damage (like liver spots)
- Uneven skin tone
- Actinic keratoses (rough patches that can lead to skin cancer)
- Skin laxity

The most commonly used types of medium peels include:

- [TCA](https://aedit.com/procedure/tca-peel) in concentrations of about 20 to 35 percent 
- [Glycolic acid](https://aedit.com/procedure/glycolic-peel) in concentrations of about 35 to 50 percent 
- [Modified Jessner’s solution](https://aedit.com/procedure/jessners-peel) applied in multiple coats for deeper penetration

### **Deep Chemical Peels**
As the name suggests, [deep chemical peels](https://aedit.com/procedure/deep-chemical-peels) go the deepest and provide the most dramatic results. That also means they carry the highest risks. These peels remove the entire epidermis and the papillary dermis and may also penetrate down into the reticular dermis. Deep dermal peels may only be performed by a highly trained, board certified provider.

Appropriate for Fitzpatrick types I to III, deep peels address the most significant skin concerns, including:

- Acne scars
- Fine lines to deep wrinkles
- Sun damage
- Uneven skin tone
- Pre-cancerous growths
- Skin laxity

Though TCA in concentrations of 50 percent or more are capable of inducing a relatively deep peel, the most powerful chemexfoliating treatment is the Baker-Gordon Peel. Developed in the 1960s, the formula was composed of [phenol](https://aedit.com/procedure/phenol-peel) (an acid) mixed with [croton oil](https://aedit.com/procedure/croton-oil-peel) (an ancient purgative derived from the seeds of the croton tiglium plant) to resurface the skin. The results were impressive, but it sometimes resulted in unwanted hypopigmentation and a waxy, unnatural appearance to the skin.

Modern Baker-Gordon formulations adjust the amount of croton oil used to give practitioners more control over peel depth. Combined with pre-treatment regimens designed to mitigate pigmentation problems, this new generation of deep peel is experiencing a resurgence of sorts thanks to its effectiveness and relative ease (no bulky, expensive laser necessary!).

## **How to Prepare for a Chemical Peel**  
Depending on the type and degree of chemical exfoliant being applied, chemical peel prep can vary from a simple cleanse to weeks of pre-treatment prescription skincare. A good rule of thumb is that the more intensive the peel, the more involved the regimen beforehand. Here’s a general breakdown of what your provider may suggest pre-peel:

- **Skincare**: Your doctor may recommend switching to a mild cleanser and increasing your moisturizer application to keep skin calm and hydrated.
- **Retinoids**: A vitamin A exfoliant — either over-the-counter or a prescription like Retin-A — will help slough off dead cells to provide a more even peel result.
- **Bleaching Agent**: Suppressing the skin’s melanocytes with a topical bleach like hydroquinone can help mitigate post-procedure pigmentation problems.
- **Sunscreen**: Keeping your skin protected from the sun is crucial both before *and* after a chemical peel.
- **Medication**: Certain drugs (including oral contraceptives, some antibiotics, and Accutane) can make skin more prone to pigmentation problems and sun sensitivity, so you may need to temporarily stop taking them pre-and post-treatment.
- **Preventative Antivirals**: Whether you can recall having a history of cold sores or not, most of us have been exposed to the herpes simplex virus (HSV), so many docs prescribe a course of antiviral meds to ward off a possible outbreak.

Your provider should provide all of this pre-op care information during the consultation and booking process.

## **What It’s Like to Get a Chemical Peel**
Before beginning your chemical exfoliation procedure, your practitioner will prep your skin by cleansing and degreasing it, usually with alcohol, acetone, or both. To make the procedure more comfortable, numbing cream may be applied. Some superficial peels don’t require any topical numbing at all, while deeper peels require local anesthetic, IV sedation, or [general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). It all depends on the depth and area being treated. 

Once your skin is prepped, your provider will brush on the solution as evenly as possible. Self-neutralizing peels like TCA quit working in a matter of seconds, while continuous peels like glycolic acid must be timed and neutralized when necessary. When the peeling agent is applied, the skin begins to take on a white, frosted appearance. The degree of frost is an indication of the depth of the peel. Your doctor may reapply the peeling solution in certain areas (around the mouth, for example) where wrinkling is deeper. The frost makes it difficult to discern exactly how deep the peel is penetrating, so the provider’s experience and skill here is critical.

## **Recovering from a Chemical Peel**
With just about any type of chemical peel, you can expect to experience some degree of burning, itching, redness, swelling, and flaking afterwards. Recovery from a superficial peel may only last a couple of days, whereas a medium peel can take about a week. Deeper peels require about two weeks of downtime, with some swelling and redness hanging around for weeks (if not months) longer.

“You can have a peel where your skin doesn’t truly peel off but rather flakes very unnoticeably, or you could do a deep peel where your skin sheds to the point where you may have to trim some of the dead skin from your face,” explains [Julie Russak, MD](https://aedit.com/provider/julie-russak-md-4645), a board certified dermatologist and founder of Russak Dermatology in New York City. “It all depends on your personal goals, what issue we are treating, and your at-home care — we can customize all treatments for your needs.”

Taking care of your skin during the healing process is crucial to achieving a successful result. Follow your provider’s post-treatment instructions exactly, [keeping skin clean and hydrated](https://aedit.com/aedition/skincare-after-facial-plastic-surgery-procedures). And, however tempting, don’t poke, pick, or peel your fragile skin. For medium and deep peels, stay out of the sun until your wounds are healed. At that point, it’s safe to apply a [sunscreen with SPF 30 or higher](https://aedit.com/aedition/best-lightweight-non-greasy-sunscreens-to-wear-indoors) and a color-correcting concealer formulated for post-procedure skin. 

## **Chemical Peel Risks** 
Although it may seem like a simple procedure (hey, all you have to do is brush on a little fruit acid!), chemical exfoliation carries serious risks. Your chance of having a successful outcome depends heavily on the skill and knowledge of your provider, as well as your skin type and medical history. Many peels are not suitable for [darker skin tones](https://aedit.com/aedition/the-best-skin-treatments-for-dark-complexions). Discussing your complete medical history during a thorough skin exam can help decrease your chances of experiencing complications, including:

- Infection (viral, bacterial, and fungal)
- Prolonged erythema (a.k.a. redness) 
- Increased sun sensitivity (sunscreen is a must!)
- Exacerbation of skin conditions ([psoriasis](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-psoriasis), [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter), [rosacea](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-rosacea), melasma)
- Dyschromia (both hypo- and [hyperpigmentation](https://aedit.com/aedition/what-its-like-to-treat-hyperpigmentation-with-skincare-cosmetic-treatments))
- Scarring (if skin is too damaged to repair itself normally)
- Blistering 
- Milia (white, cyst-like bumps)
- Lines of demarcation (when peel solution is applied unevenly)
- Cardiac complications (though rare, phenol peels can cause temporary heart arrhythmia)

And for those who need another reason to quit, both [smoking and vaping](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health) inhibit healing and cause wrinkling — especially around the eyes and mouth — which defeats the purpose of getting a peel in the first place.

If you’re considering a chemical peel, talk to your doctor before taking the plunge.

There’s a reason chemical peels have been around for millennia — they treat a wide array of skin concerns without any fancy equipment. Here’s what you need to know.

Guide To Medical-Grade Chemical Peels: Treatment, Benefits, Recovery, Risks

The Ultimate Guide To Chemical Peels

shutterstock 1537515995

The term ‘laser’ — short for light amplification by stimulated emission of radiation — includes a host of technologies aimed at everything from correcting complexion concerns to zapping warts and cancerous lesions. There are lasers for [tattoo removal](https://aedit.com/procedure/laser-tattoo-removal), lasers for getting your glow on, and lasers that [remove unwanted hair](https://aedit.com/procedure/laser-hair-removal) (to name just a few).

We’ve touched on the [different types of lasers](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures) before, so here’s a recap:

- **Ablative**: These lasers removed some or all of the epidermis.
- **Non-Ablative**: Lasers that leave the skin intact, while heating the dermis to stimulate collagen and elastin production.
- **Fractional**: These lasers have a pixelated energy beam that dissipates some of the heat.
- **Non-Fractional**: The laser beam remains focused and concentrated to treat smaller areas.

Different combinations of the above (think: [ablative fractional](https://aedit.com/procedure/ablative-fractional-lasers), [ablative non-fractional](https://aedit.com/procedure/ablative-nonfractional-lasers), [non-ablative fractional](https://aedit.com/procedure/nonablative-fractional-lasers), [non-ablative non-fractional](https://aedit.com/procedure/nonablative-nonfractional-lasers)) make a laser better suited for different concerns. Non-ablative [pulsed dye lasers](https://aedit.com/procedure/pulsed-dye-laser) like the Vbeam®, for example, are great for treating vascular lesions (i.e. broken capillaries and stretch marks). A non-ablative fractional laser like [Clear + Brilliant](https://aedit.com/procedure/clear-brilliant) is commonly called a ‘lunchtime laser’ because it produces only very slight inflammation (the ‘glow’) with minimal downtime. The tradeoff, of course, is less dramatic results.

When it comes to the big guns (so to speak) — those lasers capable of actually resurfacing the skin in the most technical sense — we’re talking about [ablative carbon dioxide (CO2)](https://aedit.com/procedure/ablative-co2-laser) and [ablative erbium](https://aedit.com/procedure/ablative-erbium-laser) lasers. Treatments with these technologies are also known as a laser peel, laser vaporization, and lasabrasion. The trend has been toward using the fractional varieties, like [Fraxel® Re:pair](https://aedit.com/procedure/fraxel-repair) (CO2) and erbium YAG (a.k.a. Er:YAG, which stands for yttrium aluminium garnet, for you science-y types).

## **Ablative Laser Skin Resurfacing 101**
Let’s back it up for a minute: what do these ‘amplification radiation’ tools really do to your skin? “Lasers are light waves that attack certain targets,” explains [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), board certified plastic surgeon in Los Angeles. “There are certain lasers that attack redness and certain lasers that attack any dark pigmentation. Those are generally for tattoo removal, red spots, or taking redness out of scars.”

So, where do the skin resurfacing lasers come into play? “Then there’s skin resurfacing lasers, which attack water,” he continues. “A carbon dioxide laser is more like a general nuke bomb that causes more heat in the area and has more thermal injury.” There is an increased risk of [hyperpigmentation](https://aedit.com/aedition/what-its-like-to-treat-hyperpigmentation-with-skincare-cosmetic-treatments) after treatment because that thermal injury can also destroy melanocytes (the skin's pigment cells), he adds. Erbium lasers, meanwhile, have a “higher affinity for water,” which means they cause “less thermal damage,” Dr. Jason says. Typically, this results in a quicker recovery time compared to carbon dioxide lasabrasion.

The net net? With ablative laser resurfacing, we’re talking about creating a controlled burn to the skin to stimulate the healing process, generate elastin and collagen production, and, ultimately, produce brand spanking new skin cells.

### **What Concerns Does Ablative Laser Resurfacing Treat?**
Erbium and CO2 lasers address a myriad of aesthetic skin concerns, including:

- Fine lines and wrinkles (especially on the forehead, around the mouth, and under the eyes)
- Chickenpox and acne scars
- Sun damage
- Age spots (a.k.a. liver or sun spots)
- Warts 
- Certain birthmarks
- Sebaceous hyperplasia (tiny bumps — often on the nose — as a result of inflamed oil glands)

“Ablative resurfacing is a good option for people who have surface changes to the skin such as extensive sun damage, dark spots, large pore size, fine lines and wrinkles,” says [Adriana Lombardi, MD](https://aedit.com/provider/adriana-lombardi-md-12670), a board certified dermatologist and founder of the Skin Cancer & Cosmetic Surgery Center of New Jersey.

### **How Ablative Laser Skin Resurfacing Works**
Laser skin resurfacing machines vary, but they’re essentially vertical, box-like contraptions on wheels with some type of wand or handheld attachment that offer customizable treatment options. “You can control the depth based on the settings of the laser,” Dr. Jason says. “You can up the energy and it’s going to go a little bit deeper.” 

In addition to the machine’s settings, the degree of resurfacing is also dependent on the technique of the practitioner. “If you keep doing passes, it’s going to go deeper and deeper and deeper,” he explains. The trick is to create as little overlap as possible with each pass to ensure an even result.

We went down the rabbit hole for a second and wondered: how deep is too deep? “You don’t want to go so deep to the point where you’re causing true scarring,” he says. To explain that sweet spot, [let’s revisit skin anatomy 101](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures)…

### **How Deep Ablative Laser Skin Resurfacing Goes**
Human skin is composed of two layers: the epidermal (outer) layer and the dermal (inner) layer. The former contains mostly keratin and dead skin cells and the latter is made mostly of collagen and elastin. We’ve covered the five layers making up the epidermis already, so now let’s delve — *ahem* — deeper into the two layers that make up the dermis:

- **Papillary**: The superficial of the two dermal layers, it’s composed of highly vascular connective tissue.
- **Reticular**: A thicker and denser layer of connective tissue that makes up the majority of the dermis.

The dermis contains blood vessels, nerve endings, hair follicles, and glands. This layer supports the epidermis, helps regulate body temperature, and serves as an important physical and immunological barrier. It’s important that you don’t do too much damage to this layer or your skin won’t be able to regenerate. But certain skin concerns call for maximum penetration. “For deep wrinkles around the mouth, you need to go deep into the dermis,” Dr. Jason explains. “We tend to go down to the reticular and papillary juncture at the most.” In case you were wondering, this is precisely why you need to visit a highly trained, [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon or dermatologist for any laser treatment.

If you paid attention during our [primer on the five epidermal layers](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures), you might be wondering how the epidermis ‘magically’ reappears after it's burned off. According to Dr. Jason, there are still enough skin cells left in the dermis after treatment (in the recesses of the hair follicles, for example) for your epidermis to gradually rebuild itself.

### **Preparing for Ablative Laser Skin Resurfacing**
With any type of laser skin treatment, it’s best to consult with a board certified provider. Ablative laser resurfacing absolutely requires the expertise of a board certified plastic surgeon or dermatologist, however, the rules governing exactly who can perform laser treatments vary from state to state. In California, for example, it has to be a medical professional (read: not an aesthetician). Regardless of the regulations, do your research and find someone with extensive experience.

During your [consultation](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation), talk to your provider about your medical history. Treatment can trigger outbreaks like herpes and [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter). Your [skin type](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types), as well as any skin conditions like [rosacea](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-rosacea) and melasma will certainly affect your treatment plan. You’ll also need to stop certain medications, including drugs and [supplements](https://aedit.com/aedition/vitamins-supplements-to-avoid-before-cosmetic-surgery) that inhibit blood clotting (think: aspirin, ibuprofen, [vitamin E](https://aedit.com/aedition/guide-to-topical-vitamin-e-in-skincare), turmeric).

### **What It’s Like to Get Ablative Laser Skin Resurfacing**
In a nutshell, you’ll be asleep for the entire procedure. Due to the pain involved, [general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) — though not absolutely required — is the standard of care for ablative CO2 and erbium YAG laser skin resurfacing. Dr. Jason says that it’s too difficult to numb the face with topical anesthetic to the degree necessary to keep the patient comfortable.

Depending upon the area(s) being treated, laser skin resurfacing can take anywhere from 30 minutes to two hours, and it will set you back somewhere in the neighborhood of $2,000 to $3,000. Unless you’re undergoing more extensive plastic surgery at the same time, it’s an outpatient procedure.

### **Recovering From Ablative Laser Skin Resurfacing** 
“We have many different types of lasers, so what to expect afterwards and how much downtime there is depends on the type of laser you are receiving,” explains [Julie Russak, MD](https://aedit.com/provider/julie-russak-md-4645), a board certified dermatologist and founder of Russak Dermatology Clinic in New York City. Intensive laser skin resurfacing isn’t exactly a ‘set it and forget it’ cosmetic procedure. After treatment, your face will be bandaged. Beginning 24 hours post-op, you’ll clean the area and apply ointment (like petroleum jelly) several times a day to prevent scabbing. Healing takes anywhere from 10 to 21 days, depending on the treatment area. 

[Swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) after resurfacing is common. Your doctor may prescribe steroids to keep it in check, especially if you’ve had treatment around the eyes. [Elevating the head](https://aedit.com/aedition/best-pillows-for-plastic-sugery-recovery-healing) (including while sleeping) and icing for the first 48 hours can minimize swelling. Burning or itching in the first few days is common. Expect the skin to peel about a week post-treatment.

[Avoid your usual skincare and makeup](https://aedit.com/aedition/skincare-after-facial-plastic-surgery-procedures) until the wounds heal completely. Instead, look for products specially formulated for sensitive, post-procedure skin, and use only as directed by your doctor. Redness can linger for a few months (maybe even longer, if you’re fair-skinned). Your provider will let you know when it’s safe to use a green-tinted concealer to hide residual redness. [Sunscreen](https://aedit.com/aedition/best-lightweight-non-greasy-sunscreens-to-wear-indoors) and [moisturizer](https://aedit.com/aedition/difference-between-creams-lotions-moisturizers) are critical to keeping your fresh skin hydrated and protected. 

## **Combining Laser Peels with Other Procedures**
Many surgical facial rejuvenation patients (think: facelifts and blepharoplasties) opt to add on ablative laser skin resurfacing while they’re at it. Experts say that cosmetic procedures like these can be [safely combined](https://aedit.com/aedition/best-surgical-and-non-surgical-cosmetic-procedures-to-combine) in the right candidates. A resurfacing laser, he says, can be like the icing on the cake of any anti-aging facial surgery. Patients experience the added bonus of one recovery period.

“Right now, in the time of COVID-19, it’s perfect for treatments that require more downtime because most people are staying home and [wearing masks](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends) when they are out and don’t need their faces to be seen,” Dr. Russak notes. “ Chemical peels and strong ablative lasers are [very popular at the moment](https://aedit.com/aedition/aedit-survey-reveals-how-2020-altered-aesthetic-landscape).“

## **Non-Ablative Lasers & IPL**
We promise we’re not purposely trying to confuse you, but there are also erbium YAG lasers (and a whole host of other types) that are non-ablative, meaning they don’t remove the epidermis. Don’t be surprised if a ‘simple’ Google search for laser resurfacing leaves your head spinning. That’s why it’s best to consult with your trusted provider and rely on their expertise to address your particular concerns.

Technically speaking, it’s more accurate to describe [non-ablative lasers](https://aedit.com/procedure/nonablative-laser-skin-resurfacing) and [intense pulsed light (IPL)](https://aedit.com/procedure/ipl) as skin refining rather than skin resurfacing, since they don’t remove the epidermis. Instead, these treatments use light to heat the underlying dermal layer, stimulating collagen and elastin production. Non-ablative lasers treat skin with a single wavelength of light, whereas IPL utilizes multiple wavelengths. The result? A gentler (but also less dramatic) procedure.

Dr. Lombardi’s go-to non-ablative regimen includes non-ablative erbium YAG (M22 ResurFX) and IPL. She uses them alone or in combination, depending on the patient. “Combining a non-ablative laser plus the IPL targets both surface changes as well as wrinkles and scarring and has minimal downtime,” she notes.

### **What It’s Like to Get Non-Ablative Laser & IPL Skin Resurfacing**
As Dr. Lombardi explains, IPL does not require any topical numbing medication. While the flash of light can be startling, the pain is described as similar to a snapping rubber band. Most patients find it tolerable. Non-ablative erbium YAG treatments do require topical anesthetic because the laser is going deeper into the skin and can be more painful. “We typically use a topical numbing product for 30 minutes prior to the procedure and use ice packs during it,” she shares.

Unlike the one-and-done nature of ablative resurfacing, non-ablative and IPL treatments are usually done in series. Dr. Lombardi often recommends three sessions spaced one month apart for best results. Another tip? Consider booking now. “The winter time is ideal as a patient cannot be tan prior to laser treatment,” she adds.

### **Recovering From Non-Ablative Laser & IPL Skin Resurfacing** 
Compared to ablative laser procedures, non-ablative lasers and IPL have a far more truncated recovery process. “Clear + Brilliant really doesn’t have any downtime besides the few hours of redness post laser, whereas IPL will make brown spots appear darker post-treatment and flake off after a few days and you will have swelling for a few days following,” Dr. Russak explains. “With an erbium laser you can have redness and skin peeling for up to one week.”

## **Risks of Laser Skin Resurfacing**
Removing layers of skin — your body’s first line of defense — is a delicate business. Risks of both ablative and non-ablative laser treatments include infection, burns, scarring, and unwanted pigmentation changes (either hyper- or hypopigmentation). Darker skin carries a higher risk of hyperpigmentation. Burning, itching, redness, skin peeling, and milia (tiny white bumps on treated areas) are typical and temporary post-ablative procedure side effects.

Forget everything you think you know about lasers. Here’s the scoop on the lasers capable of actually resurfacing the skin in the most technical sense.

Ablative Laser Skin Resurfacing: Treatment, Benefits, Recovery, Cost

Everything You Need To Know About Laser Skin Resurfacing

nicola-fioravanti-IXs4vNROZTE-unsplash

Even the most skincare savvy among us may be confused by the differences between [dermabrasion](https://aedit.com/procedure/dermabrasion) and [microdermabrasion](https://aedit.com/procedure/microdermabrasion). After all, they practically share the same name and can both be effective [skin resurfacing procedures](https://aedit.com/aedition/ultimate-guide-to-skin-resurfacing-procedures). Here, we’re breaking down the two treatments in terms of invasiveness, technology, and what aesthetic concerns each address to help you understand which might be the best choice for you. 

## **Dermabrasion vs. Microdermabrasion**
Yes, dermabrasion and microdermabrasion are similar in theory, but they are very different in reality. “While both sound similar and are resurfacing procedures that damage the skin in a specialized manner to improve it, they are otherwise pretty dissimilar,” says New York City-based board certified dermatologist [Blair Murphy-Rose, MD](https://www.mdcsnyc.com/provider/blair-murphy-md). Dermabrasion and microdermabrasion differ greatly in their intensity, depth of skin damage and, therefore, in the results, downtime, and associated risks.

In a nutshell, dermabrasion is the mechanical removal of the epidermis and upper layer of the dermis. Microdermabrasion, meanwhile, is a minimally invasive treatment option that exfoliates the surface of the skin. While microdermabrasion is suitable for all skin types, dermabrasion is best for people with lighter skin — usually [Fitzpatrick skin types](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types) I through III, explains [Jennnifer Levine, MD](https://drjenniferlevine.com/), a double board certified facial plastic and reconstructive surgeon in NYC. 

Now that we understand the differences between the two, it’s time to explore the ins and outs of each.

## **Dermabrasion 101**
[Dermabrasion](https://aedit.com/procedure/dermabrasion) is a surgical method that uses a high-speed rotary tool to abrade the skin in order to resurface it, Dr. Murphy-Rose says. She likens the device to a “sanding-like” tool that can penetrate deep into the skin. “Layers of skin are essentially removed down into the upper dermis and then, through the natural healing process, a new layer of healthier, smoother skin replaces them,” she adds.

The procedure typically requires [local or general anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) and comes with one to two weeks of downtime. High-quality dermabrasion can reduce deeper wrinkles, lines, pigmentation, and other textural abnormalities (like scars), explains [Jessica Weiser, MD](https://www.weiserskin.com/), a board certified dermatologist in NYC. But it’s not without risk. “Dermabrasion carries risk of infection, discoloration, and scarring,” she says. 

### **Popular Types of Dermabrasion** 
Dermabrasion can be performed with a motor-powered diamond fraise, wire brush, or serrated wheel. Alternatively, it can be done manually using a medium-grade drywall sanding screen. “Dermabrasion rapidly planes the skin surface,” Dr. Weiser explains. The tool used will likely depend on what you are trying to treat. “The wire brush is best used for [deeper scars](https://aedit.com/aedition/dermabrasion-might-be-the-scar-treatment-youve-been-looking-for) and irregularities, whereas the fraise and wheel are typically utilized to soften the edges of skin removed by the wire brush,” Dr. Weiser says. 

### **What to expect from dermabrasion** 
Prior to dermabrasion, you’ll be treated with pain medication, local anaesthetic for nerve blocks, and, on occasion, general anesthesia. “Eyes are covered to protect from possible spray, and the skin is sometimes treated with gentian violet stain to monitor how deep the treatment is extended,” Dr. Weiser shares. “The skin is held taut and then abraded, leading to a raw skin surface and some bleeding.”

You can expect significant redness, [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery), and moderate pain (managed by [pain medication](https://aedit.com/aedition/opioid-crisis-plastic-surgery-recovery-pain-management)). Bleeding may also occur after treatment. “As the area heals, scabbing or crusting will occur and the redness and swelling will eventually subside over one to two weeks,” Dr. Murphy-Rose says. “You will need to follow your doctor’s instructions and take very good care of your skin during the healing process to prevent infection.” You’ll also want to ask your doctor when it’s safe to go into the sun again. “During the healing process, you should avoid all exposure to sunlight on the treated area,” she says. Most doctors will also advise [avoiding strenuous exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) for about a month post-procedure. 

## **Microdermabrasion 101**
While dermabrasion lives at the invasive side of the aesthetic procedure spectrum, [microdermabrasion](https://aedit.com/procedure/microdermabrasion) falls at the other end. “Microdermabrasion is a non-invasive procedure that removes the dead skin cells from the epidermis to help exfoliate the skin surface,” Dr. Weiser explains. It does not, however, reach the viable skin cells of the lower epidermis and superficial dermis. Microdermabrasion can improve superficial skin concerns such as fine lines, brown spots, and enlarged pores, Dr. Murphy-Rose says.

Microdermabrasion, which is generally considered painless and involves little to no recovery time, can be done with a [diamond](https://aedit.com/procedure/diamond-tip-microdermabrasion) or [crystal](https://aedit.com/procedure/crystal-microdermabrasion) tip tool. “A handheld device sprays tiny crystals onto the skin causing light skin abrasion or exfoliation to the outermost ‘dead’ skin cells with minimal discomfort, no real downtime, and without the need for anesthesia,” Dr. Murphy-Rose explains. 

There are also over-the-counter skincare devices with microdermabrasion in their names. These are exfoliators designed to mimic the benefits of the in-office procedure at-home — albeit in a less intensive manner.

### **Popular Types of Microdermabrasion?**
Microdermabrasion is best suited for younger skin. It can also be a helpful treatment option for [acne-prone skin types](https://aedit.com/aedition/best-professional-treatments-for-acne-and-acne-scars). The most common forms of microdermabrasion include: 

1. **[Crystal Tip](https://aedit.com/procedure/crystal-microdermabrasion)**: “Crystals are sprayed on the skin surface and a vacuum-based tip suctions up both dead skin cells and loose crystals,” Dr. Weiser says. It’s best for acne because the crystals also have antibacterial properties.
2. **[Diamond Tip](https://aedit.com/procedure/diamond-tip-microdermabrasion)**: This technique involves a tip made from natural or synthetic diamond chips with attached suction. “The diamond abrades the dead skin cells which are removed by the vacuum-based suction,” she notes. 
3. **Dermasweep**: A gentler vacuum pump with a silk, nylon, or polyester bristle-tipped head is used to allow for greater customization.

### **What to expect from microdermabrasion** 
Unlike the seven to 14 days of downtime associated with dermabrasion, there is little to no downtime with microdermabrasion. “There is a mild scratching sensation over the skin surface — sometimes in single or repeated passes — depending on the skin type,” Dr. Weiser says. Post-treatment, your skin may appear pink or red. Dr. Levine likens it how the skin looks after a scrape. “Any procedure or product that causes exfoliation will make you more sensitive to the sun, so excellent [sun protection](https://aedit.com/aedition/best-lightweight-non-greasy-sunscreens-to-wear-indoors) is essential,” Dr. Murphy-Rose advises. She recommends applying mineral sunscreen daily and wearing a hat and sunglasses after microdermabrasion. Other tips? Skip washing your face the day of. In the following days, opt for a gentle cleanser and [moisturize](https://aedit.com/aedition/difference-between-creams-lotions-moisturizers) liberally. “You can otherwise go about your regular routine without limitations,” Dr. Murphy-Rose says. 

## **Which Procedure Is Best for You?**
Generally speaking, microdermabrasion can be an effective treatment option for patients with acne, pore congestion, and oily skin. At lower settings, it can be used for drier skin types as well. “Very sensitive skin does not respond well to microdermabrasion, and treatment should also be avoided in patients on [Accutane](https://aedit.com/procedure/accutane) therapy where the skin surface is very fragile,” Dr. Weiser notes. It is also not a good choice for patients with [rosacea](https://aedit.com/aedition/what-its-like-to-live-with-and-treat-rosacea), [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter), and lupus because the treatment stimulates blood flow to the skin, which can worsen certain skin conditions.

Dermabrasion, meanwhile, is best suited for those with significant textural abnormalities such as scarring, wrinkles, and sun damage. It can be used to treat small areas with deep wrinkles (think: lines around the mouth). “These wrinkles are hard to treat and need a treatment that will go deep enough to fully address the wrinkle,” Dr. Levine explains. As such, it is also good for scars and [acne scarring](https://aedit.com/aedition/how-to-treat-acne-scars). Additionally, someone who has failed to achieve desired results from [fractional laser resurfacing](https://aedit.com/procedure/nonablative-fractional-lasers) may be a candidate.

But it’s not for everyone. “Because it can go deep, it may lead to the stimulation of melanocytes, causing the cells to produce more or less pigment,” Dr. Levine notes. Therefore, it is not recommended for people with darker skin. “Darker skin types may be more prone to adverse effects like pigmentation changes, and anyone prone to keloid formation should avoid dermabrasion,” Dr. Murphy-Rose explains. “Any underlying medical conditions causing poor wound healing would be a contraindication to treatment.”

Sure, dermabrasion and microdermabrasion sound similar, but they are very different procedures. Here’s what you need to know about the benefits of each.

The Difference Between Dermabrasion And Microdermabrasion For Skin Resurfacing

Dermabrasion vs. Microdermabrasion: What’s The Difference?

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Let’s face it: we tend to take our skin for granted. When we’re young, our skin seems impervious to daily abuse. Our [sunburns](https://aedit.com/aedition/how-to-relieve-and-treat-sunburn) heal, our pores survive bouts of pimple-picking, and creases instantly plump back up all thanks to a seemingly endless supply of fresh, new skin cells constantly regenerating. But, as we age, that process of cell turnover (technically known as desquamation) slows, leading to a buildup of dead skin cells on the surface. Even with the most [diligent skincare routine](https://aedit.com/aedition/aesthetic-skin-aging-concerns-skincare-cannot-treat), scars, sunspots, broken blood vessels, and fine lines (to name a few!) become more pronounced. The complexion takes on a dull, uneven, and crepey appearance.

The solution to this problem seems simple: Why not just slough it all off? And that’s the underlying premise of skin resurfacing, a category of cosmetic treatments that’s gaining popularity as technology advances. To make sense of all the procedure options, we talked to two cosmetic dermatologists about the ins and outs of skin resurfacing.

## **Skin Structure 101**
Before undergoing or even considering a skin resurfacing treatment, it’s useful to know a little about the anatomy of the body’s largest organ. Human skin is made up of two layers: the dermis and the epidermis. The innermost layer is called the dermis and contains blood vessels, nerves, sweat and oil glands, hair follicles, and the coveted collagen and elastin that gives the skin its structure. The outermost layer, meanwhile, is known as the epidermis. It is comprised of five distinct levels, Below is a breakdown from the inside out: 

1. **Stratum Basale**: Where skin cells (a.k.a. keratinocytes) are born. This layer also contains melanocytes (pigment cells) and merkel cells (receptors sensitive to touch).
2. **Stratum Spinosum**: Composed of eight to 10 cell layers, this ‘spiny’ layer contains irregularly shaped cells that fortify the skin.
3. **Stratum Granulosum**: This granular level, three to five cell layers deep, contains bundles of keratin (to give skin strength) and lipids (to provide a cohesive moisture barrier). 
4. **Stratum Lucidum**: Present only in the thicker skin of the fingers, palms, and soles, this ‘clear’ layer (named for the absence of granular bodies) is two to three cell layers thick.
5. **Stratum Corneum**: Made up of about 20 to 30 layers of keratin and dead keratinocytes, it’s the uppermost layer of our skin  and plays an important role in our immunity. 

The body has a natural skin resurfacing mechanism known as desquamation. During this process, the entire stratum corneum is replaced by new cells that have worked their way up from the stratum basale. This regeneration happens every four weeks or so. 

The desquamation process changes with age, which often results in a thicker layer of dead cells on the surface of the skin. “We build up skin cells that block the pores from receiving all the nutrient- and vitamin-rich serums we’re applying daily. Dead skin cell buildup also makes our skin appear dull and accentuates wrinkles,” explains [Julie Russak, MD](https://aedit.com/provider/julie-russak-md-4645), a board certified dermatologist and founder of Russak Dermatology Clinic in New York City. “In order to get optimal product penetration and help slow down the aging process, we need to aid the process of regeneration quicker by resurfacing our skin.”

## **What Is Skin Resurfacing?**
Skin resurfacing treatments are designed to remove the skin’s outermost layers to reveal brighter, smoother, and more even skin beneath. The term ‘skin resurfacing’ encompasses a variety of cosmetic treatments that address common complexion concerns, including:

- Fine lines and wrinkles
- Pigmentation (think: sunspots and broken capillaries)
- Acne and acne scarring
- Uneven skin tone and texture

Different treatments remove layers of skin to varying degrees, which allow them to address different aesthetic concerns. “Skin resurfacing creates wounds and stimulates the healing process which, in turn, stimulates collagen production,” says [Adriana Lombardi, MD](https://aedit.com/provider/adriana-lombardi-md-12670), and board certified dermatologist and co-director at Advanced Laser and Skin Cancer Center of New Jersey. Needless to say, collagen and elastin are the hallmarks of youthful, healthy skin.

## **What Are the Main Types of Skin Resurfacing?**
Though there are several categories of skin resurfacing, the modalities share a common bond: they all use energy, in various forms, to remove layers of skin cells and/or stimulate the skin to rebuild itself. The most common types of skin resurfacing techniques include:

- Light-based therapy (think: lasers and IPL)
- Mechanical methods (like dermabrasion, dermaplaning, microneedling)
- Chemical treatments (i.e. peels)

If you feel like you've heard more talk of skin resurfacing in the past year, you’re not imagining it. “COVID-19 has given people an opportunity to have cosmetic procedures done without having to worry about ‘downtime,’” Dr. Lombardi says. “People have been working from home, major events have been placed on hold, and [people are wearing masks](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends).”

In the coming weeks, we’ll be diving deep into each of the categories mentioned above to bring you everything you need to know about these treatments. For now, we’re just, well, scratching the surface:

### **Laser Skin Resurfacing**
The word ‘laser’ is actually an acronym for: Light Amplification by Stimulated Emission of Radiation. In other words, a laser device focuses light energy into a concentrated beam. There are four general classifications for skin resurfacing lasers: 

1. [Ablative Fractional Skin Resurfacing](https://aedit.com/procedure/ablative-fractional-lasers)
2. [Ablative Non-Fractional Skin Resurfacing](https://aedit.com/procedure/ablative-nonfractional-lasers)
3. [Non-Ablative Fractional Skin Resurfacing](https://aedit.com/procedure/nonablative-fractional-lasers)
4. [Non-Ablative Non-Fractional Skin Resurfacing](https://aedit.com/procedure/nonablative-nonfractional-lasers)

Ablative (a.k.a. wounding) lasers completely remove the top layer of the skin, whereas non-ablative (or non-wounding) lasers heat up the skin’s underlying layers to stimulate collagen production. ‘Fractional’ means that the energy from the laser is dispersed, rather than concentrated in a beam. Breaking up — or fractionating — the energy makes the treatment gentler, with less downtime, but it also means that the laser treatment isn’t as powerful. Non-fractional lasers act on the entire surface area.

Due to the variety, laser skin resurfacing can address a myriad complexion concerns:

- Fine lines and wrinkles
- Hyperpigmentation (including both sun damage and rosacea)
- Scars
- Tattoo removal

In fact, it’s even being used to treat skin cancer. While milder laser skin treatments require only topical numbing cream, the more intense ablative lasers are best done with some form of [anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). It’s absolutely critical to visit a highly experienced professional for any type of laser procedure to avoid the possible risks ranging from infection and burns to unwanted pigment changes and scarring.

Unlike lasers, which use a single wavelength to target complexion concerns, [intense pulsed light (IPL) therapy](https://aedit.com/procedure/ipl) uses multiple wavelengths to treat skin. Compared to lasers, IPL tends to be less targeted and less intense (think: less downtime but also less dramatic results). Case in point? “IPL does not require any topical numbing medication,” Dr. Lombardi notes. It can treat more minor skin concerns and is also used for [hair removal](https://aedit.com/procedure/ipl-for-unwanted-hair).

### **Dermabrasion, Microdermabrasion, & Dermaplaning**
Dermabrasion, its gentler cousin microdermabrasion, and dermaplaning are all mechanical forms of skin resurfacing. These techniques involve physically scraping the outer layers of the skin’s surface to remove textural irregularities like fine lines and mild scarring. Like laser skin resurfacing, dermabrasion can address irregularities like fine lines, pigmentation, age spots, and scars.

So, what’s the difference between these techniques?

- **[Dermabrasion](https://aedit.com/procedure/dermabrasion)**: This invasive, surgical procedure essentially sands the skin using a rotating abrasive brush or wheel to remove the upper layers. Depending upon the area being treated and the depth desired, some form of anesthesia is required. The skin is wounded and requires time to heal before revealing smoother skin beneath.
- **[Microdermabrasion](https://aedit.com/procedure/microdermabrasion)**: This minimally invasive treatment uses an abrasive crystalline material sprayed or rubbed onto the skin to remove only the outermost dead skin cells. Although there is no damage to the skin’s underlying layers, some inflammation and swelling occurs, resulting in a ‘glow’ effect.
- **[Dermaplaning](https://aedit.com/procedure/dermaplaning)**: Also called microplaning, this non-invasive treatment exfoliates the skin’s dead outer cells (along with any peach fuzz) with a surgical scalpel. Bolstered by COVID-19 stay-at-home orders, [DIY dermaplaning](https://aedit.com/aedition/benefits-of-face-shaving-at-home-dermaplaning) has been trending recently. It’s similar to shaving, but the blade is tailored specifically for exfoliation.

Because of the risks involved (and the anesthesia required), dermabrasion should only be performed by a plastic surgeon or experienced dermatologist. It’s safe to see a licensed aesthetician for microdermabrasion and dermaplaning, but it’s a good idea to run it by your dermatologist first — especially if you’re going the DIY route.

### **Chemical Peels**
Resurfacing the skin using a chemical solution (usually an acid) is known as a chemical peel. Chemical peels are classified into three basic categories: 

1. [Superficial chemical peels](https://aedit.com/procedure/superficial-chemical-peels)
2. [Medium chemical peels](https://aedit.com/procedure/medium-depth-chemical-peels)
3. [Deep chemical peels](https://aedit.com/procedure/deep-chemical-peels)

Superficial peels (a.k.a. ‘lunchtime’ peels) remove only the outermost, dead cells, while medium and deep peels reach — you guessed it — progressively deeper levels. Regardless of the potency, the chemical solution is applied, given time to work its magic, then neutralized. Afterwards, the skin literally peels or flakes off over time. The severity and duration is dependent upon the strength of the peel. Like their resurfacing counterparts, chemical peels address skin concerns ranging from dullness and sun damage to fine lines and wrinkles.

Medium and deep chemical peels require a doctor’s supervision, in spite of what you may have seen on the internet and social media. It’s safe, however, to have your licensed aesthetic practitioner perform a superficial peel, though you should consult your dermatologist before using any [at-home peel treatments](https://aedit.com/aedition/difference-between-medical-grade-chemical-peels-at-home-exfoliators).

### **Microneedling**
This trendy treatment (also known as collagen induction therapy) involves pricking the skin with tiny, sterile needles. Creating these micro-wounds stimulates the skin’s innate rebuilding process, while swelling and inflammation lend a temporary glow. 

Proponents of [microneedling](https://aedit.com/procedure/microneedling) cite measurable increases in new collagen and elastin production with repeated sessions, particularly with the addition of the patient’s [platelet rich plasma (PRP)](https://aedit.com/procedure/microneedling-with-prp). Other reported benefits include a reduction in fine lines, pore size, acne, acne scars, and hyperpigmentation.

Despite its ubiquity on social media, microneedling (and its [at-home counterpart dermarolling](https://aedit.com/aedition/difference-between-professional-microneedling-at-home-dermarolling)) is not a one-size-fits-all, risk-free treatment. Possible complications include infection, bleeding, bruising, enlarged pores, and scarring, so make sure you do your homework and seek out a highly trained, licensed professional. Before dermarolling at home, consult with your dermatologist (and follow the directions to a T).

## **Preparing for Skin Resurfacing Treatment**
Before trying any skin resurfacing treatment — whether it be in your doctor’s office, a medspa, or at home — do your research. Not all techniques are appropriate for all [skin types](https://aedit.com/aedition/guide-to-fitzpatrick-skin-types) or all skin conditions. We’ve covered many of the risks here, but it’s important to talk to a professional about your medical history and treatment options. Certain medications (like [Accutane](https://aedit.com/procedure/accutane) and [retinoids](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare)) can cause healing complications, while some medical conditions (like herpes and [eczema](https://aedit.com/aedition/best-skincare-products-to-treat-eczema-flare-ups-in-the-winter)) can flare up post-op. 

Although downtime and side effects vary based on the treatment, it's best to avoid sun exposure and follow your post-procedure plan as directed by your provider. Whereas more invasive resurfacing options may have been avoided in the past due to the recovery time involved, there has been renewed interest during the pandemic. “Chemical peels and strong ablative lasers are very popular at the moment,” Dr. Russak notes.

## **How to Choose a Provider for Skin Resurfacing**
Skin resurfacing is typical of most other cosmetic procedures: the quality of your result depends on the skill of the practitioner you choose. But how do you determine whether it’s safe to see a licensed aesthetician for your treatment versus when you need to seek out a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon or dermatologist? Generally speaking, experts agree that less invasive treatments (think: microneedling, dermaplaning, and light peels) can be safely performed by aestheticians, whereas deeper resurfacing (like ablative lasers and TCA peels) are best left to plastic surgeons and dermatologists. And for those [determined to do it yourself](https://aedit.com/aedition/dangers-of-diy-at-home-dermatology-beauty-treatments), be sure to talk to your doctor first.

From dermabrasion and microneedling to laser therapy and chemical peels, here’s what you need to know about resurfacing the skin.

Guide To Skin Resurfacing Procedures: Lasers, Chemical Peels, Microneedling, Dermabrasion, More

The Ultimate Guide To Skin Resurfacing

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If you are a regular AEDIT user, you are familiar with our mission to simplify and safeguard the search for aesthetic solutions and qualified providers through innovative, user-first technology. Today, we are excited to announce the results of our inaugural consumer trends survey. 2020 brought unprecedented changes to the entire world. Now, we’re exploring how the year changed the aesthetic landscape and consumer behavior as priorities shifted.

Findings indicate that millennials and gen Z now account for the largest age group interested in aesthetic procedures. The [COVID-19 pandemic](https://aedit.com/aedition/plastic-surgery-dermatology-cosmetic-dentistry-practices-reopening-during-covid-19) has not slowed down this demographic’s interest in pursuing self-confidence and self-expression through beauty. The rise of video conferencing for work and widespread communication, as well as rapid advances in beauty technology, have helped to [strengthen demand](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments) for aesthetic treatments and procedures over the past year. 

AEDIT polled 1,000 men and women ages 18 and over to unearth the biggest beauty trends of 2020 and how the unprecedented year altered our aesthetic proclivities — possibly forever. 

![AEDIT-2020-aesthetic-trends-infographic](//images.ctfassets.net/zw35sfestf1t/5QhHe0VPhNmEdrdoDDMl15/82c05bca824db9cecb80dfb9e634f9e3/AEDIT-2020-aesthetic-trends-infographic.jpg)

## **The Zoom Effect** 
Never before have we been so bombarded with seeing ourselves on video. With the advent of daily Zoom meetings, Google Hangouts, and FaceTimes, people who are not used to viewing themselves on screen were suddenly thrust into their very own spotlight. This led to nitpicking their appearances. AEDIT’s survey found that those interested in non-surgical and surgical treatments participate in video conferencing meetings significantly more often than those who do not. In fact, 39 percent of respondents who use video conferencing weekly reported interest in non-surgical aesthetic treatments, while 37 percent reported interest in surgical treatments. 

A full 29 percent of millennials agree that using video conferencing makes them [more interested](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends) in getting aesthetic treatments. The biggest areas of concern for those who engage in regular video conferences are their teeth (39 percent), weight (33 percent), stomach/midsection (28 percent), under eye bags/pouches (23 percent), and hair thinning/loss (16 percent).

Despite spending significantly [more time at home](https://aedit.com/aedition/aestheticians-dermatologists-share-at-home-skincare-tips) in 2020, demand for treatments remained high with 23 percent of respondents stating that they are more interested in aesthetic treatments now that they can recover at home during the pandemic.

## **The Dawn of a Digital Age of Aesthetics** 
“Technology is revolutionizing the beauty industry. It places more emphasis on personalized experiences, giving consumers the opportunity to be in more control of their beauty decisions, whether that be virtually trying on lipstick before purchasing or, in our case, [trying on a cosmetic procedure](https://aedit.com/aeditor-app) before booking a consultation,” shares Willian A. Kennedy III, MD, a double board certified facial plastic and reconstructive surgeon and founder of AEDIT.

Much like our social and work lives, many of those [consultations are moving virtual](https://aedit.com/aedition/virtual-consultations-telemedicine-plastic-surgery-dermatology-cosmetic-dentistry). The AEDIT survey reveals that the pandemic has decreased interest in going into doctors’ offices and has increased interest in telemedicine by over 20 percent.

Moreover, 44 percent of survey respondents wish there was a way to see exactly how surgery would affect their face before taking the leap. This desire is even greater for younger women, with 50 percent of millennials and gen Z and 51 percent of women showing keen intrigue in the ability to predict the outcome of aesthetic procedures.

As a way to address this desire, AEDIT created a platform that offers medically approved, easy-to-understand information and a 3D aesthetic simulator — [The AEDITOR](https://aedit.com/aeditor-app) — that allows users to virtually ‘try on’ cosmetic procedures and visualize realistic results right from the palm of their hand. The iOS app is the most accurate facial morphing technology available outside a professional medical setting. 

While AEDITOR was not specifically asked about in the survey, 55 percent of adults (including 62 percent of women and 67 percent of millennials and gen Z) indicated that they would be interested in an app or website that would allow them to see how surgery or aesthetic procedures affect their face/looks in a medically accurate way. 

## **Owning It Is In — So Is Good Skin**
Millennials have long been influencing beauty trends as the first generation who came of age during the digital revolution. However, baby boomers tend to eclipse them when it comes to seeking out a tweak, lift, or poke in the search to remain naturally ageless.

A shift is happening. The AEDIT survey showed that [millennials and gen Z](https://aedit.com/aedition/millennial-cosmetic-surgery-aesthetic-medicine-trends) have significantly more interest in non-surgical and surgical treatments than men and women age 35 and up — *and* they are more likely to already have seen a doctor or had a surgical treatment than their gen X and boomer peers. Millennials and, now, gen Z, largely embrace aesthetic edits with open arms and zero apologies. 40 percent stated they do not feel ashamed or embarrassed of getting aesthetic treatments. 

The survey supports this, showing that over 40 percent of respondents still want to feel confident in their looks during the pandemic. This population is specifically interested in aesthetic treatments to look *naturally* more attractive. It’s not surprising then that the survey also uncovered a jump in participants using facial [skincare products](https://aedit.com/aedition/category/skincare) during the pandemic, despite a decrease in using cosmetics in 2020.

“At AEDIT, we believe true beauty is unearthed by those who choose to be uniquely themselves rather than conform to a standard,” Dr. Kennedy notes. “We strive to inspire a movement that will empower everyone to be bold and challenge the preconceived notions of beauty by living by their own aesthetic.”

## **Looking Ahead**
AEDIT [Beauty Board](https://aedit.com/beauty-board) member and Beverly Hills-based double board certified facial plastic and reconstructive surgeon [Andrew Frankel, MD](https://aedit.com/provider/andrew-frankel-md-275), predicts, “[2021 will begin](https://aedit.com/aedition/biggest-medical-aesthetics-trends-of-2021-for-face-body) as 2020 has been for the past three months. There might be a lull in elective surgery once the pandemic is cleared and life returns to normal because people will likely not want to be home recuperating at that point — they will long to be out enjoying themselves. As such, promoting injectables and non-surgical procedures will be fruitful right as the world opens up again and people wish to look their best upon reentry.”

*AEDIT and third-party [ACUPOLL Precision Research](https://www.acupoll.com/) conducted an online survey in December 2020 of a nationally-representative population of 1,000 male (n = 539) and female (n = 460) respondents 18 years of age and older.*

Now Trending

Video conferencing, beauty tech, natural skin, and millennials are making waves in our latest consumer survey.

AEDIT Survey Reveals How 2020 Altered The Aesthetic Procedure Landscape

AEDIT Survey Reveals How 2020 Altered The Aesthetic Landscape Forever

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In the early twentieth century, unsuccessful federal court cases and continued adverse consequences of unsafe food, drugs, and cosmetics quickly illustrated the inadequacies of the [Pure Food and Drug Act of 1906](https://www.fda.gov/about-fda/fdas-evolving-regulatory-powers/part-i-1906-food-and-drugs-act-and-its-enforcement). As we discussed in [part I of this series](https://aedit.com/aedition/early-history-of-us-food-drug-cosmetic-regulation-fda), the law did provide some safety standards and labeling accuracy, but it also required that the government prove a manufacturer intended to defraud with its labeling — a nearly impossible burden to meet.

The law also had no power to regulate cosmetics, medical devices, or advertising, nor did it create any standards for food safety. Among the tricks and bad practices used by manufacturers: 

- Glass bottles that only appeared to be full
- False-bottomed boxes
- Misleading and fraudulent advertising claims
- Inadequate record keeping for prescription drugs
- A lack of safety testing for new drugs and cosmetics

Consumer advocacy groups and the publication of books like Arthur Kallet and F.J. Schlink's *100,000,000 Guinea Pigs: Dangers of Everyday Food, Drugs and Cosmetics* (1933) raised awareness of the law’s shortcomings, but the offenses continued.

## **The American Chamber of Horrors**
In 1933, the chief education officer (Ruth deForest Lamb) and chief inspector (George Larrick) of the [United States Food and Drug Administration (FDA)](https://www.fda.gov/home) assembled a collection of misleading and dangerous products to illustrate the inadequacies of the current laws and to advocate for broadened regulatory powers. The exhibit gained notoriety when Eleanor Roosevelt toured it with a reporter, who dubbed the collection the “Chamber of Horrors.”

Included in the exhibit (which was a sensation at the Chicago World’s Fair) were a variety of packaging tricks, advertising swindles, and products that didn’t work or, worse, were hazardous and toxic. Some of the highlights:

- **Lash Lure**: The toxic aniline eyebrow and eyelash dye that caused serious infections, blindness, even death among salon-goers.
- **Banbar**: A blend of alcohol, water, and horsetail (a weed) flavored with peppermint purported to treat diabetes that actually killed those who relied on it instead of insulin.
- **Bred-Spred**: A line of enticingly packaged ‘jams’ that contained artificial colors and flavors, pectin, and hayseeds but no fruit.
- **Koremlu**: Billed as a harmless hair removal cream, this toxic concoction contained thallium acetate and caused systemic hair loss and neurological damage.

## **The Elixir of Sulfanilamide Disaster**
As a result of mounting evidence and pressure, a bill to revise and expand the Pure Food and Drug Act of 1906 was introduced before Congress in 1933. But passage of the bill was stalled for years as politicians, advocacy groups, and lobbyists debated. In 1937, a Tennessee manufacturer created what was believed to be a red raspberry-flavored liquid version of sulfanilamide, a true ‘wonder drug’ that had proven to be safe and effective (in powder form) to treat strep infections. After the elixir was tested for flavor, appearance, and fragrance, it was shipped to doctors and pharmacies across the country.

[Elixir Sulfanilamide](https://www.fda.gov/files/about%20fda/published/The-Sulfanilamide-Disaster.pdf) killed 107 people, many of them children, because the sweet liquid was, in fact, a solution of the powdered drug and diethylene glycol — a chemical commonly used as antifreeze and documented at the time to be a deadly poison, though the manufacturer hadn’t bothered to check.

The combined efforts of the FDA, physicians, and media saved countless more deaths. But, due to the limitations of the 1906 law, the FDA was only able to prosecute the S.E. Massengill Co. because it had mislabeled its product an “elixir” (which must contain alcohol) instead of a “solution.” The fact that the formula contained a deadly poison was not legally actionable. 

## **Finally: The Food, Drug & Cosmetics Act of 1938**
The Elixir Sulfanilamide disaster provided the final incentive Congress needed to act. In 1938, the [Food, Drug, and Cosmetics Act](https://www.fda.gov/about-fda/fdas-evolving-regulatory-powers/part-ii-1938-food-drug-cosmetic-act#:~:text=FDR%20signed%20the%20Food%2C%20Drug,adequate%20directions%20for%20safe%20use.) was passed, making it illegal to market unsafe drugs, cosmetics, and devices, establishing food safety standards, and requiring that a drug be proven safe prior to marketing. Factory inspections and court injunctions were also added to the FDA's arsenal. 

In the ensuing decades, court cases and congressional acts bolstered the original FD&C Act. The highlights:

- **Wheeler-Lea Act (1938)**: Empowered the Federal Trade Commission (FTC) to regulate drug, device, and cosmetic advertising.
- **“The Black Book” (1949)**: A guide to evaluate the safety of chemical food additives that was updated in 1982 to include color additives and is now known as “The Red Book.”
- **Durham-Humphrey Amendment (1951)**: Defined what drugs require a prescription from a licensed practitioner
- **Miller Pesticide Amendment (1954)**: Established procedures for setting safe pesticide limits on agricultural products (this is now handled by the Environmental Protection Agency).
- **Food Additives Amendment (1958)**: Prohibited use of cancer-causing substances and required new food additives to be proven safe prior to marketing.
- **Color Additive Amendment (1960)**: Prohibited use of cancer-causing color chemicals in food, drugs, and cosmetics, and required manufacturers to first establish safety before use.
- **Kefauver-Harris Drug Amendments (1962)**: Required manufacturers of new drugs to prove effectiveness to the FDA.
- **Federal Anti-Tampering Act (1983)**: Passed in response to cyanide poisoning from tainted Tylenol, it made it a crime to tamper with packaged consumer goods.
- **Nutrition Labeling and Education Act (1990)**: Required all foods to have standardized labeling.
- **Family Smoking Prevention and Tobacco Control Act (2009)**: Gave the FDA authority to regulate tobacco products.
- **Drug Quality and Security Act (2013)**: Passed in response to a deadly meningitis outbreak in 2012 originating from a compounding pharmacy, it required greater oversight and electronic prescription drug tracing.

## **Drugs vs. Cosmetics, According to the FDA**
After generations of federal oversight, most people today are familiar with the FDA. From lettuce recalls to Botox® approval, the agency affects our lives on a daily basis. But, in spite of its notoriety, many Americans aren’t clear about how the FDA regulates cosmetics and beauty products in this country. “If you ask 10 different people, then you will get 10 different answers,” says cosmetic chemist [Ni’Kita Wilson](https://www.nikitawilsonbeauty.com/).

Here’s where the definitions spelled out in the FD&C Act become important:

- **Drugs**: “Articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease” and “articles (other than food) intended to affect the structure or any function of the body of man or other animals.” (e.g. oral contraceptives and the active ingredients in [sunscreen](https://aedit.com/aedition/how-to-apply-sunscreen-and-not-miss-a-spot))
- **Cosmetics**: “Articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body… for cleansing, beautifying, promoting attractiveness, or altering the appearance.” (e.g. moisturizer, lipstick, hair color)

Some products meet the definition of both a drug and a cosmetic. These include things like [dandruff shampoo](https://aedit.com/aedition/best-hair-care-products-by-texture-color) (shampoo is a cosmetic but controlling dandruff alters bodily function like a drug) and most [toothpaste](https://aedit.com/aedition/best-natural-oral-care-toothpaste-mouthwash-brands) (tooth cleanser is a cosmetic but added fluoride is a drug).

So, how does the FDA influence the creation of skincare and makeup? “When we're developing [acne](https://aedit.com/aedition/best-skincare-ingredients-to-treat-acne-blackheads-whiteheads), sunscreen, or other over-the-counter products, we have to adhere to the ‘rules of engagement’ outlined in the monograph ‘rule book’ for that category,” Wilson explains. “I have to be careful with the benefit claims of each product that I develop to ensure that I am not misleading the consumer to think that my cosmetic product has drug benefits.” For example, there are certain colorants that she can’t use on the lip or eye area as per the FDA. “They definitely have a say in how things are done,” she notes.

## **The Difference Between FDA Approval & FDA Regulation**
The FD&C Act and ensuing laws gave the FDA the power to regulate food, drugs, cosmetics, and medical devices. 

- **FDA Regulation**: Implies the agency legally oversees those industries — setting rules, guidelines, and standards and enforcing compliance with relevant laws. 
- **FDA Approval**: Signifies a product has been proven safe and effective through research and clinical trials prior to its market release.

Drugs (both prescription and over-the-counter) must either obtain FDA approval or meet strict standards called ‘monographs’ prior to being marketed. With the exception of color additives, cosmetic products and ingredients do not need FDA approval, nor do they need to be registered with the FDA like drugs and drug manufacturers do.

Falsely claiming that a product is “FDA approved” may be a federal offense. Here’s a rundown of what the U.S. Food and Drug Administration does and does not approve:

### **The FDA Does Approve:**
- New drugs and biologics (like vaccines and blood products)
- Medical devices (via a tiered clearance system)
- Human cells and tissues (through a risk-based approach)
- Food additives
- Color additives used in FDA-regulated products 
- Animal food additives and drugs

### **The FDA Does Not Approve:**
- Companies
- Compounded drugs
- Tobacco products
- Cosmetics
- Medical foods
- Infant formula
- Dietary supplements
- Food labels/nutrition facts
- Structure-function claims (like “calcium builds strong bones”)

## **FDA Recall vs. FDA Withdrawal**
So, what happens when a product is deemed unsafe, contaminated, or questionable? In cases of minor violations that wouldn’t involve legal action, the FDA requests a so-called ‘market withdrawal.’ The company isn’t in trouble per se, but they’re being asked to remove the product from distribution until the correction is made.

On the other hand, the FDA recalls a product when there’s a clear legal violation. Goods are removed from distribution and consumers are advised to either return or dispose of the product. Recalls are divided into three categories: 

1. **Class 1**: Product could cause serious harm or death
2. **Class 2**: Product can cause temporary or reversible health consequences
3. **Class 3**: Not likely to cause harm but still a violation

It’s estimated that over 4,000 drugs and devices are recalled each year.

## **The Push for Cosmetic Regulation**
The FD&C Act of 1938 does not require cosmetics manufacturers to register (it’s voluntary), and they are not obligated to follow [Good Manufacturing Practices (GMPs)](https://ispe.org/initiatives/regulatory-resources/gmp/what-is-gmp) the way drug companies are. Under current law, the FDA has no authority to recall cosmetics — the agency can only request that a manufacturer voluntarily recall a product. If a cosmetic manufacturer is making claims reserved for drugs or if their ingredients are found to mimic drugs, then the FDA can step in, as they’ve done with several [lash serum](https://aedit.com/aedition/eyelash-growth-serum-benefits-safety-results) makers over the past decade.

The need for cosmetic regulation came to a head in 2019 with the revelation that Johnson & Johnson concealed for decades that the talc in their baby powder could be contaminated with asbestos. The problem arose again with tween accessories giant Claire’s when it refused to recall several makeup products that independently tested positive for asbestos. Instead, it opted to withdraw the items from shelves while reassuring the public that its makeup is safe. 

Currently, Congress is considering two bills that would expand the FDA’s authority over cosmetics. The [Cosmetics Safety Enhancement Act of 2019](https://www.congress.gov/bill/116th-congress/house-bill/5279/text) would require manufacturers to establish product safety and report adverse effects, while empowering the FDA to conduct its own cosmetic safety testing. The [Safe Cosmetics and Personal Care Products Act](https://www.congress.gov/bill/116th-congress/house-bill/4296?q=%7B%22search%22%3A%5B%22increasing+accountability+at+VA%22%5D%7D&s=1&r=2) would require that all ingredients (including the notoriously-vague [‘fragrance’](https://aedit.com/aedition/fragrance-free-beauty-skincare-for-sensitive-skin)) be detailed on labels and would ban all toxic ingredients.

## **Safety & Efficacy**
Given that many consumer goods are not expressly approved prior to marketing, we’re generally left to trust that the manufacturers are following good practices and that the market will weed out those who aren’t. After all, it’s in a company’s best interest to meet its claims.

However, there are plenty of examples of dangerous products being marketed and widely used before the FDA stepped in (hello, [tobacco](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health)). So, how skeptical should we be before purchasing? “In general, I would presume a large majority of the products to be safe,” Wilson says. “[Read the ingredient label](https://aedit.com/aedition/category/read-the-label) to see if the product contains ingredients that don't raise any red flags.”

If you’re not sure about an ingredient, do some research. “[Paula's Choice](https://www.paulaschoice.com/ingredient-dictionary) has a helpful ingredient dictionary based on relevant studies,” Wilson suggests. Another tip? Keep your sources varied. “Read all types of information — not just those stating that everything is toxic,” she cautions.

What about ‘green,’ ‘clean,’ ‘vegan,’ or ‘organic’ beauty products? [We’ve talked about green beauty recently](https://aedit.com/aedition/what-clean-green-natural-mean-for-beauty-makeup-skincare-products), but in terms of FDA regulation, these terms are simply buzzwords. “The only term that has a true meaning tied to it is ‘organic,’ which is attached to the USDA,” Wilson explains. “The FDA does not recognize any of the others. They are just marketing terms and are no indication of the product’s safety profile or if it's better than another product.”

## **The Takeaway**
While the FDA has certainly made the consumer landscape — including the beauty business — safer and more efficacious, it’s still up to us to do our homework before making cosmetics and personal care choices. With consumers demanding more transparency than ever from brands and manufacturers, it seems like only a matter of time before the laws evolve again. 

Beauty

In this two-part series, we’re examining the history of the FDA, and the people, products, and events that contributed to the past and present of American food, drug, and cosmetic policy.

The AEDITION

AEDUCATION