Skin Deep - A look at Treatments Performed by Dermatologists

Reviewed by James Brann, M.D.

Dermatologists, the "skin" doctor; often visits to his or her office meant an easy fix of steroid cream for the occasional break out. Not so anymore. In the world of beauty, the Dermatologist has become as popular as the Plastic Surgeon. Flocks of men and women alike are looking for alternative surgical procedures to reduce the fine lines or "crow's feet" of aging. Because the sun and other environmental hazards can effect the skin's appearance and even cause the skin to change at a deeper level, dermatologists have been studying the benefits of surgical alternatives to help their patients. And many offer these procedures in their office.

Collagen, the basic building block of skin, becomes thinner and less elastic with time. The effects of sun and pollutants cause damage, as well. Acne and blemishes from adolescence can leave scarring and noticeable effects on the skin.

The following is a detailed account of the treatments offered that you as a consumer might be interested in when visiting your local dermatologist for skin care options:
  • Topical Applied Treatments, usually most effective when the manifestation of aging is minimal. There are several options of treatment that your dermatologist may suggest, as well as a combination of these. First, Tretinoin, a Vitamin A derivative has been shown to reduce fine wrinkles, age spots and discoloration's, as well as aiding in smoothing out rough sun damaged skin. Tretinoin cream with strength of .02%- .05% is the only FDA approved drug used for these purposes. Higher dosages may be given in the treatment of acne in adolescence.

  • Alpha-hydroxy acids (AHAs) are acids derived from fruits or dairy products, the most used AHA is glycolic acid, derived from honey and sugar cane. Dermatologists often prescribe doses of 15%-25% AHA to treat mildly damaged skin. Often this is used with the Tretinoin.

  • Over-the-Counter products with retinols, low AHA's, anti-oxidants, creams enriched with Vitamin C and E, as well as, moisturizing agents may be suggested to temporarily improve the appearance of fine lines and wrinkles.
Many dermatologists recommend more extensive treatments that are often performed in the office, such as:
  • Chemical Peels or Dermapeels, a chemical solution is applied to the facial skin, the top layer of skin then blisters and peels off. New skin forms to take its place. The new skin is usually smoother and less wrinkled than the old skin. Chemical peels are effective for the surface skin damage only. Effects of aging in deeper tissue must be addressed by other means.

  • Soft-Tissue Augmentation or Collagen treatments are injected beneath the skin to elevate wrinkles, pits, and scars. Collagen, a protein found in human tissue, gives the skin toughness and elasticity. Most collagen injections are derived from cattle, however, self-donated collagen by the patient or a tissue donor, may be used. These treatments are often done in a series. The effects of these treatments may last for 3 to 12 months. Another type of soft-tissue augmentation is called microlipoinjection. Fat is harvested from the patient's own body and injected under the skin.

  • Botulinum Toxin or the infamous Botox is a protein that is injected into the muscles of the face to temporarily paralyze their actions. This immobilization of the muscle prevents wrinkling of the skin. The injections are most effective for dramatically improving effects of aging such as frown lines, crow's feet, and facial wrinkles. The effects of this treatment usually last 3 to 4 months.

  • Dermabrasion is the removal or reduction of acne, scarring from acne or chicken pox. This procedure is often called surgical skin planing, because the planing off of the surface skin with a rapidly moving brush occurs. A new layer of skin grows to replace the skin removed. A mild form of this procedure is called microderabrasion; it is used most often for superficial skin defects only. Often this procedure is combined with other treatments, such as the above-mentioned soft-tissue augmentation.


The use of laser treatments in the dermatologist's office has increased dramatically. There are several types of laser or electrosurgical procedures that may be looked considered:
  • Laser Skin Resurfacing is used to remove or improve lines and wrinkles, treat discoloration or age spots, remove or improve scars, skin cancers, vascular moles, tattoos, warts, and unwanted hair. The laser acts as a light pump that resurfaces the skin. There are several types of lasers used; one common laser used is the Carbon Dioxide Laser. These laser attacks water contained top layers of skin, thus removing sun damaged layers of skin. Besides removing the outer layer of skin, the heat of the laser causes contraction of collagen in the deeper layers of the skin. This tightens and gives the appearance of smooth, firm skin. Other lasers are used to decrease or treat broken blood vessels or spider veins. The Versapulse laser or VPL removes 50%-70% of broken blood vessels in each treatment. The face can be treated in 10 to 25 minutes. Sun damaged neck areas also react well to this type of laser treatment, lightening the area.

  • Electrosurgical Resurfacing or "cold ablation" is an alternative to the conventional laser surgery. This technique uses a micro-electrical radio frequency to deliver a pulse of energy to the skin. This treatment removes signs of age by improving superficial and moderate skin damage.
Often times the treatments listed above can reduce the signs of aging without the expense of surgical means. Most treatments leave the skin feeling smoother, softer, and healthier looking with mild or moderate discomfort. Consumers should educate themselves on the treatments available, as well as, finding a reputable dermatologist. Together, the consumer and their doctor can decide the best treatment and solution for fighting time.