In the early 20th century, different and stronger acids were used to enhance complexion in the same way that cleopatra had done 5000 years before. Surgeons then came to realize that patients who had large scrapes or burns to there face (but not too deep) had smoother, less wrinkled skin when the wounds had healed. The surgeons imitation of these injuries was a process called Dermabrasion (not to be confused with microdermabrasion), which uses a rotating sander to carefully remove the top layer of skin. The result is a smoother less wrinkled complexion and it worked great. The only problem with dermabrasion was the technical skills required to perform this in a safe and reproducible manner.

Next came the CO2 Laser. In the early 1990’s, this laser was touted as an easy reproducible way to get the same results as the Dermabrasion technique without the risks of scarring. This technique immediately caught on with dermatologists and any other doctor interested in getting a foothold in the anti-aging market. The CO2 lasers virtues included ; 1) Good smoothing out of many skin wrinkles 2) Easy to control the penetration of the laser, so the risk of scarring was minimized for those who were not trained to perform the dermabrasion procedure 3) The hype of using a space age technology – the laser – was an overwhelming reason to sell and use it.

Almost everyone, including myself jumped on the CO2 bandwagon, albeit with a bit of reluctance, since it was not better than Dermabrasion, only more high tech!

But in the end, CO2 lasers were sent to the scrap heap. Why? 1) Almost everyone who had the treatment suffered with hypopigmentation – their skin became pale white. 2) The risk of scarring and burning was not that much different than dermabrasion. 3) the downtime – scabbing and redness was prolonged 3-6 weeks, and 4) the benefits only lasted from 6-18 months.

So where did the dermatologists who created an entire anti-wrinkle industry go from there?First they tried the Erbium laser – this laser did many of the same things as a CO2 laser but with less downtime, less wrinkle correction and less complications. The only problem was that the laser was expensive, the results were minimal and the patient still had redness and downtime.

Then came a slew of non-ablative lasers and intense pulsed light procedures called photofacials. These procedures promised little and gave little but cost a lot. Non-ablative means that they did not remove any skin, like the dermabrasion or CO2 laser so the results were minimal. My biggest disgust with these treatments was not the outcome , but was the hype and questionable photography to demonstrate successful outcomes.

Now we have come full circle and the latest treatments are the fractionated CO2 lasers like Fraxel. This means that the laser is pointed onto the skin in little polka dots , as opposed to the old painting the skin like a painter paints the walls of your house. The minimal injury created eliminates some of the adverse consequences of the previous CO2 laser, the downtime is now only ten days and the hypopigmentation problem is gone. But the results are still less than the o;d CO2 laser – which was only 6-18 months. For my money, I would stick with a cheap skin peel!

So in the end, Cleopatra was way ahead of her time. Here in the 21st century, Acid peels and Dermabrasion are still excellent techniques, unless you still want to sound high tech!

What should you do?

1- Retin-A/ Alpha Hydroxy acids

2- Exfoliate with a Buf Puf once a week.

3-Sunblock

4- Drink lots of water

5-Gets lots of sleep

6-Topically apply anti-oxidants

6-Orally take anti-oxidants

7-Hyroquinone to belach out sunspots

8-Office based skin peels (lactic acid, Jessners, TCA)

9- Surgical based treatments include Dermabrasion and Strong TCA Peels.