LAM FACIAL PLASTICS

Dear Doctor, I always was puzzled by the mechanisms put into play by wounding "intentionally" the skin to regenerate it. Either throuch laser, peels, dermabrasion or any other ablative procedure.

I understand the logics of: if you create a "wound" (well, obviously not too deep or severe), you will kickstart the natural process of cicatrization of the body and so kickstart a process that otherwise that area (wrinkled, scarred, pigmented, whatever) would not be encouraged by the own body to have its cells "renewed".

What I am not sure I understand is the "how" in terms of the timelines to consider.

Say, any ablative procedure obviously requires a recuperation time, where the skin "builds up" the new healthier skin, new collagen, etc. Ok.
It would only make sense that undergoing too close laser or peel treatments, or anything that would wound the skin with the purpose of creating better skin, could result in creating a too deep wound and not give time for the skin to recuperate enough or totally before trying to make it even better by having another treatment *some time after*.

What I have noticed is that doctors and the literature on the matter seem to not agree on how often x or y type of procedure msut be performed for optimal results. I assume it's related to what each doctor considers is the right time to make the used method to do its job and not cause further problems by causing more aggression to the skin before it starts healing.

But I often see different timelines set for the "in between" times to respect for peels, treatments, etc. even with one same substance.

This makes me wonder. How can a doc or anyone know when it is ok to start a new treatment and know that the skin has healed enough before making it suffer an aggression again?

On the other hand... I can understand that if you wound over a "open" wound (so to speak), you only create a deeper, worse wound. What I wonder, though... once the collagen buildup/better skin buildup has been kickstarted, so that the skin is into regenerating mode.. why does one have to wait a lot in between treatments? (this "a lot" seeming to vary among docs). If a skin has healed enough (not reached its fullest result, but the skin is no longer really wounded but already recuperating), wouldn't creating a mini wound again only kickstart an even stronger response from the *new* skin that is forming and the whole area to create even more healthy skin?

In other words, a peel not long ago after a first peel (although not immediately after) that left the skin raw or even a bit wounded, couldn't actually make the recovery and new skin better and to make it grow faster precisely because the skin is into repair mode?

I am asking that because I see "don't do a peel x before y time has passed by", "don't do cross before z time has passed by"... but after the skin is not wounded, wouldn't frequent peels accelerate the process of skin regeneration that the first "aggression" started?

Gee, I know it sounds confusing, but I don't know how to explain it better!

hopefully this answer will be clear:
1. we actually don't fully understand how collagen rebuilds. i have often cited a paper that i wrote that won for best clinical research paper in 2002 that showed collagen remodeling even with a non-ablative laser that is off the market for lack of efficacy. so clearly don't even believe a well constructed, blinded, prospective study, i.e., mine.
2. think of collagen like building muscles. you need to tear the muscle down to build it but if you keep tearing the muscle down it will never rebuild. that can lead to only destruction. collagen has a time period between 60 to 90 days in most cases for rebuilding.
3. if you over stimulate collagen growth, you can enter what i call an overshoot where you just form scar. that is particularly possible with the CROSS TCA treatment you ask me about. i work very slowly on depressions that are shallow. oftentimes waiting the full 90 days before making a read on things.
hope that is clearer.
love and respect,
sml

[quote="dr. lam"]hopefully this answer will be clear:
1. we actually don't fully understand how collagen rebuilds. i have often cited a paper that i wrote that won for best clinical research paper in 2002 that showed collagen remodeling even with a non-ablative laser that is off the market for lack of efficacy. so clearly don't even believe a well constructed, blinded, prospective study, i.e., mine.
2. think of collagen like building muscles. you need to tear the muscle down to build it but if you keep tearing the muscle down it will never rebuild. that can lead to only destruction. collagen has a time period between 60 to 90 days in most cases for rebuilding.
3. if you over stimulate collagen growth, you can enter what i call an overshoot where you just form scar. that is particularly possible with the CROSS TCA treatment you ask me about. i work very slowly on depressions that are shallow. oftentimes waiting the full 90 days before making a read on things.
hope that is clearer.
love and respect,
sml[/quote]

The muscle and workout example was fantastic!!
I was not thinking of TCA Cross in particular, rather of peels in general (most docs suggest series of peels, but not all seem to say that glycolic or low tca peels or the like have to happen with an in between period of x days... they vary in what they say). But the answer was what I needed, yes, and it applies to all.
How interesting! thanks!

perfect. glad that i hit the right button with my analogy.
love and respect,
sml