Skin resurfacing with Dr Michael Prager

If you want to look younger, you need skin resurfacing. Studies have shown that erasing lines does little to achieve a more youthful appearance, merely a less wrinkled one. In contrast, porcelain skin is the unwavering hallmark of skin vitality, good health and youth. This is why skin resurfacing has become big business. But how can there suddenly be mass proficiency in what is actually a fairly technical process? The answer is machines. We’re living in a push-button age producing manufactured concepts of beauty via mechanical methods that require little thought or skill beyond the ability to plug in and go. But like anything in life, skin resurfacing is not that simple, and effective safe skin resurfacing is even more complex.

A Brief History of Skin Resurfacing

The myths of Cleopatra are plenty, but the story of her bathing in sour donkey milk is more than likely true, and this ancient Egyptian pastime is the first known example of skin resurfacing.

The milk sugar lactose in sour milk is converted by bacteria into lactic acid, and when alpha hydroxy acids (AHAs) such as lactic acid are applied to the skin, they cause the surface layer to peel off.

In other ancient news, the Egyptians, Greeks, and Romans all favoured face masks made of crushed grapes that were washed away with red wine for a glowing complexion. The key ingredient in this beauty trick is tartaric acid, another AHA. Lemon extract, sulphur, and limestone were also routinely used to fade sun spots and freckles.

Move on to the late 1800s and a few guys with handsome facial hair began dabbling with chemical peels. There was William Tilbury Fox in the UK, Paul Gerson Unna in Germany, and Ferdinand Ritter von Hebra in Austria – a man often cited as the father of modern dermatology.

While Fox and von Hebra favoured phenol, croton oil, and nitric acid, Unna developed treatments with salicylic acid and trichloroacetic acid.

Of course, as pioneering as these men were, their methods were primitive and damaging, but they got the ball rolling.

The Evolution of Facial Peels

Moving on from the 1930s, when everyone seemed obsessed with phenol peels, a more modern horror story began to emerge with the acid peel masks of the 1990s; masks that burned the skin so severely that people did in fact look like burns victims. Full facial bandages were advised for three weeks post treatment.

By the end of this ordeal, the skin would be very smooth and taut, but with the burn being so deep, this was a one-off procedure done at middle age leaving you with no tolerance of the sun for the rest of your life.

When I first came to London, ideas were slowly changing and we entered the era of glycolic acid.

The problem is, peels are difficult and they were especially dangerous to manage in the days when heavy duty and highly concentrated acids were all the rage

Next came the Easy Peel, a trichloroacetic acid (TCA) peel that was methodical, but worked. While glycolic makes the skin red and flaky, TCA really burns leaving dark black patches of skin.

While there are undeniably good results with these peels, especially in regard to acne and stretch marks, they come with a certain risk. When I started out, I could insure myself for under a £1,000 and this included peels. Five years later, just for peels, I was looking at £10,000.

You see, every Tom, Dick, and Harry started peeling, which is fine if you peel on very dark skin or very white skin with a TCA; you’re safe. If you work on skin in the middle of that spectrum, you can end up in deep trouble.

Man v Machine

In the mid-90s, the CO2 laser arrived. Now, instead of acid and a brush to burn people’s skin they could use a device that was capable of setting fire to the neighbour’s curtains.

Basically, the CO2 laser was the size of a needle pin and it burned a hole in the skin, the size of which was dependent on how long you held it in one spot. It was very operator dependent and, once again, too intense. Its successor, Fraxel, was an improvement on this, but not a foolproof one, and it heralded the dawn of the Age of the Machine.

It was in this period of cosmetic renaissance, that we entered the mass production of skin resurfacing.

It brought the arrival of IPL (intense pulsed light), RF (radio frequency), ultrasound, and cryolipolysis, which uses cold temperatures to freeze and destroy fat cells.

Among the popular machines you may have heard of are: Ultherapy (ultrasound); Morpheus8 (RF); Thermage (RF); and CoolSculpting (cryolipolysis).

Personally, I don’t consider any of them safe enough for use on my patients.

I had my fingers burned many years ago using CoolSculpting, not excessively so, but enough to understand that the small risk for patients is too big a gamble to take to achieve results that can be done far more safely and effectively with a needle.

Unfortunately, celebrity endorsements by the likes of Judy Murray and Karren Brady give these methods a spotlight they little deserve, but as we have seen in the case of the supermodel Linda Evangelista, spotlights can also burn, and messing up the face of one of the world’s top supermodels is about as disastrous as it can get for a company selling anti-ageing beauty via a machine.

Meanwhile, over on Facebook there are groups devoted to people suffering from complications apparently wrought by these machines.

Complaints about Morpheus8, Thermage, Ultherapy
Problems allegedly encountered with machines like Morpheus8 and Ultherapy

The Prager Clinic: Setting the Gold Standard in Skin Resurfacing

So, how do we do it better? Well, instead of machines, we rely on a professional therapist who performs several manual treatments that are far less invasive than today’s off-the-shelf, mechanical procedures. They also achieve better and kinder results.

Before machines came along, resurfacing was actually a very skilled job, and because we never compromised on that skill by buying into the supermarket hype, we retained that knowledge and built on our experience to produce the most effective, skin resurfacing programmes available today.

One of our most popular treatments is the Illuminator facial, simply because it offers incredible results with no downtime. This is the go-to treatment if you have somewhere to go to and need to look a million dollars, immediately.

One step up from the Illuminator, is the Rejuvenator, a skin resurfacing treatment that relies not on machinery or the latest marketing must-have, but on human expertise and the purest, finest natural ingredients.

There are no gimmicks, no small-town celebrity endorsements, just skin resurfacing at its finest, leaving you looking naturally younger while remaining true to our values of skin care and skin kindness.

The Rejuvenator facial can result in slight redness and tenderness, with a maximum four-day downtime period, but there is zero chance of severe or lasting side effects. The risk profile is extremely low and yet, after one procedure, we see very, very good results.

Fifteen years ago, when people were still prepared to put up with a lot of downtime, I did all of the above but way more aggressively.

Over time, we toned down the pain and downtime factor, but by retaining skilled professionals and combining treatments that increased the benefit-to-downtime ratio tremendously, both these treatments are now pretty much enjoyable. And, as I said, the results are spectacular. But don’t just take my word for it.

Here are the Visia pictures of one of our clients. There’s no soft-lighting, no clever make up, only a 42% reduction in porphyrins, a 42% reduction in large open pores, a 28% improvement in skin texture, 15% fewer wrinkles, a 3% reduction in red areas, a 3% reduction in brown spots, and an 8% reduction in spots.

Visia images of skin resurfacing before and after
Visia images tell the full story, they don’t sell an illusion

At the Prager Clinic we don’t go deep because we don’t need to. We don’t take risks because there’s no need for them either. We get the results our clients want with proven techniques that don’t compromise patient safety or cost you the earth. At the Prager Clinic we achieve great results through repeat procedures and combination treatments.

For us, skin resurfacing will never be a one-machine-fits-all kind of experience. People are not cattle, and they deserve better. Your face deserves better. It’s time the industry relaunched skin resurfacing, not as a push button procedure, but as a treatment in which skill, care, and experience counts.

The Illuminator Facial: £599 per treatment (includes three Dr Prager Urban Protect skincare products).

The Rejuvenator Facial: £795 per treatment (includes three Dr Prager Urban Protect skincare products, and a course of three treatments is recommended for best results).