A Paradigm for Facial Skin Rejuvenation

ABSTRACT

There is a significant desire by patients to reverse the signs of aging caused by photodamage. Numerous procedures for facial skin rejuvenation have been developed in an attempt to minimize the erythema, dyspigmentation, and rhytides associated with photoaging. The initial procedures developed for facial rejuvenation involve skin resurfacing via complete ablation of layers of skin. Of these procedures, ablative laser resurfacing is the most precise technique and is considered the gold standard for facial skin rejuvenation. Although ablative procedures are quite efficacious, they carry significant patient downtime and risks of adverse effects such as scarring and dyspigmentation. Concerns regarding patient morbidity have led to the development of nonablative procedures that target dermal collagen without damaging the epidermis. Of these technologies, intense pulsed light is the most commonly used because it effectively targets both the erythema and dyspigmentation seen in photoaging. Nonablative techniques minimize side effects and patient downtime; however, they do not match the results seen in fully ablative procedures. Fractional laser technologies—first nonablative and more recently ablative—represent the most recent attempt to match the results seen in fully ablative procedures with less patient downtime. Their results are promising but require further study.

KEYWORDS

Photodamaged - rejuvenation - resurfacing - laser - fractional

REFERENCES

• 1 Rabe J H, Mamelak A J, McElgunn P J, Morison W L, Sauder D N. Photoaging: mechanisms and repair.  J Am Acad Dermatol. 2006;  55 1-19
• 2 Yaar M, Gilchrest B A. Photoageing: mechanism, prevention and therapy.  Br J Dermatol. 2007;  157 874-887
• 3 Sadick N S, Karcher C, Palmisano L. Cosmetic dermatology of the aging face.  Clin Dermatol. 2009;  27 s3-s12
• 4 González S, Fernández-Lorente M, Gilaberte-Calzada Y. The latest on skin photoprotection.  Clin Dermatol. 2008;  26 614-626
• 5 Serri R, Iorizzo M. Cosmeceuticals: focus on topical retinoids in photoaging.  Clin Dermatol. 2008;  26 633-635
• 6 Draelos Z D. The cosmeceutical realm.  Clin Dermatol. 2008;  26 627-632
• 7 Rubin M G. Manual of Chemical Peels. Philadelphia, PA; JB Lippincott 1992: 5
• 8 Clark E, Scerri L. Superficial and medium-depth chemical peels.  Clin Dermatol. 2008;  26 209-218
• 9 Landau M. Chemical peels.  Clin Dermatol. 2008;  26 200-208
• 10 Ditre C M, Griffin T D, Murphy G F et al.. Effects of alpha-hydroxy acids on photoaged skin: a pilot clinical, histologic, and ultrastructural study.  J Am Acad Dermatol. 1996;  34(2 Pt 1) 187-195
• 11 Kligman D, Kligman A M. Salicylic acid peels for the treatment of photoaging.  Dermatol Surg. 1998;  24 325-328
• 12 Khunger N, Sarkar R, Jain R K. Tretinoin peels versus glycolic acid peels in the treatment of melasma in dark-skinned patients.  Dermatol Surg. 2004;  30 756-760 discussion 760
• 13 Monheit G D. The Jessner’s-trichloroacetic acid peel. An enhanced medium-depth chemical peel.  Dermatol Clin. 1995;  13 277-283
• 14 Brody H J, Hailey C W. Medium-depth chemical peeling of the skin: a variation of superficial chemosurgery.  J Dermatol Surg Oncol. 1986;  12 1268-1275
• 15 Coleman III W P, Futrell J M. The glycolic acid trichloroacetic acid peel.  J Dermatol Surg Oncol. 1994;  20 76-80
• 16 Spencer J M, Kurtz E S. Approaches to document the efficacy and safety of microdermabrasion procedure.  Dermatol Surg. 2006;  32 1353-1357
• 17 Spencer J M. Microdermabrasion.  Am J Clin Dermatol. 2005;  6 89-92
• 18 Emsen I M. A different and cheap method: sandpaper (manual dermasanding) in treatment of periorbital wrinkles.  J Craniofac Surg. 2008;  19 812-816
• 19 Janik J P, Markus J L, Al-Dujaili Z, Markus R F. Laser resurfacing.  Semin Plast Surg. 2007;  21 139-146
• 20 Fodor L, Carmi N, Fodor A, Ramon Y, Ullmann Y. Intense pulsed light for skin rejuvenation, hair removal, and vascular lesions: a patient satisfaction study and review of the literature.  Ann Plast Surg. 2009;  62 345-349
• 21 Alexiades-Armenakas M R, Dover J S, Arndt K A. Laser therapy. In: Bolognia JL, Jorizzo JL, Rapini RP Dermatology. London; Mosby 2008: 2099-2120
• 22 Goldberg D J. Photodynamic therapy in skin rejuvenation.  Clin Dermatol. 2008;  26 608-613
• 23 Sukal S A, Geronemus R G. Thermage: the nonablative radiofrequency for rejuvenation.  Clin Dermatol. 2008;  26 602-607
• 24 Jih M H, Kimyai-Asadi A. Fractional photothermolysis: a review and update.  Semin Cutan Med Surg. 2008;  27 63-71
• 25 Wanner M, Tanzi E L, Alster T S. Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium-doped fiber laser.  Dermatol Surg. 2007;  33 23-28