FACIAL REJUVENATION Dr Asna Hassan - PowerPoint Presentation

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FACIAL REJUVENATION

Dr Asna Hassan

Nmch patna

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AGING OF SKIN

Slide3

AGING

Continuous ,dynamic, chronological , irreversible process

Slide4

AGING

Progressive, intrinsic, time dependent deterioration of an organism’s structural or functional integrity

Inevitable & culminate with the eventual death of the organism

Slide5

THEORIES OF AGING

PROGRAMMATIC THEORY

Telomere shortening

Cellular senescence

Slide6

THEORIES OF AGING

STOCHASTIC THEORY

Oxidative stress

DNA damage

Amino-acid

Racemization

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TYPES OF SKIN AGING

INTRINSIC

EXTRINSIC

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TYPES OF SKIN AGING

INTRINSIC

universal, presumably inevitable change attributable to the passage of time alone

occurs in all skin whether or not exposed

to external ageing factors

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INTRINSIC AGING

FACTORS AFFECTING INTRINSIC AGEING

Reactive oxygen species

Sex hormone level alterations

Genetic-telomere shortening

Cytokines-TGF beta 1,increases

Slide10

INTRINSIC AGING

Wrinkling,

Exaggerated expression lines

Decreased pliability

Slow recovery from trauma

Benign neoplasm

Thinning,

laxity

Dryness,

pigmentary

changes

Intrinsic aging

Periorbital

sagging,

pigmentation,

eyebags

Slide11

INTRINSIC AGING

HISTOPATHOLOGY

Flattening of

rete

ridges

Decr

blood

supply,innervation

Dermal atrophy-reduction in

callagen

and

elastin

Atrophy of hair follicle-thin hair

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INTRINSIC AGING

HISTOPATHOLOGY

melanocytes-greying

no and function of sweat glands

linear nail growth

Atrophy of s/c fat

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EXTRINSIC AGING

Superimposition on intrinsic aging changes, accelerated skin ageing due to external influences

Primarily chronic sun exposure

Wind, heat & smoking are other factors.

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EXTRINSIC AGING

Most premature aging -by sun exposure.

Repetitive facial expressions

Gravity

Smoking

Alcoholism

Poor nutrition

Stress

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PHOTOAGING

Superimposition of changes of

photodamage

on the usual chronological aging changes of skin

Skin ageing is almost synonymous with

photoageing

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PHOTOAGING

UVB radiation

Responsible for most of acute & chronic

photodamage

of the normal skin

Slide18

PHOTODAMAGE

Clinical effects of sunlight on normal skin

Tanning

Sunburn

Altered immunity

Photoaging

photocarcinogenesis

Slide19

EXTRINSIC AGING

HISTOPATHOLOGY

Epidermal

hyperplasia,dysplasia

Dermal thickening-

incr

ground

sub,decr

callagen

Solar

elastosis

Actinic

vasculopathy

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EXTRINSIC AGING

HISTOPATHOLOGY

Pigmentary

changes-

lentigenes

Vascular-

telengiectasia,purpura,ecchymosis

AK

Malignant skin

tumours

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PHOTOAGING

There are four types of

photoaging

according to

Glogau

classification

Type 1 to type 4

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WRINKLES

Earliest & cosmetically most unwanted problem of aging.

Results from the changes in the elastic fibers in the upper most papillary dermis

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WRINKLES

In the aged, elastic

fibres

fibers are replaced by abundant quantities of

microfibrils

Compromise dermal elasticity

Along with alterations in collagen fibers, predispose the skin to tear type injuries

Slide25

CLASSIFICATION OF WRINKLES

GLYPHIC WRINKLES

LINEAR FURROWS

CRINKLES

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WRINKLES

STATIC WRINKLES-follow normal facial expressions

DYNAMIC WRINKLES-follow aging and physical tension

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REJUVENATION

To restore to youthful vigor or appearance, make young again

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REJUVENATION

The primary goal of any

antiaging

therapy is to achieve a smooth, tight, blemish-free translucent skin, with even plane topography and more highlight than shadows.

Slide29

ANTIAGING THERAPIES

•

Cosmetological

care

• Topical agents

• Systemic agents

• Procedures

Slide30

FACIAL REJUVENATION

CONDITIONS THAT CAN BE TREATED BY REJUVENATION

Static wrinkles

Dynamic wrinkles

Pigmentation-

freckles,melasma

Scars-acne or skin injury

Vascular conditions-

telangiectasia,facial

blush

Loss of skin tone

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MANAGEMENT OF AGEING SKIN

Level I –primary intervention

Avoiding risk factors

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MANAGEMENT OF AGEING SKIN

Level I –primary intervention

COSMETOLOGICAL CARE

Avoidance of

hot,frequent

& prolonged baths

Avoidance of highly alkaline soaps

Use of

moisturisers

Use of make ups

Eat plenty of fresh fruits and green leafy vegetables

Regular exercise

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MANAGEMENT OF AGEING SKIN

Level I –primary intervention

COSMETOLOGICAL CARE

Avoidance of

hot,frequent

& prolonged baths

Avoidance of highly alkaline soaps

Use of

moisturisers

Use of make ups

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MANAGEMENT OF AGEING SKIN

Eat plenty of fresh fruits and green leafy vegetables

Regular exercise

Adequate sleep

Avoiding strong sun and wind

Regular use of sunscreens ,adopt strategies to avoid sun

Avoid smoking and alcohol

Avoid stress

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MANAGEMENT OF AGEING SKIN

Level II-secondary intervention.

In early ageing

Early detection and treatment to prevent or reduce changes

occuring

in ageing skin

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MANAGEMENT OF AGEING SKIN

Cleansing

Moisturising

Avoiding strong sun and use of sunscreens

Topical

retinoids

Alpha –OH acids

Superficial chemical peels

Microdermabration

Nonablative

rejuvanation

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MANAGEMENT OF AGEING SKIN

Level III-tertiary intervention

Treatment of established aging skin

Medical therapy

Surgical interventions

lasers

Slide38

SUN PROTECTION

Sunscreens with SPF 15 or greater

Avoiding sun exposure between 11.00 to 16.00 hours

Use of protective clothing, glasses, umbrellas & hats

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TYPES OF SUNSCREENS

CHEMICA L

UVA blockers

UVB blockers

PHYSICA L

BROAD SPECTRUM SUNSCREENS

Provides protection through the entire spectrum of both UVA and UVB

SYSTEMIC SUNSCREENS

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UVA Sunscreens

UVA1 & UVA2

Avobenzone

UVA2 & UVB

Dioxybenzone

Oxybenzone

Sulisobenzone

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UVB Sunscreens

PABA Derivatives

Padimate

O

Salicylates

Octocrylene

Homosalate

Octyl

salicylate

Trolamine

salicylate

Cinnamates

Octinoxate, CinoxateOctocryleEnsulizole

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Systemic Sunscreens

Paba

Indomethacin

Steroids

Psoralens

Retinol

Antimalarials

like

chloroquine

& HCQS and antioxidants

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MEDICAL THERAPY

Slide44

TOPICAL ANTIOXIDANTS

- reduce free-radical damage

- inhibit inflammation(which leads to collagen depletion)

- offer protection against

photodamage

and skin cancer

Slide45

ANTIOXIDANTS

ALPHA-LIPOIC ACID (ALA)

Anti-inflammatory

properties,exfoliant

Topical 5% ALA applied

b.I.D

. For 12 weeks reduced skin roughness,

lentigines

and fine wrinkles

Slide46

ANTIOXIDANTS

NIACINAMIDE (VITAMIN B3)

Potent antioxidant

Improves the lipid barrier component of the epidermis

An inhibitor of

melanosome

transfer

Significant reduction in fine lines and wrinkles,

hyperpigmented

spots & red blotchiness, improved skin elasticity

Slide47

ANTIOXIDANTS

VITAMIN C(

L-Ascorbic Acid )

Blocks UVR induced

erythema

Stimulates fibroblasts-increases

neocollagenesis

Decreases melanin formation

Anti inflammatory activity

- improve fine lines and reduce both pigmentation and inflammation

- accelerate wound healing

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ANTIOXIDANTS

GI absorption is the rate limiting factor in

cutaneous

delivery of vitamin C

Even

supraphysiological

doses do not increase the concentration to optimal levels

The inherent instability of vitamin C is the major therapeutic challenge

Exposed to air-inactive

di

hydro ascorbic acid

Slide49

ANTIOXIDANTS

VITAMIN E (

α

-

Tocopherol

)

Lipid soluble , membrane bound anti oxidant in plasma, cell membrane and tissues

Slide50

ANTIOXIDANTS

- reduce sunburn cells after UV exposure, neutralize free radicals, and act as a

humectant

- moisturizing

properties,anti

-inflammatory, antioxidant

- improve the function of the sebaceous gland and ameliorate excessive pigmentation in the skin

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ANTIOXIDANTS

N-ACETYL-GLUCOSAMINE (NAG)

More stable form of glucosamine

Interrupt the chemical signals that promote melanin production

Prevent new signs of

photodamage

from occurring

Fade existing imperfections

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ANTIOXIDANTS

UBIQUINONE(COENZYME Q10)

Naturally occurring, fat-soluble antioxidant

Suppress production of

uva

-induced

collagenase

by fibroblasts, thereby reducing collagen breakdown

Effective against UV mediated oxidative stress in human

keratinocytes

Protects the dermal matrix from both intrinsic and extrinsic aging.

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ANTIOXIDANTS

IDEBENONE

Derived from coenzyme Q10

100 times powerful than coenzyme Q10 & better absorbed

Related to hydroquinone hence shows pigment fading effect

Incr

collagen

synthesis,decr

breakdown

Antioxidant

antiinflammatory

Slide54

ANTIOXIDANTS

VINE SHOOT

Vitis

vinifera

shoot

Polyphenol

rich antioxidant

In combination with

ectoine,hidroine

-compounds found in

halophilic

microorganisms growing in extreme temperature and humidity

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ANTIOXIDANTS

SOY

Active ingredients-

isoflavones

including

genistein

and

diadzein

Others-essential fatty acids, amino acids,

phytosterols

, serine protease inhibitor such as Bowman –

Birk

inhibitor, soy

trypsin

inhibitor(STI)

Slide56

ANTIOXIDANTS

STI inhibits PAR-2 and thus

melanosome

transfer to

keratinocytes

Antiinflammatory,skin

lightening ,photo protective

Slide57

ANTIOXIDANTS

TEA

Antioxidant, anti inflammatory, anti carcinogenic properties

Inhibits

UV induced

erythema

,

cyclobutane

pyrimidine

dimers

Slide58

ANTIOXIDANTS

FERULIC ACID

Potent antioxidant in the cell wall of grains , fruits and vegetables

Absorbs UV radiation acting as sunscreen

Slide59

ANTIOXIDANTS

YQUEM

Novel highly potent antioxidant which decreases free radical production

Slide60

ANTIOXIDANTS

COFFEE BERRY

Fruit of

coffea

arabica

Active ingredients-

chlorogenic

acid,quinic

acid,

ferulic

acid,

proanthocyanidins

Ability to quench free radicals

0.1 - 1%

coffeeberry

skin cleansers

andfacial

creams

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ANTIOXIDANTS

Omega-3 fatty acids

Fish,roasted

or ground flax

seeds,walnuts

,

hemp,salmon

,

spirulina

Sea food ,algae

DHA,EPA

Control inflammation

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BOTANICALS

FLAVONOIDS

Soy

Silymarin

(milk thistle)

Hesperidin

Diosmin

CAROTENOIDS

Astaxanthin

(tomatoes)

Lutein

(tomatoes)

Lycopene

(tomatoes)

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BOTANICALS

POLYPHENOLS

Rosmarinic

acis

(rosemary)

Hypericin

(

st

john’s

wort

)

Ellagic

acid(pomegranate)

Curcumin

(turmeric)

Pycnogenol

(marine pine bark)

Terpenoids

(ginkgo

biloba)Procyanidin(grape seed)Epigallocatechin(green tea)

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BOTANICALS

Green Tea Extract

- green tea (

Cammelia

sinensis

)

potent suppressors of carcinogenic activity from UV radiation

- exert broad protection against sunburn,

immunosuppression

, and

photoaging

.

- improves the microcirculation

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BOTANICALS

Grape Seed Extract

- contains

oligomeric

procyanidins

.

- potent

antioxidant,has

EFAs

- speed up wound contraction and closure

- enhance the

spf

in humans

Slide66

BOTANICALS

Chlorella

-

aquatic plant extract

- alters the

thrombospondin

1 balance in the skin to exert its

antiaging

effect

Slide67

BOTANICALS

Rosehip seed oil (

Rosa

Mosqueta

)

- high in EFAs

- smoothens wrinkles by hydrating the skin and slows new signs of aging

Slide68

BOTANICALS

Other topical antioxidants

Leaf wax of

eucalyptus

Leaves of barley

Sesame seeds

Aloe

vera

Papaya

Witch hazel

Allantoin

Gentisic

acid

Mulberry extract

Slide69

SYSTEMIC ANTIOXIDANTS

The free radical theory

Many antioxidants work synergistically to regenerate and enhance the power of each other (network antioxidants)

Slide70

SYSTEMIC ANTIOXIDANTS

Nonenzymatic

antioxidants

Vitamin E

Coenzyme Q10

Ascorbate

Carotenoids

Enzymatic antioxidants

Superoxide dismutase

Catalase

Glutathione

peroxidase

Slide71

Nutritional supplements with antioxidant properties

Vitamins

Coenzyme Q10

Nicotinamide adenine dinucleotide (NADH)

Vitamin A,B2,C,E

Natural antioxidants

Flavanoids ( red grapes, strawberries, red cabbage)

Quercetin (onions, apple skins, berries, broccoli)

Catechins (green tea)

Isoflavones (soybeans)

Carotenoids (carrots, sweet peppers, oranges)

Lycopene (tomatoes)

Minerals

Copper,Manganese,Selenium,Zinc

Amino acids

Cysteine,Methionine,Taurine

Glutamine (glutathione precursor)

Glutathione

Hormonal

Alpha-carotene,Beta-carotene

Carotenoids,Melatonin,Lycopene

Miscellaneous

Alpha-lipoic acidGrape seed extractN-Acetylcysteine

Slide72

DEPIGMENTING AGENTS

Phenolic

agents

Hydroquinone

- agent of choice for skin lightening

- permanent

depigmentation

, possible carcinogenicity

- US FDA- between 1.5% and 2% in skin lighteners.

Arbutin,N-Acetyl-4-S-Cysteaminylphenol

Slide73

DEPIGMENTING AGENTS

Nonphenolic

agents

Ascorbic acid (Vitamin C)

- naturally occurring antioxidant

- is hydrophilic- skin penetration is low

- stimulate both type I and type III collagen synthesis

- problems with stability

Kojic

acid, Licorice Extract ,

niacinamide,azelaic

acid,aloe

Slide74

MOISTURIZERS

- restore water content to the epidermis

- improve the appearance and tactile properties of dry and aging skin

- restore the normal barrier function of the skin

- reduce the release of inflammatory cytokines

Slide75

TOPICAL PEPTIDES

- regarded as cellular messengers

- mimic peptide fragments with endogenous biologic activity

- comprise of a

subfragment

of type I collagen

propeptide

- signal fibroblasts to produce collagen in the skin

Slide76

RETINOIDS

-

natural and synthetic derivatives of vitamin A

- reduce

hyperpigmentation

- increase the rate of cell division

- repair

photoaged

skin by inhibiting

collagenase

and improving dermal vasculature

- stimulate new collagen deposition-- promote the down growth of

rete

ridges

Slide77

RETINOIDS

- Both extrinsic and intrinsic aging

-

Tretinoin

and

tazarotene

have been FDA-approved as

antiaging

agents

Improves thickness,

colour

and wrinkles

Decreases size of pores

Slide78

HORMONES

Oral/topical estrogen and topical progesterone

significant improvement in dry skin and skin wrinkling with estrogen replacement in females.

Increase skin collagen content

Incr

skin elasticity

Slide79

MEDICAL THERAPY

OTHER PRODUCTS

HYALURONIC ACID(GAG)

Conjunction with

vit

C for effective penetration

COPPER PEPTIDE

Most effective skin regeneration product

Promotes collagen and

elastin

production

Promotes production of GAG

Firm smooth soft skin in less time

Slide80

ENZYMES

Papain

Digests intercellular protein bonds

GROWTH FACTORS

EGF

TGF

PDGF

Slide81

PROCEDURES

Slide82

MICRODERMABRASION

Resurfacing technique consisting of mechanical abrasion of the skin with

pressurised

stream of

aluminium

oxide crystals to achieve superficial skin wounding

Slide83

MICRODERMABRASION

Vacuum pressure -10 - 20 mm of Hg

average 4 sessions at 1 to 2 week intervals

Slide84

MICRODERMABRASION

MECHANISM OF ACTION

Mechanical disruption of the stratum

corneum

Partial

epithelialisation

and stimulation of epidermal cell turn over

Vasodilatation of dermal vessels and dermal edema

Stimulation and

remodelling

of dermal collagen

Slide85

MICRODERMABRASION

CONTRAINDICATIONS

Active bacterial or viral infections

Keloidal

tendency

Use of

isotretinoin

within 1 year

Pustular

/cystic acne

Chronic skin diseases(psoriasis ,SLE)

Skin ulcers ,erosions

Slide86

MICRODERMABRASION

COMPLICATIONS

Erythema

, edema

Increased skin sensitivity

Purpura

, drying

Hyperpigmentation

Blue-gray discoloration

infection

Slide87

ENDERMOLOGIE

noninvasive mechanical body-contouring used in the treatment of cellulite

the cellulite-affected skin is sucked between the rollers and kneaded for approximately 34-45mts

temporarily reduces the appearance of the cellulite

benefits are short lived.

Slide88

CHEMICAL PEELS

To treat wrinkles,

dyschromias

and

keratoses

Use is well established and poses minimal risk in experienced hands.

Improves the cosmetic appearance of skin that has been damaged by exposure to sunlight

Slide89

Alpha

Hydroxy

Acids (AHAs)

Citric,Glycolic,Lactic,Malic,Pyruvic,Tartaric

acid

Improve skin texture

promote cell shedding in the outer layers of the epidermis

restore hydration

Improve skin elasticity

increase collagen content and

glycosaminoglycans

Smoothen skin

Slide90

Alpha

Hydroxy

Acids (AHAs)

Mechanism

-through

chelation

, remove the calcium ions from the cell adhesions

- cleavage of the endogenous stratum

corneum

chymotryptic

enzyme on the

cadherins

- reduction of the calcium ion levels promote cell growth, giving rise to younger looking skin.

Slide91

BOTULINUM TOXIN/BOTOX

Powerful neurotoxin produced by clostridium

botulinum

Alan Scott-1

st

used

botox,for

strabismus

Jean and Alastair

Carruthers

introduced

botox

to dermatology

Slide92

BOTULINUM TOXIN/BOTOX

The goal of treatment should only be softening of facial lines, not paralysis

It is truly a ‘facelift in a jar’

Eliminates only dynamic wrinkles

The only limiting factor is the cost of treatment

Slide93

BOTOX

MECHANISM OF ACTION

Blocks acetyl

choline

release at the neuromuscular junction

Inhibits transmission of nerve impulses across the synapse

Temporary flaccid paralysis of muscle

Slide94

BOTOX

This takes 1-3 days which is the time required for the onset of action of

botox

It takes 3-4 months for the axon to send out new nerve terminals, which relates directly to the duration of action of the toxin.

Slide95

BOTOX

2 serotypes of

botox

used clinically

Most commonly used-

botox

type A

Botox B-shorter duration of action than

A,used

if resistance to

btx

A

Slide96

BOTOX

INDICATIONS

Crow’s

feet,glabellar

frown,frontalis

frown

Wrinkles on nose(bunny nose)

Upper lip

rhytides

Pebbly chin

Nasolabial

fold

Jawline

wrinkles

Venus rings

Slide97

BOTOX

CONTRAINDICATIONS

Neuromuscular disorders-myasthenia gravis

Pregnancy,breast

feeding

Allergy

Infection

Drugs-

aminoglycoside,antimalarials,tubocurarine

Slide98

SOFT TISSUE AUGMENTATION

Technique in which a substance is injected under the skin usually to replace volume lost due to aging

Slide99

DERMAL FILLERS

Aesthetic improvement without major downtime or surgical intervention

Fillers are the choice for static wrinkles

Binds to the water and provides volume to fill in larger folds of skin- remove the wrinkle

Slide100

DERMAL FILLERS

Improve facial contours

Used mainly in the lower two-thirds of the face

Glabellar

lines and tear troughs can also be treated but complications are more common in these areas

Slide101

DERMAL FILLERS

According to their source

Autogenic-fat,

autologous

plasma,

autologous

collagen

Allogenic

-human cadaver

tissue,human

fibroblast cell culture

Slide102

DERMAL FILLERS

According to their source

Xenogeneic

-bovine or porcine

collagen,hyaluronic

acid

Synthetic products-

silicone,PMMA

,

hydroxyapatite,carboxycellulose,poly

-L-lactic

acid,polyacrylamide

Slide103

DERMAL FILLERS

Depending on tissue response

Non permanent bio degradable compounds

bovine

collagen,hyaluronic

acid

Semipermanent

biodegradable compounds

poly lactic

acid,alloderm

Slide104

DERMAL FILLERS

Depending on tissue response

Permanent non reversible compounds

silicones,PMMA

Permanent reversible compounds

PTFE

Slide105

DERMAL FILLERS

Xenogenic

bovine collagen- 3-12 months

Risk of delayed

cutaneous

allergic reactions

Double skin testing done

Slide106

DERMAL FILLERS

Hyaluronic

acid-6-12 months

Calcium

hydroxyapatite

-for volume replacement of

cheeks,nasolabial

folds

Poly L lactic acid-increase collagen

matrix,ground

substance, dermal elastic formation by stimulating dermal fibroblasts

Slide107

DERMAL FILLERS

Recent approach using

allogeneic

human derived fibroblasts from a single source of neonatal tissue

Slide108

DERMAL FILLERS

TECHNIQUES OF INJECTION

1.LINEAR THREADING TECHNIQUE

2.SERIAL PUNCTURE TECHNIQUE

3.FAN TECHNIQUE

4.CROSS HATCHING TECHNIQUE

Slide109

DERMAL FILLERS

Linear threading technique

Full length of needle is inserted into defect & implant injected while pulling needle backwards

Serial puncture technique

Multiple

inj

placed serially along length of treated area- causes lifting of wrinkle.

Slide110

CUTANEOUS RESURFACING

Ablative skin resurfacing (ASR

)

–

pulsed carbon dioxide and

erbium:YAG

Non-ablative dermal remodeling (NDR

)

–

non-ablative neodymium: YAG system, radiofrequency, intense pulsed light, fractional photo-

thermolysis

, light emitting diode

photomodulation

Slide111

NON-ABLATIVE RADIOFREQUENCY

Tissue tightening procedure

Cleared by FDA

Noninvasive treatment for

periorbital

wrinkles

Mechanism is twofold: immediate contraction of existing collagen fibrils & a delayed wound healing response resulting in

neocollagen

production by stimulated fibroblasts

Slide112

NON-ABLATIVE RADIOFREQUENCY

Advantage - can treat all skin types

Disadvantage - cost and need for annual maintenance treatments

A/E: transient skin numbness and subcutaneous fat atrophy

Radiofrequency and diode laser have been combined for more efficacy with less side effects.

Slide113

FRACTIONAL PHOTOTHERMOLYSIS

Creates microscopic thermal wounds, sparing the tissue surrounding each wound

Controlled dermal heating without dermal damage

Effective and safe treatment for lightening of epidermal and dermal pigmentation of

melasma

.

Slide114

LED PHOTOMODULATION

A photo-rejuvenation effect using

nonthermal

stimulation of cells requiring low energy, narrowband light with specific pulse sequence and duration

To acquire smoother appearance of the epidermis

Principle - stimulating very superficial collagen in a

nonthermal

way

Slide115

LED PHOTOMODULATION

Light is delivered through light emitting diode (LED)

Activate fibroblasts causing them to produce collagen and

elastin

Safe and effective

nonpainful,non

-ablative modality for improvement of

photoaging

Can be used in all

fitzpatrick

skin types without any adverse effect.

Slide116

INTENSE PULSED LIGHT

Gives a non coherent emission with wavelength between 500 and 1200 nm

For vascular problems,

λ

down to 500 nm

For

pigmentary

problems,

λ

down to 560 nm

Slide117

LASERS

FOR VASCULAR CHANGES

Pulse dye lasers

Alexandrite lasers

Nd

-YAG

Copper bromide

Potassium

titanyl

phosphate(KTP)

Slide118

LASERS

FOR BENIGN PIGMENTD LESIONS

Q switched ruby

Alexandrite

Nd

YAG

Q switched KTP

Slide119

LASERS

FOR SURFACE SKIN CHANGES

Pulsed CO2 laser

Er

YAG laser

Slide120

FRACTIONAL LASER SKIN REJUVENATION

Fractional

photothermolysis

creates microscopic zones or columns of thermal damage surrounded by healthy tissue

Latest

fraxel

laser system-employs motion detector-laser triggered by motion across the skin

Described as rolling FP laser system

Slide121

NON LASER SKIN SURFACE REJUVENATION

Plasma skin rejuvenation system using high surface energy generated with nitrogen gas released at high velocity

Slide122

MICROCURRENT THERAPY

DC of very low amperage 1-1000

μ

amp is used

Augments the body’s healing capacity

Subsensory

below the threshold of pain

Stimulates ATP-enhances metabolism, tissue

repair,circulation

of blood and lymph

Slide123

COLLAGEN REPAIR

Use of

signalling

peptides, growth factors and cytokines in collagen repair

Slide124

FACE LIFT SURGERIES

SMAS (superficial

musculo

aponeurotic

system)

rhytidectomy

Deep plane

rhytidectomy

Endoscopic face lift

Upper and lower eyelid

blepharoplasty

Slide125

DERMATOLOGIC APPROACH TO FACIAL REJUVENATION

Photoaging

is a multisystem degenerative process that involves the skin and the skin support systems, including the bone, cartilage, and subcutaneous compartments

These structures provide the architectural support for the dermis, epidermis, and stratum

corneum

.

Slide126

BONY ARCHITECTURE

Without a strong framework, the skin hangs formless over the face

Bone loss - dulling of the facial features

Vitamin D therapy - 50,000 IU for 2 weeks followed by 800 IU daily

Slide127

BONY ARCHITECTURE

Calcium carbonate-1gm daily accompanied by a

bisphosphonate

administered once weekly

Women at risk for facial bone loss- hip or spine

Dexascan

yearly to chart the success of therapy

At least 30 minutes of weight-bearing exercise should be undertaken 3 times weekly

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CARTILAGE ARCHITECTURE

Defines the shape of the face

With advancing age, change in shape

During pregnancy changes due to

relaxin

Use of

hyaluronic

acid fillers to preserve the youthful nose

Slide129

SUBCUTANEOUS COMPARTMENT

Contributes much to the aged appearance of the face

Unclear why subcutaneous fat

redeposited

intrabdominally

The best way to replace-

autologous

fat transfer

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SUBCUTANEOUS COMPARTMENT

Autologous

fat transfer

Does not change the essence of the individual's face

No downtime and scarring of a face-lift

Many women lose their characteristic appearance after a face-lift because the skin has been stretched and repositioned over the fat-devoid bones, creating an angular appearance

Slide131

Cosmetic Procedures Usually Done

Lentigines

,

keratoses

, sebaceous

hyperplasias

& other benign lesions

shave excision,

curettement

,

electrosurgery

&

cryotherapy

Vascular lesions

argon or tunable dye laser

Irregular pigmentation,

telangiectasias

& lesions of sun damage

dermabrasion

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Cosmetic Procedures Usually Done

Ptotic

eyebrows

brow lifting

Droopy or saggy appearance of eyelids

blepharoplasty

Scalp alopecia

hair transplantation, scalp reduction procedures

Unwanted fat deposits

liposuction

Slide133

Cosmetic Procedures Usually Done

Tattooing of eyelid margins augments the physical appearance of lashes

Injection of dermal fillers along the vermilion border can plump out & better define lip margins

Local

hirsutism

seen on upper lip of elderly can be treated by shaving, waxing or electrolysis

Slide134

Measurement Of Aging Process

Silicone impressions-analyze wrinkle depth

Optical

profilometry

-measures changes in skin topography

Tristimulus

colorimeters-evaluates the

colour

hue

Spectrophotometers-quantifies the skin

colour

Slide135

Conclusion

Ageing of skin is an inevitable & irreversible process, the hastening of which can be prevented to some extent by proper skin care

The primary goal of treatment modalities is improvement, rather than perfection of the individual’s appearance