Dermatologist Arielle N.B. Kauvar, MD, FAAD, clinical associate professor of dermatology at New York University School of Medicine in New York, has detailed the latest non-surgical options in skin rejuvenation for treating photodamage and pigmentation problems, wrinkles and textural changes, and loose skin.
"As we age, the majority of these skin problems are a direct result of long-term sun exposure. Also, the loss and movement of the underlying fat layer of the skin over time causes us to lose volume in our skin - creating that 'sunken in' look. Fortunately, we now have a number of minimally invasive procedures that can be used either alone or in combination to combat the telltale signs of aging," said Kauvar.
For problems ranging from pigmentation, blotchy skin, redness due to enlarged vessels or capillaries, to dry, dull skin and loss of collagen, Kauvar suggested minimally invasive lasers and light sources that target affected areas of the skin with varying wavelengths and pulse durations without injuring the top layer of skin.
Kauvar added that peeling procedures can also improve the overall radiance of the skin and also remove some of the abnormal pigmentation from sun damage.
Although wrinkles are perhaps the most obvious changes that occur, enlarged pores and even acne scars often worsen as we get older - resulting from the loss of collagen.
For treating large pores, Kauvar recommended the use of non-ablative lasers to heat the layer of tissue in the superficial dermis, resulting in the production of new, thicker and smoother skin.
While non-ablative lasers are designed for patients with superficial skin damage who are not expecting dramatic results, fractional non-ablative lasers can deliver better results for patients with more extensive signs of aging.
For patients with even deeper wrinkles and scars, fractional ablative lasers are considered comparable to the traditional ablative lasers, such as the CO2 laser, which requires much less downtime and the risks are lower than with other ablative lasers.
The popular injectible botulinum toxin, which works by relaxing the muscles that cause wrinkles, works well for these hard-to-treat wrinkles like frown lines and crow's feet, when used in combination with skin resurfacing. For deeper folds and creases, such as vertical lip lines or smile lines, Kauvar suggested hyaluronic acid fillers.
With the further loss of collagen, the skin loses elasticity and becomes lax. These deeper folds result in jowl formation or what is commonly referred to as "chicken neck." Fortunately, there are a variety of options to tighten loose skin.
Monopolar and bipolar radiofrequency, pulse infrared light and infrared lasers all work by deeply heating the skin's tissue, which causes collagen contraction and new collagen production without visibly wounding the skin. To replace volume, a number of proven fillers can be used to plump up the skin. These filler materials stimulate collagen production, as the material injected into the skin is replaced by the body's own collagen.
"Fillers are an excellent option for softening angular lines, filling the hollows under the eyes and early jowl formation, and correcting deep smile lines. A patient with more advanced aging could benefit from a combination of procedures, such as lasers and fillers, to improve the overall appearance of their skin," said Dr. Kauvar.
However, Kauvar cautioned patients to thoroughly discuss their expectations with their dermatologist before considering this irreversible procedure.
"For the average person with mild-to-moderate skin problems, minimally invasive skin rejuvenation offers a range of options to slow down or reverse the aging process. Your dermatologist can help you decide what procedures are right for you," said Kauvar.
Kauvar presented the various treatments at the American Academy of Dermatology's Summer Academy Meeting 2008 in Chicago.