Photorejuvenation

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Photorejuvenation is a skin treatment that uses lasers, intense pulsed light, or photodynamic therapy to treat skin conditions and remove effects of photoaging such as wrinkles, spots, and textures. The process induces controlled wounds to the skin. This prompts the skin to heal itself, by creating new cells. This process—to a certain extent—removes the signs of photoaging. [1] The technique was invented by Thomas L Roberts, III using CO2 lasers in the 1990s. [2] [3] Observed complications have included scarring, hyperpigmentation, acne, and herpes.

Contents

Skin rejuvenation

Skin rejuvenation can be effected through various modalities, including thermal, chemical, mechanical, injection, and light. [4]

Laser resurfacing

A physician performing laser resurfacing using an erbium laser DrAlicePienPerformingErbium.jpg
A physician performing laser resurfacing using an erbium laser

Laser resurfacing is a laser surgery technique that disassociates molecular bonds. It is used for the treatment of wrinkles, solar lentigenes, sun damage, scarring (acne scars and surgical scars), stretch marks, actinic keratosis, and telangiectasias. It can be combined with liposuction to help tighten and smooth over the new contours after removal of excess fat. Resurfacing can be ablative, which vaporizes tissue and creates wounds, or non-ablative which keeps the skin intact.

Laser resurfacing is usually done with a 2940 nm Er:YAG laser or a 10,600 nm CO2 laser. Complete resurfacing was first done with a CO2 laser. Both erbium and CO2 are used to treat deep rhytides, sun damage and age spots. Through the heating of the deep dermis, fibroblasts are stimulated to form new collagen and elastin helping to bring increased turgor and thickness to the skin. A variety of modes have been developed including Nd:Yag lasers and a plasma device. [5]

CO2 resurfacing has been shown to have an increased risk of hypopigmentation and scarring than erbium lasers. This is due to the high degree of coagulation and thus heat production that occurs as a nature of the CO2 wavelength.

Fractional laser

Fractional laser photothermolysis (FP) is a form of laser-based skin resurfacing, with several devices on the market, such as Fraxel. A fractional laser delivers laser light to the skin. Hundreds or thousands of laser pinpoints may be used per square inch, leaving healthy skin between the ablated areas.

Complications observed in a study of 961 treatments included acne and herpes outbreaks. [6] There have been anecdotal negative accounts of bad scarring and hyperpigmentation. [7]

Erbium and CO2 fractional systems have a better safety profile than lasers of the past. [8]

Intense pulsed light

Intense Pulsed Light (IPL) uses flashlamps (and not lasers) to produce high intensity light over broad visible and infrared wavelengths with filters that select the desired range. IPL is used to treat dyschromia, rosacea, melasma, acne, photodamage, vascular and pigmented lesions, and rhytides. [9]

One study conducted by a group of four researchers from the Weill Cornell Medical College of Cornell University in 2004 found IPL to be a "non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events". [10]

Other studies, however, have noted that exposing cells to direct heat can cause DNA damage—not only in those cells, but also in surrounding tissue that was not directly exposed, and concluded treatments can cause microscopic thermal injuries, and that further research is warranted. [11]

IPL is effective for pigmentation and telangiectasias, but has lesser results for wrinkles. [12]

Photodynamic therapy

Photodynamic therapy (PDT) uses photosensitive compounds that are activated by light. It is used to treat actinic keratoses, acne, photoaging, and skin cancer.

See also

Related Research Articles

<span class="mw-page-title-main">Scar</span> Area of fibrous tissue that replaces normal skin after an injury

A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.

Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation as well as to alleviate dermatologic diseases such as acne. IPL is increasingly used in optometry and ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction.

<span class="mw-page-title-main">Laser hair removal</span> Process of hair removal by exposure to laser pulses

Laser hair removal is the process of hair removal by means of exposure to pulses of laser light that destroy the hair follicle. It had been performed experimentally for about twenty years before becoming commercially available in 1995–1996. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998. Laser hair removal is widely practiced in clinics, and even in homes using devices designed and priced for consumer self-treatment. Many reviews of laser hair removal methods, safety, and efficacy have been published in the dermatology literature.

<span class="mw-page-title-main">Hyperpigmentation</span> Skin condition

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

Dermabrasion is a type of surgical skin planing, generally with the goal of removing acne, scarring and other skin or tissue irregularities, typically performed in a professional medical setting by a dermatologist or plastic surgeon trained specifically in this procedure. Dermabrasion has been practiced for many years and involves the controlled deeper abrasion of the upper to mid layers of the skin with any variety of strong abrasive devices including a wire brush, diamond wheel or fraise, sterilized sandpaper, salt crystals or other mechanical means.

<span class="mw-page-title-main">Er:YAG laser</span>

An Er:YAG laser (erbium-doped yttrium aluminium garnet laser, erbium YAG laser) is a solid-state laser whose active laser medium is erbium-doped yttrium aluminium garnet (Er:Y3Al5O12). Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light.

Facial rejuvenation is a cosmetic treatment, which aims to restore a youthful appearance to the human face. Facial rejuvenation can be achieved through either surgical and/or non-surgical options. Procedures can vary in invasiveness and depth of treatment. Surgical procedures can restore facial symmetry through targeted procedures and facial restructuring and skin alterations. Non-surgical procedures can target specific depths of facial structures and treat localized facial concerns such as wrinkles, skin laxity, hyperpigmentation and scars.

<span class="mw-page-title-main">Exfoliation (cosmetology)</span> Removal of dead skin cells from the epidermis

In cosmetology, exfoliation is the removal of the surface skin cells and built-up dirt from the skin's surface. The term comes from the Latin word exfoliare. This is a regular practice within the cosmetic industry, both for its outcome of promoting skin regeneration as well as providing a deep cleanse of the skin barrier. Being used in facials, this process can be achieved by mechanical or chemical means, such as microdermabrasion or chemical peels. Exfoliants are advertised as treatments that enhance beauty and promote a youthful and healthy appearance.

Laser surgery is a type of surgery that uses a laser to cut tissue.

<span class="mw-page-title-main">Photoaging</span> Ultraviolet light-induced biological development over time

Photoaging or photoageing is a term used for the characteristic changes to skin induced by chronic UVA and UVB exposure. Tretinoin is the best studied retinoid in the treatment of photoaging.

<span class="mw-page-title-main">Laser medicine</span>

Laser medicine is the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy, photorejuvenation, and laser surgery.

<span class="mw-page-title-main">Actinic elastosis</span> Medical condition

Actinic elastosis, also known as solar elastosis, is an accumulation of abnormal elastin in the dermis of the skin, or in the conjunctiva of the eye, which occurs as a result of the cumulative effects of prolonged and excessive sun exposure, a process known as photoaging.

<span class="mw-page-title-main">Fraxel</span> Medical treatment

Fraxel Laser Treatment is a line of lasers developed by Reliant Technologies in 2004. It was developed from a US patent licensed from the Wellman Center for Photomedicine. R. Rox Anderson was the inventor. Fraxel lasers cause fractional photothermolysis for skin resurfacing.

Radio-frequency skin tightening is an aesthetic technique that uses radio frequency (RF) energy to heat skin with the purpose of stimulating cutaneous collagen, elastin and hyaluronic acid production in order to reduce the appearance of fine lines and loose skin. The technique induces tissue remodeling and production of new collagen and elastin. The process provides an alternative to facelift and other cosmetic surgeries.

Cameron K. Rokhsar is an associate clinical professor of dermatology at Mount Sinai Hospital and the founder and medical director of the New York Cosmetic, Skin, and Laser Surgery Center. He is a fellowship-trained cosmetic and mohs surgeon, a specialist in laser surgery including laser resurfacing and laser treatment of wrinkles and scars.

<span class="mw-page-title-main">Yoram Harth</span> Israeli dermatologist and inventor (born 1958)

Yoram Harth is an Israeli dermatologist and inventor. He co-invented blue light acne vulgaris phototherapy, as well as a radio frequency device for home treatment for wrinkle reduction.

<span class="mw-page-title-main">Venkataram Mysore</span>

Venkataram Mysore is a dermatologist, dermatopathologist, and hair transplant surgeon from Bangalore, India. He has over 30 years experience as a dermatologist, 18 years as a teacher and is currently the director of the Venkat Center for Advanced Dermatology and Post-Graduate Training.

Laser-assisted drug delivery (LADD) is a drug delivery technique commonly used in the dermatology field that involves lasers. As skin acts as a protective barrier to the environment, the absorption of topical products through the epidermis is limited; thus, different drug delivery modalities have been employed to improve the efficacy of these treatments. The use of lasers in LADD has been shown to enhance the penetration of drugs transdermal, leading to a higher absorption rate, limited systemic effects, and reduced duration of treatment. Although this technique has evolved in the past decade due to its efficacy through scientific research and clinical practice, there remain some limitations regarding the safety aspect that needs to be taken into consideration.

Tina S. Alster, MD, FAAD, is an American dermatologist, educator, researcher, and author. Alster specializes in dermatologic laser surgery and cosmetic dermatology. She is the founding director of her skin care clinic, the Washington Institute of Dermatologic Laser Surgery, and is a Clinical Professor of Dermatology at Georgetown University Medical Center in Washington, D.C.

An Er:glass laser is a solid-state laser whose active laser medium is erbium-doped glass. Ytterbium (Yb) is sometimes added to these lasers to improve their efficiency. Er:glass lasers emit light in the infrared region of the electromagnetic spectrum, often in the range of 1530–1560 nanometers.

References

  1. Lim, Henry W.; Herbert Honigsmann; John L. M. Hawk (2007). Photodermatology. CRC Press. pp. 402, 403. ISBN   978-0-8493-7496-8.
  2. Roberts, Thomas L III. The emerging role of the CO2 lasers in aesthetic plastic surgery. Presented at the XIII Congress of the International Society for Aesthetic Plastic Surgery, New York, NY, Sept. 28-Oct. 1, 1995.
  3. Roberts, Thomas L III; Lettieri, John T; Ellis, Laura B. (1996). "CO2 Laser Resurfacing: Recognizing and Minimizing Complications". Aesthetic Surgery Journal. 16 (2). American Society for Aesthetic Plastic Surgery: 142–148. doi: 10.1016/S1090-820X(96)70038-9 .
  4. "Photo Rejuvenation for Better-Looking Skin: What Doctors Are Saying" . Retrieved 2009-07-02.
  5. "Portrait(R) Plasma Skin Regeneration". medicalnewstoday.com. MediLexicon International Ltd. September 2006. Retrieved 17 February 2014.
  6. Graber, Emmy M.; Tanzi, Elizabeth L.; Alster, Tina S. (March 2008). "Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments". Dermatologic Surgery. 34 (3): 301–307. doi:10.1111/j.1524-4725.2007.34062.x. PMID   18190541. S2CID   23942929.
  7. Hoene, Christine. "Adverse Effects Fraxel Repair". realself.com. RealSelf, Inc. Retrieved 17 February 2014.
  8. Ortiz, A. E.; Goldman, M. P.; Fitzpatrick, R. E. (December 2014). "Ablative CO2 Lasers for Skin Tightening: Traditional Versus Fractional". Dermatologic Surgery. 40 (Suppl 12): S147–51. doi:10.1097/DSS.0000000000000230. PMID   25417566. S2CID   8266926.
  9. Babilas, P; Schreml, S; Szeimies, R. M.; Landthaler, M (Feb 2010). "Intense pulsed light (IPL): a review". Lasers Surg. Med. 42 (2): 93–104. doi: 10.1002/lsm.20877 . PMID   20166155.
  10. Sadick NS, Weiss R, Kilmer S, Bitter P, NS; Weiss, R; Kilmer, S; Bitter, P (January 2004). "Photorejuvenation with intense pulsed light: results of a multi-center study". Journal of Drugs in Dermatology. 3 (1): 41–49. PMID   14964745.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. Purschke, M; Laubach, HJ; Anderson, RR; Manstein, D (2010). "Thermal injury causes DNA damage and lethality in unheated surrounding cells: active thermal bystander effect". The Journal of Investigative Dermatology. 130 (1): 86–92. doi: 10.1038/jid.2009.205 . PMID   19587691.
  12. Kohl, E. A.; Babilas, P; Landthaler, M (2010). "Skin rejuvenation with intense pulsed light". Acta Dermatovenerol Croat. 18 (3): 181–4. PMID   20887700.