Photoaged skin treatment
The chronic and prolonged sun exposure, or tanning, will results in abnormal and disorganized maturation of keratinocytes and increase in the cellular bonding and adhesion when compared to healthy skin. Due to the beforementioned facts, desquamation will decrease, resulting in a rough and thickened stratum corneum which has impaired barrier function. Dullness (yellow-gray) and skin discoloration are a result of poor light reflection due to the rough texture of the skin. The dysfunctional epidermis and inability to work as a proper barrier result in water loss and dehydration.The irritant penetration will increase significantly resulting in allergic reaction and erythema. Photoaged skin also demonstrates pigmentary changes due to overactive melanocytes and disorganized melanin deposition in the epidermis. Regions with excess melanin are evident as hyperpigmentation and regions with melanin deficits appear as
In the dermis, chronic UV exposure has many damaging effects on the extracellular matrix. Structural proteins such as collagen are degraded due to upregulation of enzymes (e.g., matrix metalloproteinases), and weakened due to cross-linkage. This accelerated collagen degradation combined with reduced collagen synthesis that occurs over time, contribute to the formation of fine lines and wrinkles and scars. In some instances of advanced photoaging, solar elastosis happens which consists of tangled masses of damaged elastin protein in the dermis; seen clinically as coarse wrinkling, sallow discoloration, and skin thickening. Abnormal dilation of dermal blood vessels is also common, leading to visible facial erythema and telangiectasias.
Laser treatment, plasma injection, and microdermabrasion are considered to be the golden standard of therapy for photoaged skin signs and lesions.
Microdermabrasion provides mechanical peel along with serum infusion such as salicylic acid.
Lasers Targeting Water • Nonfractional lasers that target water (1064 nm, 1320 nm, 1450 nm) were the first generation of nonablative lasers to be used for skin resurfacing and are still in common use today. The depth of penetration of these lasers is based on their affinity for water where shorter wavelengths such as 1320 nm have lower water absorption and deeper cutaneous penetration, while longer wavelengths such as 1450 nm have higher water absorption and more superficial penetration. These lasers can be used for all skin types. • Fractional lasers that target water (1410 nm, 1440 nm, 1540 nm, 1550 nm, 1565 nm, 1927 nm) are the most recent addition to the class of nonablative lasers used for skin resurfacing and 1550 nm was the first fractional nonablative wavelength used for treatment of photoaged skin( see Introduction and Foundation Concepts, Fractional Lasers section). The depth of penetration of these lasers is also based on their affinity for water where shorter wavelengths such as 1550 nm have lower water absorption and deeper cutaneous penetration, which is associated with more significant dermal effects such as collagen remodeling and reduction of dermal dyschromia such as melasma. Longer wavelengths such as 1927 nm have higher water absorption with more superficial penetration and are used for the treatment of epidermal pigmented lesions such as lentigines and ephelides. These lasers can be used in all skin types but caution is advised with darker skin types due to the risk of PIH. Fractional non-ablative lasers are also used to treat dyschromia. Fractional lasers vary in how the fractionated beam is applied to the skin. One of the most commonly used types of fractional lasers uses a disposable roller on the tip that is continuously moved across the skin during treatment (e.g., Fraxel Re:Store ™, Solta). Other devices utilize a stamping technique, where a lens inside the handpiece fractionates the beam each time the laser pulses and all pixels are created at once (e.g., Icon Max1540 ™, Cynosure/ Palomar). Some devices utilize scanners to fractionate the beam where pixels are sequential, either in a fixed pattern or randomly distributed on skin that is treated during the pulse. Lasers Targeting Melanin and Oxyhemoglobin • Lasers that target melanin and oxyhemoglobin (532 nm, 585 nm, 595 nm, 755 nm, 1064 nm, intense pulsed light) are all nonfractional. They are primarily used for the treatment of vascular ectasias and/ or pigmented lesions as they are highly absorbed by colored tissue chromophores. The 532 nm and pulsed dye 585 nm and 595 nm lasers have traditionally been used for the treatment of vascular lesions. Recent technologic advancements in these devices (i.e., larger spot sizes and longer pulse widths) have enhanced cutaneous penetration and improved their safety profiles, expanding their application to include wrinkle reduction while reducing the risk of purpura. The 1064 nm (Nd:YAG) laser is one of the most commonly used nonfractional lasers for skin resurfacing. While it targets multiple chromophores (water, melanin, and oxyhemoglobin), the long wavelength allows for deep penetration to the dermis, and it essentially bypasses epidermal melanin making it safe for all skin types. It is used in a long-pulsed mode (e.g., Laser Genesis ™, Cutera) and very short-pulsed modes as Q-switched lasers (e.g., RevLite ®, Cynosure/ ConBio). Studies of 1064 nm lasers with both modes demonstrate histologic and clinical reduction of wrinkles, as well as other collagen remodeling effects, such as reduction of pore size, rough skin texture, and superficial acne scarring. In addition to dermal remodeling, Q-switched 1064 nm lasers are also commonly used for tattoo removal, reduction of dermal pigmentation such as melasma, and reduction of fine dark hair, due to melanin chromophore specificity. The diverse applications of 1064 nm and other colored chromophore– dependent lasers offer a means to
Plasma injection offers the tired skin the essential nutrients and helo with dullness and rejuvenation. The fractional non-ablative laser uses the water and chromophore and heals the skin deep inside to help skin resurfacing. The new skin layers will have regular cellular matrix and desquamation. Each one of the before mentioned treatment has advantages and disadvantages which will be discussed in details in different posts.
Do not hesitate to contact us for free consultation for skin tightening, wrinkle removal, skin care, skin rejuvenation, skin resurfacing, acne scar removal, acne treatment, stretch mark removal, filler, botox, vampire facial, body shaping and fat removal
Dr. Kamal Alhallak
Ph.D., MSc, CDE, CRE, APA, MBA candidate
Director of Albany Cosmetic and Laser Centre INC
In modern times, Edmonton experienced the highest population explosions. In the 80s, It went from 250,000 to basically one million in the late 90’s.