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Treatment for photoaged skin

Compared to healthy skin, chronic and continuous sun exposure, or tanning, results in an aberrant and disorderly maturation of keratinocytes and an increase in cellular binding and adhesion. Desquamation will diminish due to the factors mentioned earlier, resulting in a rough and thicker stratum corneum with a decreased barrier function. The skin’s rough texture causes dullness (yellow-gray) and skin discoloration. Water loss and dehydration occur due to the epidermis’s malfunction and inability to act properly as a barrier. The penetration of the irritant will dramatically increase, producing allergic responses and erythema. Additionally, photoaged skin exhibits pigmentary alterations due to hyperactive melanocytes and disordered melanin deposition in the epidermis. Regions with an excess of melanin show hyperpigmentation, whereas regions with a deficiency of melanin appear as hypopigmentation.

Photoaging

Chronic UV exposure has several detrimental consequences on the extracellular matrix in the dermis. Collagen and other structural proteins are destroyed and weakened due to the increased activity of enzymes (e.g., matrix metalloproteinases). The combination of collagen degradation and decreased collagen synthesis creates fine lines, wrinkles, and scars. Solar elastosis occurs in some cases of severe photoaging and is characterized by tangled masses of degraded elastin protein in the dermis. It manifests clinically as coarse wrinkling, sallow coloring, and skin thickness. It is typical for cutaneous blood vessels to dilate abnormally, resulting in noticeable face erythema and telangiectasias.

The gold standard of treatment for photoaged skin indications and lesions is laser treatment, plasma injection, and microdermabrasion.

Microdermabrasion combines a mechanical peel with an injection of serums such as salicylic acid.

silk microdermabrasion peel

Fraxel nonablative dual fractional laser for skin tightening

Spectra Laser for the elimination of pigmentation and the treatment of melasma

Water Lasers

Water-based nonfractional lasers (1064 nm, 1320 nm, and 1450 nm) were the first generation of nonablative lasers used for skin resurfacing and are still widespread today. Their affinity for water determines the penetration depth of these lasers. Short wavelengths such as 1320 nm absorb less water and penetrate deeper into the skin, whereas longer wavelengths such as 1450 nm absorb more water and penetrate more superficially. These lasers are suitable for use on all skin types. • Water-targeting fractional lasers (1410 nm, 1440 nm, 1540 nm, 1550 nm, 1565 nm, and 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 utilized to treat photoaged skin ( see Introduction and Foundation Concepts, Fractional Lasers section). The depth of penetration of these lasers is also determined by their affinity for water, with shorter wavelengths such as 1550 nm exhibiting lower water absorption and greater cutaneous penetration, resulting in more significant dermal effects such as collagen remodeling and reduction of dermal dyschromia such as melasma. Longer wavelengths, such as 1927 nm, absorb more water and penetrate deeper into the skin, making them ideal for treating epidermal pigmented lesions such as lentigines and ephelides. These lasers are safe to use on all skin types, but caution is suggested on darker skin types due to the possibility of photoinduced hyperpigmentation.

Dyschromia

Dyschromia is also treated with fractional nonablative lasers. How the fractionated beam is applied to the skin varies among fractional lasers. One of the most frequently used fractional lasers (e.g., Fraxel Re: Store TM, Solta) has a disposable roller on the tip that moves continually across the skin during treatment. Other devices, such as the Icon Max1540 TM, Cynosure/ Palomar, use a stamping technique in which a lens inside the handpiece fractionates the beam each time the laser pulses and all pixels are generated simultaneously. Certain systems employ scanners to fractionate the beam into successive pixels, either in a predetermined pattern or randomly scattered throughout the skin treated during the pulse. Melanin and Oxyhemoglobin Lasers • Nonfractional lasers (532 nm, 585 nm, 595 nm, 755 nm, 1064 nm, strong pulsed light) target melanin and oxyhemoglobin. They are generally utilized to treat vascular ectasias and pigmented lesions due to their strong absorption by colored tissue chromophores. Historically, vascular lesions have been treated using 532 nm and pulsed dye 585 nm and 595 nm lasers. Recent technological developments in these devices (bigger spot sizes and longer pulse widths) have increased cutaneous penetration and improved their safety profiles, allowing them to be used for wrinkle removal while minimizing the danger of purpura. The 1064 nm (Nd: YAG) laser is a nonfractional laser frequently used for skin resurfacing. While it targets multiple chromophores (water, melanin, and oxyhemoglobin), the long-wavelength enables deep dermal penetration and effectively skips epidermal melanin, making it suitable for all skin types. It is employed in both long-pulsed mode (e.g., Laser Genesis TM, Cutera) and short-pulsed mode (e.g., RevLite ®, Cynosure/ ConBio) as Q-switched lasers. Studies using 1064 nm lasers in both modes demonstrate histological and clinical reductions in wrinkles and other collagen remodeling effects, such as pore size reduction, smoother skin texture, and reduction of superficial acne scars. Due to the melanin chromophore selectivity, Q-switched 1064 nm lasers are also frequently employed for tattoo removal, a decrease of cutaneous pigmentation such as melasma, and reduced fine dark hair. The numerous applications of lasers operating at 1064 nm and other colored chromophore–dependent wavelengths provide a means of

Plasma

Plasma injections provide vital nutrients to tired skin and aid in dullness and regeneration. The fractional nonablative laser utilizes water and chromophore to cure the skin from the inside out, hence assisting in skin resurfacing. The new skin layers will have a uniform cellular matrix and be desquamated. Each of the treatments above has several pros and cons, which will be covered in subsequent posts.

Please contact us for a complimentary consultation regarding skin tightening, wrinkle removal, skincare, skin rejuvenation, skin resurfacing, acne scar removal, acne treatment, stretch mark removal, filler, botox, vampire facial, body shaping, and fat removal.

kamal-picture

 

Sincerely

Dr. Kamal Alhallak

Ph.D., MSc, CDE, CRE, APA, MBA candidate

Director of Albany Cosmetic and Laser Centre INC

 

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