Photorejuvenation

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 on the skin, prompting it to heal itself by creating new cells. This process reverses the signs of photoaging to a certain extent by removing appearances of damage.[1] The technique was invented by Thomas L Roberts, III using CO2 lasers in the 1990s.[2][3]

Skin rejuvenation

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

  1. Thermal rejuvenation using a radio-frequency device to induce a thermal effect in the skin.
  2. Chemical rejuvenation with chemical peels.
  3. Photo rejuvenation with light pulses from lasers or lamps.
  4. Mechanical rejuvenation by dermabrasion or microneedling damage the outer layers to promote skin regrowth.
  5. Injections for rejuvenation with botox, fillers, collagen.

Laser resurfacing
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. When compared to a chemical peel, dermabrasion or other forms of treatment, a laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.

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 commonly used now, with several devices on the market. A fractional laser delivers tiny pinpoints of laser light to a part of the skin. Hundreds or thousands of laser pinpoints may be used per square inch, leaving healthy skin between the ablated areas, to allow more rapid healing and lower risks. FP may provide similar results to CO2 laser resurfacing without risk of scarring or significant downtime. Complications observed in a study of 961 treatments included acne and herpes outbreaks and were temporary.[6] There have been, however, anecdotal negative accounts of bad scarring and hyperpigmentation without any findings of infection.[7] Erbium and CO2 fractional systems have a better safety profile than lasers of the past.[8]

Laser types

Laser Wavelength Uses
CO2 10,600 nm rhytides, photodamage
Er:Yag 2940 nm scars, photoaging
Er:Glass 1540 nm rejuvenation, scaring
Nd:Yag 1064 /1320 nm photodamage
Diode 1450 nm facial rejuvenation

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]

Beginning in the late 1990s, a number of studies have been performed to evaluate the safety and effectiveness of IPL on wrinkle-removal and rejuvenation of the skin. One such 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]

Studies 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 has become a popular treatment and is effective for pigmentation and telangiectasias, but has lesser results for wrinkles.[12] The procedure is quick, relatively safe and well tolerated.

Photodynamic therapy

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

See also

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 laser 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. American Society for Aesthetic Plastic Surgery. 16 (2): 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.
  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.
  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.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.
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