Photorejuvenation
Encyclopedia
Photorejuvenation is a skin treatment that uses intense pulsed light
or other thermal or chemical methods to treat some skin conditions and remove wrinkles arising from photoaging
. The process induces controlled wounds on the skin, prompting it to heal itself by creating new cells. This process reverses the effects of photoaging to a certain extent by removing wrinkles.
wherein molecular bonds are dissolved by laser. It is used for the treatment of wrinkles, solar lentigene
s, sun damage
, scar
s (see acne scar treatment), stretch marks
, actinic keratosis
and telangiectasia
s or "spider veins".
It can be combined with liposuction
to remove excess fat from the chin and jaw area. The skin may be wrinkled after fat is removed and laser resurfacing can help tighten and smooth over the new contours.
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. More commonly now, laser resurfacing is done with a fractional laser. The term fractional pertains to the method in which the laser light is transferred. Tiny pinpoints of laser light are used to deliver the laser to the surface of the skin in only a fraction of the area. Several hundred or thousands of laser pinpoints may be used per square inch, leaving healthy skin in between the ablated
areas, to allow more rapid healing and lower risk.
Skin resurfacing can also be performed with a plasma
-based device instead of a laser. At least one manufacturer of such a plasma device claims "It’s the only treatment proven to generate new skin, at the fundamental levels, for as long as a year after treatment". However these claims do not have supporting evidence published in a peer-reviewed
medical journal
, and have not been verified by any independently funded studies. When used proficiently, it has been shown to be significantly more precise in control, while producing less bleeding, bruising and post-operative discomfort compared to other skin resurfacing methods.
Fractional photothermolysis (FP) is another form of laser treatment with several devices currently on the market. Some doctors claim FP provides similar results to CO2 laser resurfacing without risk of scarring or significant downtime. As of January 2008, there are a number of papers referenced on PubMed
which mostly support those claims. Complications observed in a study of 961 treatments included acneiform eruptions
(1.87%) and herpes simplex
virus outbreaks (1.77%). Side effects and complications observed in this study were of a temporary nature. There have been, however, anecdotal negative accounts of bad scarring and hyperpigmentation
without any findings of infection
.
When compared to a chemical peel, dermabrasion
or other forms of laser treatment, a laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.
CO2 laser resurfacing has been shown to have an increased risk of hypopigmentation
and scarring when compared to the erbium lasers. This is due to the high degree of coagulation and thus heat production that occurs as a nature of the CO2 wavelength. Both Erbium and Co2 fractional systems have a better safety profile than lasers of the past.
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.
Beginning in the late 1990s, a number of studies has 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 4 researchers from the Weill Cornell Medical College of Cornell University and published in the Journal of Drugs in Dermatology in 2004 found IPL to be a "non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events".
Intense pulsed light
Intense pulsed light , is a technology aimed at producing light of high intensity during a very short period of time. It involves specific lamps together with capacitors whose rapid discharge provides the high energy required....
or other thermal or chemical methods to treat some skin conditions and remove wrinkles arising from photoaging
Photoaging
Photoaging or photoageing is a term used for the characteristic changes induced by chronic UVA and UVB exposure. Tretinoin is the best studied retinoid in the treatment of photoaging...
. The process induces controlled wounds on the skin, prompting it to heal itself by creating new cells. This process reverses the effects of photoaging to a certain extent by removing wrinkles.
Types
There are three types of photorejuvenation:- Thermal photorejuvenation using a radio-frequency device to induce a thermal effect in the skin.
- Chemical photorejuvenation with chemical peelChemical peelA chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical...
s. - Mechanical photorejuvenation with laserLaserA laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...
s.
Laser resurfacing
Laser resurfacing is a technique used during laser surgeryLaser surgery
Laser surgery is surgery using a laser to cut tissue instead of a scalpel. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content...
wherein molecular bonds are dissolved by laser. It is used for the treatment of wrinkles, solar lentigene
Lentigo maligna
Lentigo maligna is a melanoma in situ that consists of malignant cells but does not show invasive growth. Lentigo maligna is not the same as lentigo maligna melanoma, and should be discussed separately. It typically progresses very slowly and can remain in a non-invasive form for years...
s, sun damage
Sunburn
A sunburn is a burn to living tissue, such as skin, which is produced by overexposure to ultraviolet radiation, commonly from the sun's rays. Usual mild symptoms in humans and other animals include red or reddish skin that is hot to the touch, general fatigue, and mild dizziness. An excess of UV...
, scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other 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...
s (see acne scar treatment), stretch marks
Stretch marks
Stretch marks or striae , as they are called in dermatology, are a form of scarring on the skin with an off-color hue. They are caused by tearing of the dermis, and over time can diminish but not disappear completely....
, actinic keratosis
Actinic keratosis
Actinic keratosis is a premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people. It is associated with those who are frequently exposed to the sun, as it is usually accompanied by solar damage...
and telangiectasia
Telangiectasia
Telangiectasias /tɛ.læn.dʒiː'ɛk.teɪ.ʃi:ə/ are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin...
s or "spider veins".
It can be combined with liposuction
Liposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
to remove excess fat from the chin and jaw area. The skin may be wrinkled after fat is removed and laser resurfacing can help tighten and smooth over the new contours.
Laser resurfacing is usually done with a 2940 nm Er:YAG laser
Er:YAG laser
Er:YAG lasers are solid-state lasers whose lasing medium is erbium-doped yttrium aluminium garnet . Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light. Unlike Nd:YAG lasers, the output of an Er:YAG laser is strongly absorbed by water because of atomic resonances...
or a 10,600 nm CO2
Carbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
laser. Complete resurfacing was first done with a CO2 laser. More commonly now, laser resurfacing is done with a fractional laser. The term fractional pertains to the method in which the laser light is transferred. Tiny pinpoints of laser light are used to deliver the laser to the surface of the skin in only a fraction of the area. Several hundred or thousands of laser pinpoints may be used per square inch, leaving healthy skin in between the ablated
Ablation
Ablation is removal of material from the surface of an object by vaporization, chipping, or other erosive processes. This occurs in spaceflight during ascent and atmospheric reentry, glaciology, medicine, and passive fire protection.-Spaceflight:...
areas, to allow more rapid healing and lower risk.
Skin resurfacing can also be performed with a plasma
Plasma (physics)
In physics and chemistry, plasma is a state of matter similar to gas in which a certain portion of the particles are ionized. Heating a gas may ionize its molecules or atoms , thus turning it into a plasma, which contains charged particles: positive ions and negative electrons or ions...
-based device instead of a laser. At least one manufacturer of such a plasma device claims "It’s the only treatment proven to generate new skin, at the fundamental levels, for as long as a year after treatment". However these claims do not have supporting evidence published in a peer-reviewed
Peer review
Peer review is a process of self-regulation by a profession or a process of evaluation involving qualified individuals within the relevant field. Peer review methods are employed to maintain standards, improve performance and provide credibility...
medical journal
Medical journal
A public health journal is a scientific journal devoted to the field of public health, including epidemiology, biostatistics, and health care . Public health journals, like most scientific journals, are peer-reviewed...
, and have not been verified by any independently funded studies. When used proficiently, it has been shown to be significantly more precise in control, while producing less bleeding, bruising and post-operative discomfort compared to other skin resurfacing methods.
Fractional photothermolysis (FP) is another form of laser treatment with several devices currently on the market. Some doctors claim FP provides similar results to CO2 laser resurfacing without risk of scarring or significant downtime. As of January 2008, there are a number of papers referenced on PubMed
PubMed
PubMed is a free database accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine at the National Institutes of Health maintains the database as part of the Entrez information retrieval system...
which mostly support those claims. Complications observed in a study of 961 treatments included acneiform eruptions
Acne
Acne is a general term used for acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:*Acne aestivalis*Acne conglobata*Acne cosmetica*Acne fulminans*Acne keloidalis nuchae*Acne mechanica...
(1.87%) and herpes simplex
Herpes simplex
Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...
virus outbreaks (1.77%). Side effects and complications observed in this study were of a temporary nature. There have been, however, anecdotal negative accounts of bad scarring and hyperpigmentation
Hyperpigmentation
In dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.-Causes:Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris...
without any findings of infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
.
When compared to a chemical peel, dermabrasion
Dermabrasion
Dermabrasion is a surgical procedure that involves the controlled abrasion of the upper layers of the skin with sandpaper or other mechanical means. Nowadays it has become common to use CO2 or Erbium:YAG laser as well. The procedure requires a local anaesthetic...
or other forms of laser treatment, a laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.
CO2 laser resurfacing has been shown to have an increased risk of hypopigmentation
Hypopigmentation
Hypopigmentation is the loss of skin color. It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin.-Treatments:...
and scarring when compared to the erbium lasers. This is due to the high degree of coagulation and thus heat production that occurs as a nature of the CO2 wavelength. Both Erbium and Co2 fractional systems have a better safety profile than lasers of the past.
Both Erbium and CO2 are used to treat deep rhytides, sun damage
Sunburn
A sunburn is a burn to living tissue, such as skin, which is produced by overexposure to ultraviolet radiation, commonly from the sun's rays. Usual mild symptoms in humans and other animals include red or reddish skin that is hot to the touch, general fatigue, and mild dizziness. An excess of UV...
and age spots. Through the heating of the deep dermis
Dermis
The dermis is a layer of skin between the epidermis and subcutaneous tissues, and is composed of two layers, the papillary and reticular dermis...
, fibroblasts are stimulated to form new collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
and elastin
Elastin
Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...
helping to bring increased turgor and thickness to the skin.
Side effects of IPL usage in Mechanical Photorejuvenation
"Thermal injury causes DNA damage and lethality in unheated surrounding cells: active thermal bystander effect."Beginning in the late 1990s, a number of studies has 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 4 researchers from the Weill Cornell Medical College of Cornell University and published in the Journal of Drugs in Dermatology in 2004 found IPL to be a "non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events".