A Paradigm for Facial Skin Rejuvenation

Abstract

There is a significant desire by patients to reverse the signs of aging caused by photodamage. Numerous procedures for facial skin rejuvenation have been developed in an attempt to minimize the erythema, dyspigmentation, and rhytides associated with photoaging. The initial procedures developed for facial rejuvenation involve skin resurfacing via complete ablation of layers of skin. Of these procedures, ablative laser resurfacing is the most precise technique and is considered the gold standard for facial skin rejuvenation. Although ablative procedures are quite efficacious, they carry significant patient downtime and risks of adverse effects such as scarring and dyspigmentation. Concerns regarding patient morbidity have led to the development of nonablative procedures that target dermal collagen without damaging the epidermis. Of these technologies, intense pulsed light is the most commonly used because it effectively targets both the erythema and dyspigmentation seen in photoaging. Nonablative techniques minimize side effects and patient downtime; however, they do not match the results seen in fully ablative procedures. Fractional laser technologies-first nonablative and more recently ablative-represent the most recent attempt to match the results seen in fully ablative procedures with less patient downtime. Their results are promising but require further study.

32 Lasers for African Skin

“…This class of laser has the most significant outcomes with significant improvement of fine wrinkles and acne scars. 13 However, side effects of acne, permanent hypopigmentation, temporary hyperpigmentation, and skin infections are common. For these reasons, ablative nonfractionated lasers should be used with extreme caution in Fitzpatrick skin type IV patients and are contraindicated in phototypes V and VI due to the increased risk of scarring and dyspigmentation.…”

“…8 The targeting of tiny diameter and deep dermal penetration of each MTZ allows for stimulation of collagen formation while avoiding disruption of the epidermal barrier function. 13 These lasers can be used safely in darker phototypes with a small risk of temporary hyperpigmentation.…”

“…8 Ablative technologies offer the most significant reduction of rhytids and scarring but have the greatest risk of complications and should only be used in lighter phototypes. 13 They can be utilized with extreme caution in Fitzpatrick skin type IV patients but should not be used in Fitzpatrick skin types V and VI because of risks of scarring and dyspigmentation. 5 Nonablative fractionated and nonfractionated lasers may be used in all skin types with modest results for the reduction of fine wrinkles.…”

A comparison of wound healing between a skin protectant ointment and a medical device topical emulsion after laser resurfacing of the perioral area

“…Since then, other nonablative fractional laser therapies have emerged that produce less pain and provide various operational benefits. 8,10 However, the results obtained with nonablative fractional therapies were still inferior to ablative technologies. 11 Recently, fractional ablative lasers have been introduced.…”

“…11 Recently, fractional ablative lasers have been introduced. 8,10 These are primarily based on CO 2 and heated erbium:yttrium-aluminum-garnet systems and generate microscopic treatment zones of variable depths and widths through manipulation of the pulse energy delivery. 12,13 This ablative procedure results in faster recovery time, fewer adverse events, and proven efficacy in the treatment of rhytides, scars, and photodamage of the face.…”