Noninvasive Facial Rejuvenation. Part 3: Physician-Directed—Lasers, Chemical Peels, and Other Noninvasive Modalities

Abstract

A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin and rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but patients are in control with this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the last in a three-part series describing noninvasive facial rejuvenation. Here the authors review the mechanism, indications, and possible complications of lasers, chemical peels, and other commonly used noninvasive modalities.

Assessment of Laser Effects on Skin Rejuvenation

“…44 Lasers resurfacing of skin as peeling could remove fine wrinkles of skin although, however potentially have the advantages to treat deep wrinkles by collagen making stimulation. 45 Skin healing in deep peeling and laser resurfacing is known as like wound healing mechanism and depends on the depth of the lesion. 46…”

Modern Approaches to Skin Care

“…9 Mediumdepth peels induce coagulative necrosis of the epidermis and dermis, which results in keratinocyte regeneration and collagen synthesis. 9,12 Common medium-depth peels include Monet's combination (Jessner's solution with 35% TCA), Brody's combi-nation (solid carbon dioxide plus 35% TCA), and Coleman's combination (70% glycolic acid and 35% TCA). 10 Some practitioners may actually regard a 35% TCA peel as a deep peel.…”

“…Its clinical use is limited by the risk of cardiac compromise and therefore requires cardiac monitoring during treatment. 9,12 While skin resurfacing using chemical peels is relatively safe, it does carry the risk of undesirable side effects. Such sequelae include postoperative edema and erythema as well as desquamation and can occur with peels of all depths.…”

Dermal morphological changes following salicylic acid peeling and microdermabrasion

“…It is a hydroxyl derivative of benzoic acid that represents a carboxylic acid attached to an aromatic alcohol, phenol. It is the only member of the beta‐hydroxy acid family, and it is named so because the aromatic carboxylic acid has a hydroxy group in the beta position . It has an excellent keratolytic effects.…”