AGING GRACEFULLY
NANCY SILVERBERG, MD
Chair,
Department of Dermatology,
Hoag Hospital Memorial Presbyterian
Associate Clinical Professor
of Dermatology, UCI
Skin Anatomy
There are 3 skin layers:
Epidermis
Dermis
Subcutaneous layer
Basal
Layer
What is skin aging?
• Collagen production slows (skin gets thinner)
• Elastin fibers break down (skin loses its
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ability to snap back after stretching)
Subcutaneous fat decreases (skin looks less
plump and smooth)
Turnover of skin cells slows down
Skin becomes dryer
What causes skin to age?
• Sun (ultraviolet light)—damages elastin and
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collagen fibers, causing wrinkles, and
producing mottling and brown spots
Cigarette smoking—damages elastin and
decreases blood flow to skin
Gravity—pulls on our bodies and with loss of
elastin and collagen, causes sagging
Sleeping positions—cause creases
Facial expressions—muscles produce grooves
in skin which gradually become etched in face
Prevention of skin aging
AVOID ULTRAVIOLET LIGHT!!!!!
• Avoid deliberate tanning
• Stay out of sun between 10AM and 4PM
• Wear protective clothing (hats, long
sleeves)
• Apply broad spectrum (UVA and UVB)
sunscreen (SPF 25 or greater) year
round
Treatment of Aging Skin
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Products
Fillers and injectables
Peeling and microdermabrasion
Thermage
Lasers
Fraxel
Fractional CO2
Products
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Sunscreen
Moisturizers
Tretinoin
Everything else
Injectables and Fillers
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Botox cosmetic, Dysport
Zyderm (bovine collagen)
Restylane (hyaluronic acid)
Juvederm (hyaluronic acid)
Radiesse (hydroxyapatite)
Evolence (porcine collagen)
Sculptra (poly-L-lactic acid)
Botox
Restylane
Restylane
Juvederm
Juvederm
Sculptra
Peels and Microdermabrasion
• Light “lunchtime” peels: glycolic, beta,
Jessner
• Medium depth peels: trichloroacetic
acid
• Microdermabrasion: high pressure
crystals delivered to skin which remove
dead skin cells
Thermage
• Radiofrequency waves delivered to
deeper skin layer which causes
tightening of skin
• Produces heat in deeper layers of skin
while maintaining cool on surface of skin
• Little recovery
• Not successful in all patients!
Thermage
Thermage
Laser
• Vascular lasers and intense pulsed light
remove tiny blood vessels and brown
spots
• Q switched lasers (Ruby, Versapulse,
Medlite) remove brown spots
• Fraxel (fractionated erbium laser)
• Fractional CO2 (fractionated CO2 laser)
Intense Pulsed Light
Intense Pulsed Light uses different
wavelengths of light to target “broken”
blood vessels and superficial brown
spots. The light energy is changed to
heat energy, which gradually fades the
targeted pigment or vessels.
Intense Pulsed Light
Intense Pulsed Light
Fraxel
• Multiple tiny microscopic columns of erbium
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laser light treat a fraction of the skin at one
treatment, making recovery much easier than
resurfacing treatments.
Requires multiple treatments
Decreases fine lines, wrinkles, scars and skin
blotchiness
Not good for deep lines and sagging skin
Fraxel
Fraxel
Fractional CO2 (Active FX)
• Columns of high energy CO2 laser light
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interact with skin
Only a fraction of the skin’s surface is
treated, leaving small “bridges” of untreated
skin
Collagen in skin shrinks immediately
Stimulates collagen remodeling over time
Downtime usually less than one week
Single treatment
Fractional CO2 (Active FX)
Primary Targets:
• Fine lines and wrinkles of the face
• Crow’s feet around eyes
• Pucker marks (“smoker lines”) and frown
lines
• Brown spots and blotchy, uneven skin
tone
• Scars, especially acne scars
Fractional Resurfacing - Clinical Results
Before
Day 1
Day 7
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Fractional Resurfacing - Clinical Results
Pre-Treatment
6 Weeks post Treatment
Fractional Resurfacing - Clinical Results
Scar Revision
Fractional Resurfacing - Clinical Results
TotalFX and Juvederm Combo Treatment
Thank You