Defying Time: Resurfacing the Beauty Within
Marie Socouer L. Medina-Oblepias, MD,FPDS
Cosmetic Dermatology is a rapidly growing field that can attribute its
popularity to the aging baby boomers and to the increase media hype on
skin and the person’s physical appearance. Everyday, we are bombarded on
our televisions, radios, newspapers, magazines and even by our friends on
the latest beauty procedures that can enhance and improve the way we look.
This leaves much confusion in our minds as to what cosmetic procedures
and products would be best for ourselves as well as for our patients, if we
need it at all.
This lecture will discuss the simplest to the latest non-surgical
cosmetic procedures and cosmeceutical products on facial skin
rejuvenation available in the Philippines today and will try to distinguish
efficacious treatments from mere media marketing hype. It will also
decipher the facts about what effects these cosmetic procedures have on the
skin and its appearance. At the end of the lecture, it is hoped that the
physician will be able to have a better idea as to what procedures or
cosmeceutical products will best suit his and his patient’s problem.
DOESN’T EVERYONE WANT TO STAY YOUNG, LIVE LONGER, FEEL HEALTHIER
AND LOOK GREAT?
Since time immemorial, people have searched the ends of the earth looking for
the magic formula to keep them young forever or at least delay the signs of aging. At
present, there are approximately 6 billion people over 35 years of age. The world’s
population is getting older but wants to stay younger. THE QUEST FOR THE
FOUNTAIN OF YOUTH IS REACHING A FEVERED PITCH!
Millions of people spend and will spend millions of dollars worldwide to try every
method to keep them looking and feeling young. In 2003, the total US cosmetic market
was valued at $45.5 Billion alone. Within this category, anti-aging and sun protection
products are at the top of the demand. As the 45+ age bracket is set to grow at three
times the rate of the general population, anti-aging products and services proliferate
dramatically. A trend that is expected to continue over the next two decades.
The sad thing about aging is that it starts earlier than we think. Just when we
have reached the peak of our youth….by age 25 yrs old, we begin to feel the effects of
aging. These effects are directly related to the decline of the growth hormone from this
age onward compounded by the effects of the environment like pollution and the sun.
Our organ begin to function at less than optimum….memory is not so sharp, sex drive
diminish , sleep disturbances, eyesight begin to diminish, aches and pin occur more
frequently and most of the time, weight gain. The intrinsic aging occurs naturally and
unavoidably with the passage of time. It is a process that affects all skin and appears to
be genetically predetermined. With the same exposure to the sun, people with skin type
1 will show higher degree of aging than people with skin type IV. The most common
signs of intrinsic aging are:
a. Laxity – saagy skin due to loosening of the collagen fibers
b. Fine Wrinkling – decrease collagen and elasticity of skin
c. Benign tumors – freckles, solar lentigo and seborrheic
keratoses
d. Hair pattern and pigmentation
 male-pattern alopecia and diffuse hair loss in women due to reduction
in the density of hair follicles
 Graying of hair due to replacement of completely pigmented individual
hairs by hairs with decrease quantity of pigment.
Extrinsic aging includes factors as sleeplines, gravity, expression lines, lifestyle
(smoking) and Photodamage. This refers to the premature aging of the skin caused by
exposure to ultraviolet light – primarily UVA and UVB. Photodamage is exacerbated by
cigarette smoking particularly in women. There is a direct correlation bet. Number of
sticks smoked per day and severity of wrinkling and grayish discoloration. Most
changes associated with an aged appearance result from photoaging rather than
chronologic aging. Severity varies among individuals.
Now, what’s new in the cosmetic block to help us combat the signs of aging?
For this lecture, I would be discussing what’s new in the cosmeceutical products
and the latest non-surgical procedures for the aging face and body available in the
Philippines today and will try to distinguish efficacious treatments from mere media
marketing hype.
The clinical approach for the rejuvenation of the face involves the use of :
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Home care regimen
Superficial peels
Microdermabrasion
Photomodulation
IPL +/- RF
Microlaser abrasion
Examples of Topical regimen are retinoids; alpha and beta hydroxy acids, copper
peptides , etc….
THE NEXT GENERATION HYDROXY ACIDS
POLYHYDROXY ACIDS (PHAs)
 represent the next generation of AHAs for use in cosmetic and dermatologic skin
care
 structurally similar to traditional AHAs
 are an important cosmeceutical
 provide anti-aging and skin smoothing effects comparable to AHAs
ADVANTAGES OF PHAs
 less irritating, stinging and burning
 compatible with clinically sensitive skin types (AD, rosacea)
 enhance the skin barrier
 can be used to help smooth and condition the skin before and after laser
resurfacing, microdermabrasion, IPL or chemical peels
 provide antioxidant, moisturization and anti-aging effects
 do not increase sun sensitivity but provide free radical scavenging effects
 compatible with traditional skin care regimen (tretinoin, skin lightening agents)
 as adjunct to topical drug therapies for the treatment of inflammatory skin
conditions like psoriasis, rosacea, keratosis pilaris, acne and seborrheic
dermatitis
 examples : Gluconolactone (gluconic acid dekta lactone)
Lactobionic Acid
GENESTEIN
 soybean isoflavone with diverse biologic activities
 potent anti-oxidant
 specific inhibitor of protein tyrosine, kinase and phytoestrogens
 exhibits preventative and therapeutic effects on breast and prostate cancers,
postmenopausal syndrome, osteoporosis and cardiovascular diseases in animals
and humans
 antiphotocarcinogenic
 shown to protect human skin against UVB –induced photodamage
IDEBENONE
 powerful antioxidant compared to tocopherol, ubiquinone, ascorbic acid and
alpha lipoic acid
Matrixyl
 Pentapeptide amino acid fragment of collagen I
 Composed of lysine, threonine, serine
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Commercialized by Sederma (France)
Water soluble powder
Found to increase the synthesis of collagen I, collagen III and fibronectin
Active agent found in Olay Regenerist and Strivectin
Argireline
 Hexapeptide composed of 6 amino acids
 INCI name: acetyl hexapeptide-3
 Available as a 0.05% powder
 Modulates formation of the SNARE complex
 Mimics protein (SNAP-25) of the complex by competitive inhibition
 Relaxes muscle contraction through the same mechanism as botox – breaks
the SNARE complex
 Theoretically produces facial muscle relaxation rather than paralysis
WHAT’S NEW WITH BEAUTY PROCEDURES?
Diamond Peel
- Instead of using aluminum oxide crystals, the ends of the wand used are
natural diamonds. The diamonds have different abrasive sizes(75-100
micron). The finer the abrasive the less material removed. The vacuum
setting determines the amount of pressure between the skin and the abrasive
surface.
Indications: (claimed to ..) Lawrence N. New and Emerging treatments for photoaing.
Dermatol clin.2000
- improve skin texture
- reduce wrinkles
- hyperpigmentation
- treat comedones
- improve dry skin & photodamage skin
- remove excess skin oil
(Before and after pictures)
Advantages:
- non-invasive, non-surgical; no downtime after treatment; patients experience
softer, smoother and cleaner skin after first treatment. Treatment series
varies from 4 – 10 series depending on the condition.
Disadvantage: expensive (php 1,500- 3000/session)
Side effects:
- bleeding
- infection
- hyperpigmentation
Microdermabrasion devices have been classified as cosmetic rather than medical
and are therefore not subjected to FDA approval. There is little evidence of efficacy as
seen by double-blinded clinical trials. It is believed that the results of microdermabrasion
are comparable to those achieved with glycolic peels or to those achieved by the use of
topical retinoids. However, in my clinical practice, when microdermabrasion is
combined with topical agents like retinoids, alpha hydroxyl acids or lightening
agents, patients are very pleased with the results and would recommend the
procedure to others. It is therefore a good adjunct procedure for facial
rejuvenation and hyperpigmentation.
HYDROX PEEL/ JET PEEL
• creates a tightly focused jet stream
from compressed oxygen and sterile saline solution with a controlled PSI.
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The micro-sized water drops created by HYDROX-PEEL are 5-100 microns in
size and are accelerated to velocities of up to 200m/sec
INDICATIONS:
• Acne scars
• Skin rejuvenation
• Mild erythema
• Hand & décolleté
• Stretch marks
• Pigmentation
• Photodamage skin
• Alopecia
ADVANTAGES:
 Painless
 Rapid healing
 No toxic substance
 No thermal damage
 High satisfaction from patients
 Topical vitamins, moisturizers, etc can be incorporated in the treatment with the
use of the machine
Diasadvantages:
• relatively expensive (P2500-4000)
• results are variable since a cocktail of meds are being applied
WHAT’S NEW …WHAT’S HOT WITH LIGHT AND LASERS?
Photorejuvenation
 A dynamic non-ablative process involving the use of A NONCOHERENT
FLASHLAMP ( IPL ) to reduce mottled hyperpigmentation, telangiectasias and
smooth the textural surfaces of the skin.
 Generally administered in a series of 3 – 6 procedures in 3 – 4 week interval
 The entire face is treated and patient can return to all activity
Summary and recommendations:
 IPL is the gold standard for photorejuvenation and treatment of choice for
poikiloderma.
 Improvement up to 80% is seen when treating pigmentation and vascular
lesions
 It is ideal for patients with mild photodamage
 It has, however, minimal effect on coarse wrinkles and skin tightening
PHOTOPNEUMATIC MACHINE (PPx)
 Uses a broadband spectrum of light in combination with pneumatic energy
 Delivers 5x more effective photons to dermal and epidermal targets
 INDICATIONS:
 Hair removal
 Skin rejuvenation
 Pigmented lesions
 Vascular lesions
MECHANISM OF ACTION OF PPx
uses 4-5X less energy than other light & lasers hence
4-5x less energy is absorbed by surrounding tissues
ADVANTAGES:
 Painless
 Lower energy is used so safer and less chances of burn
 Treatment duration is faster (2-4x)
 Efficacy is equivalent to traditional treatment modalities
 Can be used for all skin types for hair reduction and photorejuvenation
Treatment duration of PPx vs IPL & Lasers (Show table)
Summary and Recommendations: This new technology holds promise for the
development of future applications in the arena of noninvasive skin treatments.
PURE RF (THERMACOOL TC/ THERMAGE)
It delivers radiofrequency energy to heat the dermis and subcutaneous layer as
deep as 5-6mm while cooling the epidermis to avoid injury and minimize patient recovery
time. 1-4 treatments at 6-8 weeks intervals are needed.
INDICATIONS:
 Reduce facial rhytides
 Non-surgical face lifting of the forehead and lower face
 Photodamage
 Reduce redundant skin
 Acne scarring
“Histological Evaluation of the Thermage RF Treatment”( Zelickson B, et al. Lasers
In Surg and Medicines. Suppl 16.2004.
“It showed changes in collagen fibril morphology. These findings suggest
collagen contraction occurring immediately after treatment and giving rise to tissue
contraction.”
70% of pts noticed significant improvement in skin laxity 3 months after a single
RF tx with greater improvement noted after multiple txs”
Iyes S et al. Cosmet Dermatol. 2003.16:37-40.
Nasolabial and mesolabial folds were more responsive to tx than mandibular
ridge and jowls”
Ruiz-Esparza J, Gomez JB. Derm Surg.2003.29:325-32
Younger pts demonstrated greater improvement . The average age of the
unsatisfactory group was 58 yrs old.”HSU TS, Kaminer MS. Semin Cutan Med Surg.2003.22:115-23
The higher the treatment setting used, the more significant the results but also
the greater the chance for pain or discomfort.
The more swelling and redness, the greater the results
SIDE EFFECTS:
 Mild edema lasting up to a few hours
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Mild-moderate erythema
 Mild-mod pain
 sore or achy sensation
 Erythematous papules resolving w/in 24 hrs
 Superficial blisters
 Excessive contraction ectropion
ADVANTAGES
 No recovery period
 No surgical scar
 Rapid treatment time
 Can be performed safely on all skin types
 No danger of hyperpigmentation
DISADVANTAGES:
 Very expensive (80,000-150,000/session)
 Moderately painful even with topical anesthesia but with the newer
treatment tips and parameter, pain is minimal
 Response to treatment is gradual
 Variable results
It has few potential complications when done with proper technique
Parameters and guidelines developed recently due to the vast experience with the
device (> 275,000 worldwide) helped decrease side effects like pain and swelling
while improving efficacy.
Results are variable with improvements gradually appearing 2-6 months after
treatment.
Effects last for a minimum of 24 months but usually can be longer depending on the
patient
Summary and recommendations:

RF device offers a safe and effective non-invasive technique for facial
skin and deep tissue tightening especially that of the lower face and anterior neck
and in the improvement of acne scars.
 It is not a substitute for a face lift. It is best suited for those who are starting to
see signs of aging: early jowling, loose skin, creases around the nose & mouth.
 On the otherhand, for those with medical problems that prevent them from having
a face lift or for those who simply do not want surgery , then thermage will at
least offer them something….. YOU JUST NEED TO ADJUST YOUR
EXPECTATIONS.
E-Light / E-Max
 Combines diode laser (810-915nm) , bi-polar RF and broadband (700-2000nm)
 Has different applicator heads for different indications
INDICATIONS:
 Hair removal
 Acne treatment
 vascular lesions (leg veins, facial telangiectasia)
 Skin rejuvenation
 wrinkle reduction
 Skin tightening
 Pigmentations
Summary and recommendations:
eMAX is the latest machine with the ELOS technology. They have combined
several applicator to target different problems associated with skin aging , hair removal
and acne. Since the machine is still very new in the market, very few studies have been
conducted to evaluate its efficacy and safety.
FRAXEL
What’s New in the treatment of cellulites and adiposities
CARBOXYTHERAPY
It is a nonsusrgical method wherein carbon dioxide (C02) is infiltrated into the
subcutaneous tissue through a tiny needle. From the injection point , the carbon dioxide
diffuses easily into the adjacent tissues.
How does the CO2 work?
1. Co2 mechanically kills the fat cells
2. It has a strong vasodilatory effect on the capillaries in the areaWider vessels
mean bigger and stronger blood flow to the area increasing the oxygen in the
area which helps eliminates the build up fluid from between the cells. The end
result is fewer fat cells and firmer subcutaneous tissue.
How many sessions are necessary?
Between 15 -20 sessions done every other day or 1-2 X a week. After the 5th
session, the skin looks noticeably healthier; 8-10 sessions the subcutaneous tissue is
firmer.
ULTRACONTOUR
All the procedures we have discussed are non-invasive but can result in
physical and emotional scarring when done by a physician not familiar with them.
With a lot of skin centers and skin salon mushrooming in every corner of the
metropolis, claiming that they are expert in skin care …. Let us be wary in
entrusting our skin let alone our face to anybody. After all… we only have one
body and one face and the face is usually the first thing that a lot of people notice
in a per