Treatment

Although the process of aging cannot be reversed, there is a wide array of dermatological treatments available today, which can remove many of the effects of aging and photoaging.

Dermatological Medical Skin Rejuvenation

Topically applied treatments are usually most effective when skin manifestations of aging and photoaging are superficial to moderate:

· Tretinoin, a substance in the vitamin A family, has been shown to reduce fine wrinkles, splotchy pigmentation, and rough skin associated with chronic sun exposure. Tretinoin cream 0.02% and 0.05% are the only prescription treatments approved by the Food and Drug Administration (FDA) of America for these indications. Other available forms of tretinoin are indicated for the treatment of acne.

· Alpha-hydroxy acids (AHSs) may be used alone or in combination with tretinoin to treat mildly damaged skin. AHAs are derived from fruit and dairy products. AHAs are designed to smooth fine lines and surface wrinkles, to improve skin texture and tone, to unblock and cleanse pores, to improve oily skin or acne, and to improve skin condition in general.
· Over-the-counter products containing retinols (of the vitamin A family), AHA, anti-oxidants and moisturizing agents may temporarily improve the appearance of fine lines and wrinkles.
· Topical antioxidants, especially vitamins C and E, function to help cells repair damage caused by ultraviolet radiation and smoking.

Dermatological Surgical Skin Rejuvenation

Chemical Peeling

Chemical peeling, also called chemexfoliation or dermapeeling, is a facial skin rejuvenation procedure that quite simply, peels the skin. It is beneficial in the treatment of wrinkles, skin discoloration and age spots, as well as dull skin texture and mild acne scars. Chemical peeling is also used in the treatment of superficial to moderate photoaging skin damage.
The surgeon applies a customized chemical solution to the skin in a controlled manner to remove outer layers of aged and sun-damaged skin. As the treated skin blisters and peels, new skin is generated which is noticeably smoother and fresher in appearance. A variety of peeling agents can be used to produce light, medium or deep chemical peels, depending on the amount of skin damage present.
Depending on the objectives of the treatment as determined jointly by the patient and dermatologist, the condition and type of the patient’s skin, and the degree of skin damage, the dermatologist individualizes the strength of the chemical solution and the depth of the peel. Peeling solution may include one or more chemicals such as alpha-hydroxy acids, trichloroacetic acid, or carbolic acid.

Soft-tissue Augmentation

In soft-tissue augmentation, a substance that is compatible with the patient’s body tissues is injected under the skin to elevate irregularities such as wrinkles, pits and scars. The substances used for injection are primarily:
· Collagen: Most of the collagen used for soft-tissue augmentation is derived from cattle. However, for people who are allergic to bovine (cow-derived) collagen, collagen-related substances may be self-donated by the patient or obtained from a tissue donor. The effects of collagen injection may last for 3 to 12 months.

· Self-donated Body Fat: Fat is taken from the patient’s own body and prepared for a procedure called microlipoinjection. This fat-transfer procedure is sometimes called body sculpturing. The injected body fat is used to replace fat lost from under the skin in the aging process. Defects improved by microlipoinjection include creases around the nose, mouth and chin, and the ‘drawn look’ created by loss of fat pads in the cheeks.

Botulinum Toxin

Dermatologists have harnessed the potent biological effects of botulinum toxin to dramatically improve effects of aging such as frown lines, crow’s feet, and facial wrinkles. Dermatologists use purified botulinum toxin in very tiny amounts to inject into a targeted facial muscle. The resulting nerve blockade of that muscle causes a local immobilization of muscle movement. This immobilization prevents ‘crinkling’ and wrinkle lines from forming when the patient frowns or squints. Results of treatment last up to 3 to 4 months. To be maximally effective, treatment with botulinum toxin is repeated over several sessions, and is combined with a program of muscle behavioural training to minimize wrinkling facial expressions.

Dermabrasion

Dermabrasion is a treatment with many applications in dermatology and dermatological surgery, from removal or reduction of acne and chicken pox scars to facial skin rejuvenation. It uses a special instrument to remove or abrade the upper layers of the skin, and smoothens out irregularities in the skin surface. The principal after-effect is redness of the skin similar to a severe sunburn; medications are prescribed to lessen discomfort. Healing is usually complete in approximately 10 days. Patients must avoid sunlight for 3 to 6 months after treatment. A technique that removes less surface skin is called microdermabrasion; it is often used for superficial skin defects and may be repeated at intervals.

Laser Skin Resurfacing

The use of lasers in dermatology has advanced rapidly over the past 30 years. Today, lasers have a broad range of dermatological applications, including:

· Removal or improvement of wrinkles, lines and other effects of aging and photoaging
· Treatment of superficial brown pigmented lesions such as age spots, and deep pigmented lesions such as port wine stains and birthmarks
· Removal or improvement of scars, and vascular moles
· Removal of some skin cancers
· Removal of tattoos, warts, and unwanted hair
· Removal of superfluous unwanted hair
Laser resurfacing uses the newest generation of the carbon dioxide and erbium YAG lasers to vapourize the undesired skin tissue one layer at a time, revealing fresh skin underneath.
The benefits of laser skin resurfacing include bloodlessness, and:
· Reduced risk of infection
· Precise control of surgical effects
· One-day outpatient treatment in many instances

Electrosurgical Resurfacing

An alternative to laser skin resurfacing is electrosurgical resurfacing, also called ‘cold ablation.’ This technique uses a micro-electrical radio frequency to deliver a pulse of energy to the skin, removing or improving superficial to moderate skin damage. The procedure has few after-effects, and recovery from mild to moderate swelling is usually complete within a month. Electrosurgical resurfacing offers the advantage of being applicable to most skin types and colours, without loss of skin pigmentation.

Non-ablative Skin Treatments

Liposuction
While wrinkles, crease lines and age spots are visible effects of aging, unwanted fat deposits are another. Sometimes, despite good diet and exercise, fatty deposits remain on the face, chin, neck, breast, abdomen, hips, thighs, buttocks, knees, and ankles. Liposuction is performed to remove these localized fat deposits.
This dermatological surgery is performed in an outpatient setting, usually under local anesthesia and anti-bleeding medication. In some cases, ultrasound is used to break down and liquefy fat cells in the area to be treated. Fat is removed from the targeted area with a vacuum inserted through an incision in the skin.

Liposuction is not a substitute for diet, exercise or weight reduction. It complements other efforts to keep a young and slim look.

Surgical Excision
Sometimes facial skin rejuvenation cannot be accomplished to the patient’s satisfaction by removal of surface defects. Long-term effects of gravity may affect deeper layers of tissue, with resulting sags in eyelids, forehead, cheeks, shin, and areas around the mouth. In such cases, a dermatological surgeon should be consulted regarding the possibility of following surgical procedures:
· Blepharoplasty (eyelid surgery) to correct ‘droopy’ eyelids by removing excess fat pads and skin.
· Brow lift to raise the eyebrows and reduce lines in the forehead.
· Rhytidectomy (fact lift) to tighten and trim excess skin on cheeks, chin, neck, and around the mouth.