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AGING GRACEFULLY

AGING GRACEFULLY. NANCY SILVERBERG, MD Chair, Department of Dermatology, Hoag Hospital Memorial Presbyterian Associate Clinical Professor of Dermatology, UCI. There are 3 skin layers: Epidermis Dermis Subcutaneous layer. Skin Anatomy. Basal Layer. What is skin aging?.

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AGING GRACEFULLY

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  1. AGING GRACEFULLY NANCY SILVERBERG, MD Chair, Department of Dermatology, Hoag Hospital Memorial Presbyterian Associate Clinical Professor of Dermatology, UCI

  2. There are 3 skin layers: Epidermis Dermis Subcutaneous layer Skin Anatomy

  3. Basal Layer

  4. What is skin aging? • Collagen production slows (skin gets thinner) • Elastin fibers break down (skin loses its ability to snap back after stretching) • Subcutaneous fat decreases (skin looks less plump and smooth) • Turnover of skin cells slows down • Skin becomes dryer

  5. What causes skin to age? • Sun (ultraviolet light)—damages elastin and 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

  6. 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

  7. Treatment of Aging Skin • Products • Fillers and injectables • Peeling and microdermabrasion • Thermage • Lasers • Fraxel • Fractional CO2

  8. Products • Sunscreen • Moisturizers • Tretinoin • Everything else

  9. Injectables and Fillers • Botox cosmetic, Dysport • Zyderm (bovine collagen) • Restylane (hyaluronic acid) • Juvederm (hyaluronic acid) • Radiesse (hydroxyapatite) • Evolence (porcine collagen) • Sculptra (poly-L-lactic acid)

  10. Botox

  11. Restylane

  12. Restylane

  13. Juvederm

  14. Juvederm

  15. Sculptra

  16. 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

  17. 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!

  18. Thermage

  19. Thermage

  20. 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)

  21. 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.

  22. Intense Pulsed Light

  23. Intense Pulsed Light

  24. Fraxel • Multiple tiny microscopic columns of erbium 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

  25. Fraxel

  26. Fraxel

  27. Fractional CO2 (Active FX) • Columns of high energy CO2 laser light 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

  28. 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

  29. Day 7 Day 1 Fractional Resurfacing - Clinical Results Before

  30. Fractional Resurfacing - Clinical Results

  31. Fractional Resurfacing - Clinical Results

  32. Fractional Resurfacing - Clinical Results

  33. Fractional Resurfacing - Clinical Results

  34. Fractional Resurfacing - Clinical Results

  35. Fractional Resurfacing - Clinical Results

  36. Fractional Resurfacing - Clinical Results

  37. Fractional Resurfacing - Clinical Results Pre-Treatment 6 Weeks post Treatment

  38. Fractional Resurfacing - Clinical Results Scar Revision

  39. Fractional Resurfacing - Clinical Results TotalFX and Juvederm Combo Treatment

  40. Thank You

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