Non-surgical Skin Rejuvenation: Making Sense out of Chaos
You’ve looked in the mirror and had an epiphany: My skin looks old and sun-damaged. Now what? Do I need expensive surgery or are there less invasive, more cost effective and safer alternatives? The first decision is to ascertain what bothers you and prioritize those concerns. Secondly, do you have the financial wherewithal, since cosmetic procedures are not covered by insurance? Lastly, are you prepared to initiate a commitment to a comprehensive skin care program consisting of a daily regimen of skin care and a healthy life style including a good diet, sun avoidance and smoking cessation. If not, don’t waste your money! Now comes the hard part: Do I make an appointment with a dermatologist, cosmetic surgeon, visit a med spa orseek the advice of a department store salesperson. All can potentially provide you with helpful advice within their realm of expertise. You need to become cognizant of what the various “experts” possess in terms of training, expertise, and credentialing-an oftentimes contentious issue. For physicians, board certification by a skin-related specialty (e.g. dermatology, plastic surgery, facial plastic surgery, opthalmoplastic surgery etc) whose training is governed by the American Board of Medical Specialities is a good start. Keep in mind however, that our current economic situation has generated a sea of new skin “experts” since this is cash business. Become educated and validate the provider’s credentials, don’t be fooled by a flashy web site or advertisement, bogus certifications, and don’t just shop cost. Generally, you get what you pay for.
Your dermatologist can help guide you in this adventure. Should you have marked laxity (sagging) of the skin, I generally recommend the redundant skin be removed by a cosmetic surgeon. If the laxity is more modest and wrinkles, skin texture and discoloration are your primary problem, then you are a candidate for many of the non-surgical procedures for skin rejuvenation such as Botox for relaxing muscles of expression, fillers to soften deep wrinkles and restore lost volume, and light-based systems (IPL and lasers) for textural problems, skin tightening and discoloration. However, should you only have minor dyschromia (discoloration) and fine wrinkles, a good skin care program with prescription strength topical agents and minor procedures like chemexfoliation (lunch time peels) and microdermabrasion may be all that is necessary. The next step for more severe dyschromia and redness is Intense Pulse Light (e.g. Photogenesis/Solargenesis) therapy whereby the red and brown colors absorb these broad wavelengths of light and disappear. Distinct blood vessels or “broken viens” generally need to be traced out and destroyed with specially designed lasers (e.g. Coolglide/Varelite etc). Prominent pores and modest textural problems can be improved by heating the skin with lasers (e.g laser genesis) and stimulating new collagen growth.
Wrinkles and pebbly skin can be dramatically improved with new “fractionated laser technologies. Some are non-ablative (no visible tissue injury and no downtime) and require many treatments with only modest improvement. In essence “no pain-no gain”. The newest lasers now use this same fractionated technology for ablative (meaning the epidermis and some of the dermis are vaporized) resurfacing. Unlike the older, but very effective ablative lasers which had a long downtime and significant risk of scarring, these new lasers (e.g. Active FX/Deep FX/Total FX) ablate, in a computer generated pattern, hundreds of tiny foci of skin while still leaving small islands of normal skin which facilitates rapid healing with a downtime of only 4-5 days! This technology is an excellent balance of downtime/risk/benefit and cost.
In summary, there are many interventions, both old and new, to help rejuvenate your skin. You however must be committed to this journey and absolutely have realistic expectations. We can drop the clock back a few years, but we can’t make you look 20 again. I wish we could.
By: Neil Fenske, MD, professor and chair of the USF Health Department of Dermatology and Cutaneous Surgery