Photorejuvenation is a skin treatment that uses lasers, intense pulsed light, thermal methods, or Photodynamic therapy to treat some skin conditions and remove wrinkles arising from photoaging. The process induces controlled wounds on the skin, prompting it to heal itself by creating new cells. This process reverses the effects of photoaging to a certain extent by removing wrinkles.
There are three types of skin rejuvenation:
- Thermal rejuvenation using a radio-frequency device to induce a thermal effect in the skin.
- Chemical rejuvenation with chemical peels.
- Photo rejuvenation with laser, intense pulse light, photodynamic therapy, light.
Laser resurfacing is a technique used during laser surgery wherein molecular bonds are disassociated by laser. It is used for the treatment of wrinkles, solar lentigenes, sun damage, scars (see acne scar treatment), stretch marks, actinic keratosis, surgical scars and telangiectasias or "spider veins".
It can be combined with liposuction to remove excess fat from the chin and jaw area. The skin may be wrinkled after fat is removed and laser resurfacing can help tighten and smooth over the new contours.
Laser resurfacing is usually done with a 2940 nm Er:YAG laser or a 10,600 nm CO2 laser. Complete resurfacing was first done with a CO2 laser. More commonly now, laser resurfacing is done with a fractional laser. The term fractional pertains to the method in which the laser light is transferred. Tiny pinpoints of laser light are used to deliver the laser to the surface of the skin in only a fraction of the area. Several hundred or thousands of laser pinpoints may be used per square inch, leaving healthy skin in between the ablated areas, to allow more rapid healing and lower risk.
Skin resurfacing can also be performed with a plasma-based device instead of a laser. At least one manufacturer of such a plasma device[who?] claims "It’s the only treatment proven to generate new skin, at the fundamental levels, for as long as a year after treatment". However these claims do not have supporting evidence published in a peer-reviewed medical journal, and have not been verified by any independently funded studies. When used proficiently, it has been shown to be significantly more precise in control, while producing less bleeding, bruising and post-operative discomfort compared to other skin resurfacing methods.
Fractional photothermolysis (FP) is another form of laser treatment with several devices currently on the market. Some doctors claim FP provides similar results to CO2 laser resurfacing without risk of scarring or significant downtime. As of January 2008, there are a number of papers referenced on PubMed which mostly support those claims. Complications observed in a study of 961 treatments included acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications observed in this study were of a temporary nature. There have been, however, anecdotal negative accounts of bad scarring and hyperpigmentation without any findings of infection.
When compared to a chemical peel, dermabrasion or other forms of laser treatment, a laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.
CO2 laser resurfacing has been shown to have an increased risk of hypopigmentation and scarring when compared to the erbium lasers. This is due to the high degree of coagulation and thus heat production that occurs as a nature of the CO2 wavelength. Both Erbium and Co2 fractional systems have a better safety profile than lasers of the past.
Both Erbium and CO2 are used to treat deep rhytides, sun damage and age spots. Through the heating of the deep dermis, fibroblasts are stimulated to form new collagen and elastin helping to bring increased turgor and thickness to the skin.
Side effects of IPL usage in mechanical photorejuvenation
Beginning in the late 1990s, a number of studies have been performed to evaluate the safety and effectiveness of IPL on wrinkle-removal and rejuvenation of the skin. One such study conducted by a group of four researchers from the Weill Cornell Medical College of Cornell University and published in the Journal of Drugs in Dermatology in 2004 found IPL to be a "non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events".
An article published in the Journal of Investigative Dermatology in 2010 found that exposing cells to direct heat can cause DNA damage not only in those cells but also in surrounding tissue that was not directly exposed, and concluded: "... treatments that cause thousands of microscopic thermal injuries in tissue produce a complicated interface between the directly heat-damaged and the surrounding “bystander“ tissue. Further studies related to such clinical implications are warranted."
- Lim, Henry W.; Herbert Honigsmann; John L. M. Hawk (2007). Photodermatology. CRC Press. pp. 402, 403. ISBN 0-8493-7496-0.
- "Photo Rejuvenation for Better-Looking Skin: What Doctors Are Saying". Retrieved 2009-07-02.
- "Portrait(R) Plasma Skin Regeneration". medicalnewstoday.com. MediLexicon International Ltd. September 2006. Retrieved 17 February 2014.
- "Laser Skin Resurfacing". Plastic Surgery Guide. April 20, 2012. Retrieved 17 February 2014.
- GRABER, EMMY M.; TANZI, ELIZABETH L.; ALSTER, TINA S. (March 2008). "Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments". Dermatologic Surgery. pp. 301–307. doi:10.1111/j.1524-4725.2007.34062.x. Retrieved 17 February 2014.
- "Adverse Effects Fraxel Repair". realself.com. RealSelf, Inc. Retrieved 17 February 2014.
- Sadick NS, Weiss R, Kilmer S, Bitter P, NS; Weiss, R; Kilmer, S; Bitter, P (January 2004). "Photorejuvenation with intense pulsed light: results of a multi-center study". Journal of Drugs in Dermatology 3 (1): 41–49. PMID 14964745.
- Purschke, M; Laubach, HJ; Anderson, RR; Manstein, D (2010). "Thermal injury causes DNA damage and lethality in unheated surrounding cells: active thermal bystander effect". The Journal of investigative dermatology 130 (1): 86–92. doi:10.1038/jid.2009.205. PMID 19587691.