Photorejuvenation

The concept of rejuvenation of aged and sun damaged skin is currently receiving considerable interest. There exists today a rapidly growing demand for safe, simple techniques for improving skin textures, colour, pore size, broken blood vessels and wrinkles. Until the recent introduction of Intense Pulsed Light (IPL™) the only available treatment techniques included chemical peeling, ablative and non-ablative resurfacing, dermabrasion and various visible light and near IR laser treatments. The term Skin Rejuvenation applies to any form of procedure that improves the texture and look of the skin, whereas Photorejuvenation means the use of a light-based therapy to induce these improvements.

Photo-damaged Skin

Photo-damaged skin occurs as the result of excessive exposure to ultraviolet (UV) light, which induces epidermal and dermal changes. Skin affected in this way is characterised by thinning of the epidermis and dermis, coarse skin texture, wrinkling, telangiectasias and changes in pigmentation.

The overall appearance of photo-damaged or sun exposed skin relates to the resultant UV damage of structural components such as collagen and elastin fibres. Appearance, however, is also affected by genetic factors, intrinsic factors, disease process such as rosacea, and the overall loss of cutaneous elasticity associated with age. More people now have extended periods of sun exposure and, coupled with the thinning of the ozone layer and other factors, this has resulted in visible signs of ageing, damage and disease evident in ever-younger people. People in their twenties and thirties are now witnessing solar elastosis, telangiectasias, solar lentigines and rhytide formation.

Treatment for photo-damaged skin involves more than simply addressing wrinkles, which will produce limited results in one aspect only. Rather, treating each of the different components of photo-damaged skin will result in a more dramatic visible improvement.

Techniques

Up until recently, the ‘in vogue’ techniques for reducing or eliminating facial rhytides or wrinkles included various topical agents such as glycolic acid, retinoids, ascorbic acid, a variety of chemical peeling agents, dermabrasion and laser skin resurfacing. Of these techniques the most effective methods for improving photo-damaged skin were invasive, which had major disadvantages of requiring a significant recovery period following procedures such as laser skin resurfacing.

The thermal effects on tissue are both time and temperature dependent.

As a result of the problems and risks associated with lasers, there has been great interest in the development of non-invasive and non-ablative methods to effectively improve the appearance of photodamaged skin, without the need for patient downtime. Recently, Nd:YAG lasers, pulsed dye lasers and electro-surgery have been used to treat selected conditions associated with ageing and sun exposure.

Classifications

• Evaluation of facial skin pigmentation prior to treatment is necessary if successful results are to be obtained. Pigment can be inherited ethnically or acquired, such as in melasma or Addison disease. A higher degree of normal pigmentation increases the risk of hyperpigmentation and hypopigmentation following treatment. Hormonal changes during pregnancy can also vary the amount of pigmentation. The Fitzpatrick Skin Type Classification, is used to assess an individuals skin type as follows:-

• Type I   Always burn, never tan

• Type II  Sometimes burn, then tan

• Type III  Always tan, rarely burn, light Mediterranean

• Type IV  Rarely burn, Dark Mediterranean, light Asian

• Type V  Very rarely burn, Dark Asian

• Type VI  Never burn, Afro-Caribbean
  

Photo rejuvenation is based on selectively transmitting light through the epidermis to the dermis for selective absorption by  chromophores. Whilst the process has shown to be effective in white skin with minimal epidermal melanin, in dark skin with dense epidermal melanin, much of the light energy is absorbed by the epidermis thereby allowing only a small amount to pass through. To reduce this side effect, low energy is recommended for dark skin, however, this also results in low efficacy.

Treatment Process

Sun damage treatment includes aspects of both pigmentation treatment and thread vein treatment but also includes fine lines and wrinkles. Exposure to UV light destroys skin cells thereby slowing down the growth of new skin and the production of collagen. Light energy in the wavelength range 500 to 550nm is known to have a stimulating effect on fibroblasts thereby increasing their production of collagen. The increase in blood flow to the region will also bring fresh supplies of oxygen and nutrients to the cells, which will assist in the removal of waste. By traumatising the epidermis and dermis the skin will be encouraged to go into ‘repair mode’ to reduce fine lines and wrinkles. 

Treatment Test Patches

Test patches are recommended prior to all treatment sessions, but are essential when treating skin type II and above. The purpose of a test patch is to verify that permanent pigmentation changes will not take place and the client is not sensitive to the treatment. Clients must be aware that treatments carried out at higher energy fluencies may induce pigmentary changes.

A suitable area representing the area to eventually be treated is selected and the test patch carried out using a few shots at the recommended system settings and energy fluency. The area is observed visually. 

Contraindications

There are certain conditions which may exclude an individual from treatment.

• Pregnancy

• Epilepsy

• Kaposi’s Sarcoma (malignant lesions)

• Tanned Skin

• Malignant or suspicious tissues

• History of poor wound healing

• Tattoo over treatment area

• History of light sensitive rashes

• Under taking treatment involving blood thinning medication

Treatment Procedure

a) The area to be treated is thoroughly cleansed and all make-up is removed.

b) All hair is removed from the treatment area to avoid burning or unwanted long-term hair removal.

c) Cold gel is applied to the area to be treated.

d) The Practitioner will then set up the system to the desired treatment parameters.

e) The Applicator Head is placed perpendicular to the treatment site and in very light contact with the skin.

f) Energy levels sufficient to produce erythema are generally effective for photorejuvenation.

g) After treatment gel is removed and an aftercare product is applied to reduce any temporary discomfort.

Number of treatment sessions required.

Generally, between four to six treatment sessions are required, although it depends upon the treatment type and the area being treated. Normally, these treatment sessions are carried out at three weekly intervals.