This document provides information on various aesthetic procedures used to treat signs of aging. It discusses the layers of skin and how aging affects the skin. Intrinsic and extrinsic aging factors are described. Common signs of facial aging are listed. Minimally invasive procedures like chemical peels, microdermabrasion, mesotherapy, microneedling, non-surgical facelifts using botox and fillers, thread lifts, and lasers are summarized in terms of how they work, indications, and potential benefits and risks. The importance of training and managing patient expectations is emphasized throughout.

1. Dr. S. Gokkulakrishnan,
MDS, FAM, FICOI, MIPS
Prof & Head, Dept. Of
Dentistry
RAMA Dental College Hospital
& Research Centre, Kanpur
Director
•IMPLADENT.
•Dr.GK’s Dental Speciality
Centre.
•Dr. Krish Everyoung –
Cosmetology & Hair Clinic.
•NIDAC - National
Institute of Dentistry &
Cosmetology .

2. What is Skin?
 Largest organ of the body
 3 layers: Epidermis, Dermis & Sub-
dermis
 Epidermis: Outer layer (layer you can
actually see)
 Dermis: Volumous second layer-25
times thicker than epidermis. It is
made up of protein fibers which give
the skin strength and elasticity.
 Subdermis: (subskin or subcutaneous
layer) This is our heat barrier,
composed of adipose fat or sub cutis
tissue. This creates a protective
cushion that gives contour and
smoothness to the body. 2

3. Ageing is a process that
accumulates changes in
organisms or objects over
time. Human aging process
involves multidimensional
changes on physical,
psychological, cultural and
social levels.
INTRINSIC SKIN
AGING (chronologic aging) or
normal aging
EXTRINSIC AGING
"Age mellows some people; others it makes rotten." -
Anonymous

4. INTRINSIC SKIN AGING (Chronologic Aging)
 Inevitable natural aging
process that occurs in all people
 Occurs as part of a pre-
programmed degeneration within
cells and extracellular matrix in all
skin layers.
 Although begin in 20’s,
visible signs are not apparent for
many decades.
 Primarily determined by
unique genetic make-up and
underlying type of skin

5. • 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
EXTRINSIC AGING – Outside factors that accelerate
intrinsic aging.

6. • Sleeping positions—cause
creases
• Facial expressions—
muscles produce grooves in
skin which gradually
become etched in face
• Being Overweight - It is
also your weight that
matters a lot when it some
to a saggy skin. More the
weight, more are the
chances of the skin tissues
spreading out.
EXTRINSIC AGING – Outside factors that accelerate
intrinsic aging.

7. Signs of Facial Aging
• Greater visibility of bony
landmarks, lines and wrinkles
• Prominence of transverse
forehead lines
• Nasolabial folds become more
prominent
• Hollowing of the mid-face
(loose skin)
• Changes in area around the
mouth (vertical wrinkles, lip
thinning and flattening)
• Development of prejowl
depression

8. Introduction
• Surgical procedures continue to
trend towards minimally invasive
techniques.
• Cosmetic alterations to combat the
effects of aging are no exception
to this trend. Patients, more and
more, are demanding cosmetic
procedures that leave no scar and
allow them to return to normal
activity quicker.
• Though traditional Rhytidectomy
and Brow lift remain in the
armamentarium of the facial
cosmetic surgeon, minimally
invasive procedures often achieve
satisfactory results for patients.

9. Aesthetic Dermatology is to treat the skin, hair or body using a treatment
that is meant to improve a patient's appearance rather than treat a disease.
Aesthetic dermatology's primary purpose is to improve a person's looks by
reducing or eliminating imperfections. The major benefit is that most of
these are painless procedures.
9

10. In other words, these
treatments can actually
rejuvenate the skin leaving
it younger, fresher and
healthier than before.
These procedures can
accomplish anything from
tightening the skin, eliminate
wrinkles, encourage healing,
remove scars, liver spots,
pigmentations and stretch
marks.

11. Realistic Goals
• Correct Sun Damage
• Reduce Scaring
• Reduce Wrinkles
• Remove Blackheads
• Improve Stretch marks
• Treatment of Acne & Post acne scarring
• Improve Pigmentation
• Improve uneven texture
11

12. Methods of stimulating the skin
Chemical peeling
Microdermabrasion
Mesotherapy
Microneedling
Non Surgical Face Lift
Permanent Make Up
 Lasers
Competencies of a Medical doctor /
Cosmetologist

13. Chemical Peels

14. Chemical Peel
• Chemical peel is a
cosmetic procedure which
uses application of acid to
the skin so as to remove
skin blemishes or
wrinkles..
14
•Underlying regenerated
skin is smoother and less
wrinkled than the older
skin

15. Benefits
• Retexturize the skin
• Restore Radiance
• Skin rejuvenation
• Minimize fine lines and
wrinkles
• Restore moisture
• Acne
• Hyper pigmentation
• Improve light scarring
• Improve imperfections
• Stimulate new skin
growth
• Stimulate collagen and
elastin
15

16. • Chemical peeling is an technique that removes superficial
lesions and improves the texture of skin
• Careful patient selection and education are crucial to both
the patient's final result and his or her satisfaction
• Learning the technique is a small part of the process;
postoperative care and close patient follow-up are equally
important
• Clinical and histological changes are long-lasting and may be
permanent for some patients
• A complication can also be permanent!!!!
16
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED
Usually, complications are minor and are
more common in dark-skinned individuals.
They are seen more in medium and deep
depth peels.

17. Microdermabrasion

18. Microdermabrasion is a
procedure that uses
microscopic crystals to
exfoliate the dead skin. This
non-invasive treatment
takes only a few minutes to
renew and rejuvenate skin.
Microdermabrasion
Microdermabrasion is safe
for all skin types and tones.
Because it is a non-invasive
procedure, it will not cause
scarring or changes to skin
tone or color.

19. Microdermabrasion can
been used to treat:
– Aging and sun-
damaged skin
– Some types of acne
scarring & acne
– Altered pigmentation
– Stretch marks
– Fine lines & wrinkles
Results may include:
•Improved skin tone
•Even skin color
•Refined skin pores
•Fewer breakouts
•Healthy glow
•Renewed elasticity
•Diminished
appearance of scars
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

20. Mesotherapy

21. Mesotherapy employs
multiple microinjections
of pharmaceutical
medications , amino
acids , vitamins and
others into the
mesoderm.
Mesotherapy was 1st described by a French Physician Michael Pistor 1952.
In 1987, French Academy of Medicine recognized Mesotherapy as part of
traditional medicine.

22. Injection Techniques
• PAPULE:
1 to 2mm, with bevel upwards
• NAPPAGE:
1 to 3mm, angle of 30° to 60°
• POINT BY POINT:
deep injections, 4 to 12mm
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

23. Indications:
• Hair : Hair Loss.
• Facial Rejuvenation.
• Facial Pigmentation.
• Body Sculpting.

24. Microneedling

25. Microneedling
Microneedling is the procedure by which multiple tiny, sterile
needles are used to create microscopic, closely spaced holes
in the skin in order to induce the body’s natural healing
response to produce fresh, new dermal tissues.
•Also referred to as Collagen Induction Therapy (CIT) or Percutaneous
Collagen Induction (PCI)
•Depth of needle used can vary based on patient need
•Can help with general cosmesis (e.g., anti-aging) or for medical
applications (e.g., scar tissue revision or to increased penetration of
topical medications)
Before After

26. Microneedling
 12 needle cartridge
 Face & body applications
 Length 0.1 to 3 mm
200 to 540 needles
Titanium better than steel
Length 0.2 to 2.5 mm
0.7 mm thick to break collagen

28. Fine lines to moderate
wrinkles
Diminished skin
texture, tone and color
Pigmentations
Atrophic acne scars
Stretch marks
Traumatic scars
Photo aging
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

29. Non Surgical Face Lift

30. • Botox
• Fillers
• 8 Point Lift
• Nefertiti Lift
• Thread Lift

31. BOTOX

32. Botox injection as a way to smooth
out wrinkles
Approved cosmetic use in 2002 by
FDA
Wrinkles can never be removed by
Botox. Botox can only diminish the
appearance of wrinkles.
 Only small amounts (about one-
tenth of a teaspoon) of Botox are
required.
Botox has a temporary effect and its
effect last about 3 - 6 months.

33. Each time we use facial muscle,
a groove forms beneath the surface of the skin
When skin ages,
 it is no longer able to
spring back in place
groove become
permanent features

34. Botox is the preferred
choice in
Frown lines
Brow lift
Crows feet
Facial contouring
Forehead lines

36. DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED
A complication can also be permanent!!!!

37. FILLERS

38. FILLERS
• Dermal fillers are substances used in soft tissue
augmentation to enhance or replace volume that is
lost in any part of the skin or subcutaneous fat.
• Fillers form an effective tool in rejuvenation, either
as a stand-alone treatment or in combination with
other procedures such as Laser resurfacing or
Botulinum toxin etc.

39.  In a short span of time, fillers have come to play
an important role in the nonsurgical
management of ageing skin.
 The technique is a safe, simple and effective
modality, when used by a properly trained
physician.
 Proper knowledge of the anatomy of the area of
injection, aesthetic sense and proper patient
selection are essential.

40. INDICATIONS
Facial lines (wrinkles, folds)
Lip enhancement
Facial deformities
Depressed scars-
(a)Post surgical
(b)Traumatic
(c) Acne and other diseases
• Lipo Atrophy

41. DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

43. Recent Advances
• Vampire Lift
• 8 Point Lift
(Liquid)
• Nefertiti Lift

44. Thread Lift

45. - Polydiosiloxane - Colorless Crystalline
Synthetic Biodegradable Polymer.
- Retain upto 50% tensile strength after 60 –
80 days.
- Insignificant Tissue Reaction but leads to
Neocollagenesis
Effect from surgical Threads :
- Promotion of local microcirculation
- Activation of reparative processes
- Stimulation of collagen production

46. Effectiveness & Safety
(Mechanism of Action)

47.  Virtually Non- Invasive
Procedure
 Minimal pain. Topical
anesthesia
 No Scarring
 Lunch-Time Procedure
 Cost Effective

48.  Restores facial firmness
 Regenerates muscle tissue
 Lifts facial features
 Opens up the eye expressions
 Increases skin elasticity
 Reduces bags under your eyes
 Fresh skin & smooth complexion
 Reduces flabbiness and sagging
 Reduces wrinkles
FEATURES
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

49. Indications
• Area of Treatment - Forehead, Cheeks, Chin
line, Nose
• Neck - Tightening, Lifting
• Wrinkles - Brow wrinkles, Crow’s-feet, Deep
wrinkles, Fine wrinkles
• Breast - Firming, Shaping.
• Hip up
• Obesity – Arms & Abdomen

50. NEED A LIFT?
Non Surgical
Face Lift Treatment
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

51. LASERS

52. LASER
• Laser use on the skin has become one of the most popular methods
for achieving a younger and smoother facial appearance
• Unfortunately, the increasingly widespread availability of cosmetic
laser therapy coupled with attendant publicity has created
extraordinary, often unrealistic expectations.
• Proper patient selection and assessment of each individual’s skin is
crucial prior to determining whether an ablative procedure is
indicated.

53. With any ablative modality,
treatment must be pursued
cautiously and with specific
precautions against scarring
and pigmentary alteration.
Nonablative lasers are the result
of technology meeting. Patient
demands for “Iunchtime”
treatments.
Nonablative resurfacing is
relatively new and, although
results may be mild it has
improved efficacy, with an
outstanding safety profile.
IPL
LASER

54. Depth of penetration as a function of a laser
wavelength (Nelson et al 2002)
Laser Wavelength μwater Depth of
(nm) (per mm) penetration
(μm)
Diode 980 0.0448 32000
Nd:YAG 1064 0.0177 81100
Nd:YAG 1320 0.204 7000
Diode 1450 3.04 470
Er.glass 1540 1.18 1200
Er:YAG 2940 1220 1.20
CO2 10600 84.40 17
μwater :absorption coefficient

55. Reported indications for Lasers
Photodamage
Rhytides
Pigmentation
Melasma
Acne
Acne scarring
Atrophic scars
Hypertrophic scars
Surgical scars
Hair removal
Resurfacing / Rejuvanation

56. Platelet Rich Plasma - PRP

57. Platelet Rich Plasma - PRP
PRP is a concentrated blood sample that
contains high levels of platelets, a critical
component of the wound healing process.
Platelets contain growth factors that
are responsible for stimulating tissue
generation and repair. Growth factors
derived from platelets are responsible
for soft tissue repair, hair growth,
development of new blood vessels, and
stimulation of the wound healing
process.

58. RESULTS OF PRP
Also Includes
Stimulating hair growth
Decreasing facial rhytids
Enhancing the taking
rate of fat transplant
stimulate collagen production
in the subcutaneous tissues
when used as a filler (alone or
combined with collagen or
hyaluronic acid
 Decreasing hematoma/seroma post rhytidectomy,
 Improving the appearance of stretch marks and scars (alone or in
combination with laser).
DO NOT PERFORM UNTIL EXTENSIVE TRAINING IS COMPLETED

59. Conclusion
• Beauty has different definitions in different times
and in different cultures
• The health professions can play a constructive role
in supporting safe and healthy behaviors and
promoting realistic ideals of beauty
• More education & Training needed at all levels

60. MASTERING AGEING WITH GRACE
Thank you for your attention!
National Institute of advanced Dentistry And medical Cosmetology