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Minimally Invasive Techniques In Facial Rejuvenation

In this presentation Naheed R. Abbasi, MD, MPH, FAAD, Summit Medical Group Department of Dermatology, shares how an understanding of the skin helps to identify technologies most likely to be effective in improving pigment, lines, volume loss and skin laxity. Dr. Abbasi explains numerous minimally invasive technologies available that pose minimal risk and produce little downtime and how surgery can be avoided or postponed through less invasive techniques.

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Minimally Invasive Techniques
   In Facial Rejuvenation

      Naheed R. Abbasi, MD, MPH, FAAD

           Summit Medical Group
          Department of Dermatology



              February 23, 2011
Background and Practice Overview
   Education
    • B.A .Harvard College
    • MD and MPH from UC Berkeley-UCSF Joint Medical Program
   Training
    • Internal Medicine internship at St. Vincent’s Manhattan
    • Dermatology residency and chief residency at New York
      University
    • Cosmetic and Laser fellowship at SkinCare Physicians in
      Boston, affiliated with Harvard/Yale/Dartmouth
   Practice
    • Medical dermatology
    • Cosmetic dermatology (Toxins, Fillers, etc.)
    • Lasers for both medical and cosmetic indications
Why Rejuvenate the Face?

   Appearances matter
   The effects of sun, smoking and time itself can make
    the skin lackluster
   Aging itself produces volume loss which is manifest as
    “sagging skin”
   There are minimally invasive techniques designed to
    rejuvenate the face with little downtime and little risk
Overview of the Skin
The Faces of Aging
How can we reverse the visible effects of photoaging?



• Toxins
• Fillers
• Superficial and Deep
  Peels
• Lasers

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Minimally Invasive Techniques In Facial Rejuvenation

  • 1. Minimally Invasive Techniques In Facial Rejuvenation Naheed R. Abbasi, MD, MPH, FAAD Summit Medical Group Department of Dermatology February 23, 2011
  • 2. Background and Practice Overview  Education • B.A .Harvard College • MD and MPH from UC Berkeley-UCSF Joint Medical Program  Training • Internal Medicine internship at St. Vincent’s Manhattan • Dermatology residency and chief residency at New York University • Cosmetic and Laser fellowship at SkinCare Physicians in Boston, affiliated with Harvard/Yale/Dartmouth  Practice • Medical dermatology • Cosmetic dermatology (Toxins, Fillers, etc.) • Lasers for both medical and cosmetic indications
  • 3. Why Rejuvenate the Face?  Appearances matter  The effects of sun, smoking and time itself can make the skin lackluster  Aging itself produces volume loss which is manifest as “sagging skin”  There are minimally invasive techniques designed to rejuvenate the face with little downtime and little risk
  • 5. The Faces of Aging
  • 6. How can we reverse the visible effects of photoaging? • Toxins • Fillers • Superficial and Deep Peels • Lasers
  • 7. Toxins • Botulinum toxins have been used for decades to decrease unwanted muscle movement  Botox®: Allergan  Dysport®: Medicis • Toxins inhibit unwanted muscle movement making “dynamic lines” softer • Effects typically last between 4.5 and 6 months • Toxins are used for treatment of wrinkles and also for migraine headaches, hyperhidrosis
  • 8. Study Subject with single injection
  • 9. Dermal Fillers • Help remedy the loss of facial volume that is characteristic of aging • There are two types:  Hylaurinic acid: 6-9 months duration of effect on average • Restylane® • Juvederm®  Non-HA • Radiesse® • Sculptra® • Collagen • Silicon
  • 10. Before and After Juvederm®
  • 11. Superficial and Deep Peels  Chemical peels use various agents (e.g. salicylic acid, glycolic acid, vitamin C, kojic acid, TCA etc.) to induce changes in the superficial to mid-levels of skin.  Most peels are superficial and thus target pigment and texture for a short-term basis.  Superficial peels are not the gold-standard therapy for wrinkles, significant volume loss, or scars, but can greatly improve skin luster and pigment.  Superficial peels can also improve acne, at least for the short-term.  Deep peels can induce more significant changes in collagen but come with greater risk.
  • 12. Lasers  LASER= Light amplification by stimulated emission of radiation  Selective photothermolysis is the concept explaining how a laser can induce selective injury to a skin structure while minimizing damage to surrounding normal tissue  At SMG we commonly use the following lasers to achieve specific endpoints:  Long-pulsed alexandrite and Nd:Yag (GentleLase and GYag) for hair removal  Pulsed dye laser to treat broken blood vessels, rosacea, vascular birthmarks, certain scars  Q-switched lasers for treatment of brown spots and tatoos  Fractional resurfacing laser for treatment of sun damage, texture, acne scars, pigment, etc.
  • 13. Laser Hair Removal • Safe in all skin types • Typically 4-10 treatments required • Common reasons to treat include ease of skin maintenance, ingrown hairs, hormonal or age-related hair changes Photos courtesy of Candela Medical
  • 14. Pulsed Dye Laser • Treats unwanted redness including that from rosacea, broken blood vessels, scars, and birthmarks Courtesy of Tom Rohrer, MD and emedicine.com
  • 15. Q-switched Lasers • Target brown spots such as freckles • Gold-standard for treatment of tatoos of every color, with black tatoos easiest to treat • Brown spots typically respond to 1-3 treatments while tatoos require more sessions
  • 16. Fractional Resurfacing Lasers • Stimulate collagen, improve fine lines, improve pigment, and recontour scars including those from acne • Many results are permanent • Studies show microscopic reversal of sun damage Images from Solta Medical Aesthetic Clinic
  • 17. ThermaCool (Thermage) • Monopolar radiofrequency device that can induce skin tightening without surgery • Remodels and tightens collagen in the deep dermis without injuring the skin • Commonly used on cheeks, mandible, upper neck Images from Solta Medical
  • 18. Conclusions • An understanding of the skin helps to identify technologies most likely to be effective in improving pigment, lines, volume loss and skin laxity. • There are numerous minimally invasive technologies available that pose minimal risk and produce little downtime. • Surgery can be avoided or postponed through less invasive techniques.