Cosmetic Laser Procedures and Facial Contouring with Injectables. 2009, American Society for Aesthetic Plastic Surgery

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1 Cosmetic Laser Procedures and Facial Contouring with Injectables

2 Stuart B. Kincaid, MD, F.A.C.S. San Diego/La Jolla Office 8929 University Center Lane, Ste. 201 San Diego, California Phone: Temecula/Inland Empire Office Winchester Road Temecula, California Phone: Toll Free: BEST IMAGE Web site: Fax: Before and after patient photographs are provided by the American Society for Aesthetic Plastic Surgery. Other photographs used for graphic design purposes are not actual patients.

3 Nonsurgical choices can provide safe, beautiful results when you wisely choose a qualified doctor and an approved, branded injectable or skin rejuvenation treatment.

4 A cost effective option with little or no downtime, non-invasive procedures treat facial wrinkles, improve signs of aging, contour facial features and help skin imperfections.

5 Injectables and rejuvenation techniques can be performed during an office visit, rather than requiring a trip to the operating room, and do not require general anesthesia.

6 Sun exposure, heredity and lifestyle factors including nutrition, alcohol consumption and smoking all may contribute to facial and body wrinkling.

7 A treatment appropriate to temporarily weaken or paralyze the muscle that causes active lines or early wrinkles is a neurotoxin, like Botulinum Toxin type A.

8 Botox is best suited for treating expression lines caused by muscle contraction. Common injection sites include horizontal forehead furrows, vertical lines between the eyes, crow s feet around the eyes and peri oral smoker s lines.

9 ASAPS The effects will generally last 3-4 months and risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups.

10 Dermal fillers are substances injected at varying depths within the skin and soft tissues to fill facial imperfections such as wrinkles, creases and concave scars, as well as to enhance the fullness, or volume and shape of facial tissue.

11 Temporary dermal fillers like collagen and hyaluronic acid, are commonly used to fill fine lines and facial creases, enhance the volume of the lips and other facial features, and to fill in scars and other depressions.

12 Collagen is a naturally occurring connective tissue component that provides strength and structure to the skin. Most commonly injected into the lips, these fillers tend to last 3 to 6 months, and have a very natural feel.

13 Hyaluronic acid like Juvederm or Restylane is a filler that binds moisture and provides fullness between the skin cells. Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds.

14 More semi-permanent dermal fillers do not readily absorb and are injected deep within the soft tissue for more long-lasting and large volume correction. Radiesse or calcium hydroxylapatite or polymethylmethacrylate are FDA approved and used in these cases.

15 An alternative to synthetic fillers is autologous fat injections, which takes fat from one area of the body to enhance another. This is natural-appearing, lasts a long time, and has less risks. Autologous fat is effective for changing body contour, revising scars, filling depressions created by liposuction, and rejuvenating the hands and face.

16 Any filler can be used alone or in conjunction with other facial plastic surgery procedures such as surgical rejuvenation and skin rejuvenation techniques.

17 An important treatment for aesthetic facial beauty is enhancing your skin s overall texture, color, and complexion with skin rejuvenation techniques.

18 You may be a good candidate for skin rejuvenation if you have one or more of the following conditions: wrinkled or sun-damaged facial skin vertical wrinkles around your mouth, such as those that cause lipstick "bleed" "crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area fine wrinkling of your upper eyelids brown spots or blotchy skin coloring certain precancerous skin growths acne or chicken pox scars superficial facial scars from a past injury

19 Chemical peels, Dermabrasion and laser skin rejuvenation remove layers of skin and, as the healing process progresses, a new, healthier-looking skin emerges.

20 A chemical peel involves the application of a solution to either your entire face or just certain regions, such as the crow's feet area around your eyes or the vertical wrinkles around your mouth.

21 Superficial peels using alpha hydroxy acids (AHAs) or Salicylic Acid often give your skin a fresher, healthier appearance and a radiant glow. Repeated treatments can further improve skin texture and tone.

22 After a skin rejuvenation procedure, your doctor will recommend a maintenance program using glycolic or retinoic acids that you can apply at home on a regular basis.

23 ASAPS Deep chemical peels such as high concentration trichloroacetic acid (TCA) and phenol are generally one-time procedures that will result in a longer downtime, during which new skin forms over the treated area.

24 TCA formulas are often preferred in treating darker-skinned patients or for spot peeling of limited areas such as around the mouth or eyes because they have less bleaching effect than solutions containing phenol.

25 A full-face deep chemical peel takes approximately one hour to perform. A light sedation is recommended as there is a burning sensation as the solution effects the area to be treated (avoiding the eyes, brows and lips). An ointment stays in place for several days as the skin develops rapidly underneath. Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Unlike TCA peels, phenol cannot be used on your neck or other parts of your body.

26 Dermabrasion uses a small, rapidly spinning wheel with a roughened surface to remove the upper layers of skin. This rejuvenation procedure can reduce the appearance of acne scars and vertical lines around the mouth without affecting skin pigmentation.

27 Chemical Peel Treatment Chart Peel Type Fine Lines Acne Acne Scars Deep Wrinkles Pigmentation AHA Peels (Glycolic Lactic, etc.) Some Good Little Little Some Jessner s Peel (14% Salicylic Acid, 14% Lactic Acid, 14% Resorcinol) Little Good Little Little Some TCA Peels - Low Concentration 10-35% Little Little Some Little Moderate TCA Peels - High Concentration + Jessner s or Glycolic Acid Moderate Little Moderate Moderate Good Effects 1 to 3 months 1 to 3 months 3 to 6 months Year+ Risks Low Low Medium High Phenol/Croton Oil Peels, Baker Gordon or Litton Formula Good Good Good Good Good Good High (with Cardiac Risks) Recovery Time 1 Day 2-4 Days 2-4 Days 5-7 Days 7-10 Days

28 A less abrasive treatment that does not require anesthetic and brightens up the skin while reducing fine lines and scarring is Microdermabrasion. It stimulates the production of skin cells and collagen, has almost no side effects, but requires periodic treatments.

29 Skin rejuvenation with laser technology refers to removing the outermost layers of the epidermis to improve skin discoloration, fine lines, and texture, while at the same time, using heat/thermal energy in the dermis to promote collagen contraction, remodeling, and stimulation of new collagen.

30 Like the other rejuvenation methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. Side effects include redness, swelling and change in the pigmentation of the skin.

31 Laser Skin Rejuvenation Can treat the following conditions: Effects of Aging Facial Blotching (Melasma) Fine Lines Large Pore Size Neck and Chest Pigmentations Pigmentation Pigmented Birthmarks Scars and Acne Stretch Marks Tattoo Removal Wrinkles

32 Two types of treatment options including non-ablative (no downtime/appropriate for all skin types) and ablative (downtime and not appropriate for all skin types) treatment to assist patients achieve their laser rejuvenation goals. This patient had non-ablative laser treatment for his acne.

33 Intense Pulsed Light treatments such as IPL Photo rejuvenation is a non-invasive skin and revitalizing treatment that corrects sun damaged skin, skin conditions marked by premature aging and or vascular conditions such as rosacea.

34 The IPL is versatile because it can treat the face, the neck, chest and hands rather than a single isolated area. With a series of treatments, IPL can help restore your skin to a more healthful and youthful appearance without the downtime or long recovery period as seen with other types treatments.

35 The Erbium Nd: Yag and Erbium fractional rejuvenation may be used for deep acne scars and is similar to fraxel repair.

36 The MicroLaserPeel is also a good option to the CO2 laser which is still considered the "gold standard" but comes with greater risks, full anesthesia and much longer downtime.

37 Fractionated Lasers is a relatively new facial procedure that eliminates old skin cells to improve tone and texture, erase unwanted brown spots, smooth wrinkles around the eyes as well as hide scars, and rejuvenate the skin around the chest, neck, and hands. The skin s natural healing process will allow for healthier and tighter skin to form, which will rid the skin of imperfections.

38 Laser Chart Laser Type IPL Non-Ablative Fractional Ablative Fractional Erbium/YSGG (Full Field) Co2 (Full Field) Fine Lines None Moderate Good Very Good Very Good Acne Moderate- Good Poor Poor Poor Poor Acne Scars Poor Excellent Excellent Very Good-Excellent Very Good-Excellent Deep Wrinkles Poor Moderate Good-Very Good Excellent Excellent Pigmentation Excellent Moderate Good Very Good Very Good Risks Redness/Burn Redness/Irritation Redness, Irritation Redness, Irritation Prolonged Erythema, Hypopigmentation Recovery Time None 1-3 days 3-7 days 3-14 days days

39 Some patients also may benefit from the laser's mild "tightening" effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of aging.

40 Infrared Light Source or Radio Frequency waves are safe, non-surgical processes for skin tightening. There is no downtime and treatment is done with topical anesthesia.

41 There is an immediate tightening noted and also a delayed tightening that occurs over a few months. Results are noted after 1 procedure but better results are achieved after 2-3 treatments spaced a month apart.

42 Laser Hair Removal is a non-invasive, gentle technique that reduces undesirable hair from most parts of the body.

43 Multiple sessions are needed but can treat large areas effectively. The best results are achieved when the patient has dark hair and a light complexion.

44 Here are examples of tattoo removals using laser technology.

45 The Following is a List of Vascular Treatments with Lasers Red Acne Scar Removal Rosacea Treatment (Facial Redness) Scar Removal-Keloid, Surgical and Other Scars Spider Vein Removal (Facial and Legs)

46 Skin care, including hydration and regular sun protection, in the form of sunscreen and sunglasses, can further enhance your refreshed appearance and maintain skin health. These regimens are essential to the prevention of unwanted changes in skin color, and to minimize age-related skin changes.

47 Every device has its unique characteristics to give a certain result and your doctor can help you decide which procedure, or combination of procedures is in your best interest.

48 With realistic expectations, there are a variety of nonsurgical treatments and options that can lead to effective and satisfactory results.

49 Stuart B. Kincaid, MD, F.A.C.S. San Diego/La Jolla Office 8929 University Center Lane, Ste. 201 San Diego, California Phone: Temecula/Inland Empire Office Winchester Road Temecula, California Phone: Toll Free: BEST IMAGE Web site: Fax:

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