| OPHTHALMOLOGY | ARTICLE The theoretical basis of rejuvenation with light is based
on the theory of selective photothermolysis combined with the phenomenon of stimulating the production of new collagen, which occurs in response to mild thermal injury in the reticular and papillary dermis. The light emitted from the flash is converted into heat inside the tissue or targeted lesion, and initiates the process. The heat generated by the flash of light ends the clotting process by heating the treated area completely, and is stored up over time to reach the required temperature, as the capacity expansion and shrinkage of the skin provides a flexible base to support the epidermal layer of the skin. Ageing causes a decrease in collagen and the skin loses its elasticity, leading to heterogeneity of the underlying support of the skin and causing the appearance of wrinkles. The rejuvenation process is complete when new collagen fibres are formed after exposure to a minimum thermal trauma. The effect of light on skin texture is based on the
stimulation of collagen growth, which helps to regenerate and standardise the irregular dermal layer. This regrowth is instigated by heating the dermal collagen. Light heat energy uses near infrared wavelengths of 700 nm or greater, directly absorbed by water within the extracellular matrix and causing a mild heat stress to the papillary and reticular dermis. This stress leads to the activation of fibroblasts, resulting in the creation of new collagen and elastin cells found in the connective tissues. The creation of new cells triggered by the injury and the subsequent activation of fibroblasts takes place over a period of a few months. The healing response leads to an improvement in skin texture and the softening of fine lines that can be maintained for a number of years if patients require rigorous sun protection. The use of monopolar RF, as part of a classic aesthetic
blepharoplasty, enables a sharper and faster cut, immediate haemostasis, and better healing. In transconjunctival blepharoplasty RF is particularly useful because of the sharpness of incision, while with a classic scalpel incision there is a greater risk of haemorrhage, as well as retraction of a small vessel deeper in the orbit. The use of non-ablative RF can heat the dermis without heating the skin. The increase in heat creates micro-
Key points
■ Periorbital ageing is multifaceted, depending on the anatomical element concerned
■ This study evaluated the use of combined techniques — blephatoplasty, fat grafting, radiofrequency and phototherapy — for the rejuvenation of the eye
■ Although the same type of treatment is used for all underlying processes, the results produced are somewhat different
■ To successfully achieve the rejuvenation of the eye, it is necessary to be aware of all the possible techniques
dermal scarring and leads to a long-term neocollagenesis that allows results to continue for a number of months. The effect is dose-dependent, requiring a minimum of 20 W delivered at 10n m per area. If doses are weak there is no thermal action and no efficacy. The ablative techniques ® CO2
lasers, Er: YAG and LED
resurfacing ® required an extended downtime, with some residual redness that can last a number of months. In all cases protection of the cornea is essential. Among the ablative techniques, TCA peels, used at a concentration of 30–40% in the area around the eyes, should be used with caution as they are not neutralised when applied to the skin. Among filling techniques, the author considers fat
grafting the most suitable technique. It is generally easy to carry out but requires a rigorous technique ® it is not without complications owing to a risk of allergy. Poor outcomes are the result of technical faults in overcorrection or undercorrection. An injection that is too superficial can, for example, result in a fat pocket. Injecting too much can also create the same effect. The alternative to fat grafting is the injection of
cross-linked hyaluronic acid. The technique is not always easy to master because one must be very careful about the quantities to be injected. Hyaluronic acid is
prime-journal.com | March 2012
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