TREATMENT GUIDE | treatment guide
Skin tightening and rejuvenation
Ines Verner reviews the treatment options available for skin rejuvenation and tightening, based on available evidence, best practice, and her expert opinion
T 130 ❚
ISSUE SAGGING IS ONE of the most prominent features of the ageing face. Traditional
facial
rejuvenation treatments focused on soft tissue
descent and the mainstay of facial rejuvenation was the surgical facelift. During the last decade great advances
have been made in our understanding of ageing and it has been established that laxity is not the only factor leading to tissue sagging. We know now that both our soft tissue and skeleton change tremendously and that deflation together with laxity lead to tissue descent by gravitation. Rapid technological advances have
characterised the new millennium, allowing us to treat facial deflation by volumising fillers and to treat tissue laxity by tightening devices.
Soft tissue fillers Volumising hyaluronic acid and other soft tissue fillers are nowadays the mainstay of facial volume loss treatment. The different fillers, with their different rheological characteristics and their very high safety profile, enable us to volumise and restructure the face. We can volumise the deep plane by injecting above the bone, thus addressing morphological bone changes. Loss of volume in the fat compartments of the face can be treated by injection into the subcutaneous fat. And
the more superficial volume losses can be treated by superficial injections into the dermis. Correction of volume in the right plane will lift the soft tissue giving us the ‘injectable’ or ‘filler’ face lift. Further lifting of tissue can be achieved by tissue resurfacing.
Fractional resurfacing The introduction of fractional resurfacing technologies by Dieter Manstein1
in 2004
has revolutionised the field of resurfacing. Up until then we only had ablative resurfacing in which the whole epidermis and a part of the dermis were treated. This form of resurfacing
(which could be a CO2 laser, Erbium laser, or a deep chemical peel) was very effective but had a long downtime and high risk for complications, such as hypopigmentaion and scarring. The other form of resurfacing available then was non-ablative resurfacing. In this form the downtime was very short and very few side effects were seen but the effectivity of the treatment was also limited because most of the non-ablative devices are in the (near) infrared wavelength range. The introduction of fractional resurfacing
and mainly of fractional ablative technologies by CO2
tremendously changed our possibilities. With these technologies it is possible to achieve remarkable results as deep
March 2013 |
prime-journal.com
microscopic thermal wounds are created (microscopic treatment zones; MTZ) and so even the deep dermis can be treated, while around the MTZ the skin is spared and serves as a healing reservoir.1
In
different studies it has been shown that full reepithelialization is achieved after 48 hours. Redness lasts for a few days and up to 2 weeks. Another interesting point that was made
out by B. Hantash in 2007 is the fact that even 3 months after treatment there is still HSP47 present in tissue, which is a sign of ongoing collagen I and III production, and interestingly, this new collagen production was not limited to the treated zones but was widespread around the treated area.2 So not only was the treated area renewed, but the area surrounding it also had an entirely new extracellular matrix. These findings, together with the remarkable clinical results that can be seen after treatment, make complete ablative resurfacing (nearly) obsolete.
Volumising hyaluronic acid and other soft tissue fillers are
nowadays the mainstay of facial volume loss treatment.
Radiofrequency Other possibilities for tightening and rejuvenation with even less downtime, yet with remarkable clinical results, are the fractional radiofrequency devices.3 with
Treating the skin these newer
technologies induces tissue tightening and textural skin improvement after multiple (3–5) repeated treatments.
or Erbium lasers has
With these technologies there is nearly no downtime as the skin is only red after treatment and can be covered with make up. The redness resolves in most cases within 24 hours after which minor scabs can be seen for 5 more days, which can easily be covered as well. As radio frequency energy spreads easily in the dermis, owing to the low dermal impedance, there is more volumetric heating at that level, which could then induce tissue tightening. The mechanism for this effect is collage denaturation, due to the heat that induces neocollagenesis afterwards.
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