PEER-REVIEW | HAND REJUVENATION | tissue properties of the skin of the dorsal hand have
made it challenging to safely and effectively improve pigmentation, wrinkles and texture with a single device10 In order to objectively quantify the severity of the
.
ageing hand, a scale for hand grading was developed. It is a five-point photonumeric
scale
primarily based on volume loss and the appearance of superficial veins. The scale ranges from 0, no loss of fatty tissue, to 4, very severe loss of fatty tissue and marked visibility of veins and tendons11
the development of non-ablative and fractional resurfacing to minimise risk and decrease recovery time13, 14
. Although the ablative CO2
and Er:YAG lasers have The radiofrequency energy penetrates the skin, heating deeper
tissues and inducing neocollagenesis, while the diode laser targets
. An algorithm was also designed by
incorporating the scale, in order to formulate a treatment approach for ageing hands using combined photorejuvenation techniques. Narurkar12
suggested
that patients who meet scale ‘0’ and have no loss of fatty tissue should be using sunscreen as well as topical retinoids. Those who meet scales ‘1–3’ are best treated with non-ablative fractional resurfacing and subsequent volumetric restoration with dermal fillers, with the possible addition of unipolar radiofrequency (RF). Ablative fractional resurfacing, dermal fillers and unipolar RF are recommended for scale ‘4’ patients, who exhibit severe photodamage and laxity12
.
Non-ablative rejuvenation The field of non-surgical skin rejuvenation continues to gain popularity as the ability to attain cosmetic enhancement with minimal risk and rapid recovery increases. Laser skin resurfacing was first introduced in the 1980s, but had a high rate of side-effects including persistent erythema, permanent hypopigmentation, scarring and a prolonged recovery time. This encouraged
remained the gold standard for resurfacing, newer systems stimulate collagen production and remodelling with little-to-no healing time and less discomfort15, 16
patient . Additionally,
pigmentation and vascular issues that are more superficial.
.
despite the significant results seen on the face with ablative fractional devices, non-facial areas such as the neck, chest and hands are more difficult to treat owing
to increased risk of prolonged healing time, scarring and dyspigmentation17, 18
Non-ablative resurfacing can produce minimal
thermal injury to the dermis in order to improve rhytides and photodamage, while preserving the epidermis. Fractional resurfacing further increases the efficacy of non-ablative and semi-ablative procedures, but with a quicker recovery period compared with ablative resurfacing13
. Thermal but non-ablative procedures
involve selective thermal injury to the papillary and upper reticular dermis, where the majority of solar elastosis is located in photodamaged skin. This leads to fibroblast activation and synthesis of new collagen without epidermal damage19–25
.
Intense pulsed light therapy Short pulsed and short wavelength lasers have been replaced by longer wavelength infrared lasers that specifically target the mid-dermis and result in a more consistent, albeit milder, improvement of rhytides. Intense pulsed light (IPL) devices target both dyspigmentation and vascularity, resulting in an
Figure 1 (A) Before and (B)
after treatment with the Fraxel laser (Solta Medical, Inc., Hayward, CA, USA)
26 ❚ October 2013 |
prime-journal.com
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