FACIAL RESURFACING:
How do you treat facial wrinkles (rhytids)?
There are two types of facial aging:
Skin Aging:
How quickly the skin ages depends on the quality and quantity of the elastic and collagen tissues within the skin. This speed of aging depends on a patient’s’ inheritance and how well the skin has been looked after (sun and wind protection; moisturizing; non-smoking).
There are unwanted wrinkles (rhytids) that develop from aging.
There is premature wrinkling that may develop from excess exposure to environmental elements like sun, wind, and smoking.
Gravity Aging:
Here we see the gentle and progressive “falling of the facial tissue” as time passes.
As we age, the soft tissues in the face start to descend from the effects of gravity. These gravity changes may affect the brow, eyes, cheeks and jowls, and neck:
Heaviness of the upper and lower eyelids with descent of the brows
Heaviness over the nasolabial folds
Bitterness and marionette lines around the mouth
Jowls
Heaviness of the neck with fat collection under the chin and neck (“turkey gobbler deformity) and cording of the neck muscles.
These gravity changes are treated with a surgery that reverses the effects of gravity.
**Please see FAQ: Brow lift, Upper Eyelids, Lower Eyelids, Facelift
What are the options for resurfacing of the facial skin and decrease wrinkling?
There are non-surgical conservative options for treating skin aging
Cosmetics:
This is a huge industry dedicated to decreasing facial wrinkling. There is a significant component of facial moisturizing in these products that increase the water content within the skin cells which will temporarily improve the smoothness of the skin. Unfortunately the effects of these products are short lived.
The camouflage of makeup use is a very useful and economic way of improving the appearance of the skin, but again short lived.
Retin A acid cream:
Retinoic acid was used to treat acne in the 1950’s. A side effect of this treatment was the slow but definite decrease in facial wrinkling which was maintained as long as the patient continued to use this cream.
Today this product can be prescribed by a physician to be applied to facial rhytids (wrinkles) with beneficial effect. It will often cause irritation and dryness of the skin being treated and sun avoidance is advisable.
Using the cream continuously, it will take up to one year before the patient notices a therapeutic effect and a skin improvement.
The concentration of retinoic acid in over the counter cosmetic products is too small to produce any therapeutic effect.
Botox ,Fillers and Fat grafting
**Please refer to FAQ: Botox, Temporary Fillers: Juvéderm & Restylane, Fat Grafting
There are surgical options for treating skin aging:
Surgical options
Dermabrasion:
Facial Dermabrasion is a consideration in patients who have developed numerous areas of facial scarring from bad acne.
Another application of this technique is in the treatment of heavy wrinkling around the mouth over both the upper and lower lips and cheeks.
This is often done at the same time a Facelift is being done (See FAQ Facelift)
This procedure can be done under Local anaesthesia (freezing) if the treatment area is fairly limited or under General Anaesthesia if a full face is being treated.
The irregular topography (surface) of the skin produced by the facial scarring cast’s irregular shadows from overhead light which exaggerates the irregular skin appearance.
Heavy wrinkling around the mouth causes a “Lipstick Bleed”. This form of skin ageing cannot be improved with a Facelift.
A special medical tool called a dermabrader smooths the skin surface (somewhat similar to sanding down a rough piece of wood to make it smoother).
The depth of the dermabrasion is carefully controlled in order to avoid violating the deeper layers of the skin dermis which could produce scarring. The dermabrasion depth reaches the superficial layer of the skin dermis where fine bleeding is produced (similar to an abrasion you get if you fall on your knees on an asphalt road).
This removes all but the very deep acne scars and wrinkles.
Often a dermabrasion may have to be repeated once and sometimes twice to get the desired effect.
After the surgery is completed, a special dressing and moisturizers are applied until the dermabraded areas heal. It takes 7 – 10 days for all the scabbing to disappear.
The patient is left with fairly bright red – pink healed fresh skin which is smoother and free of superficial wrinkles and improved deeper wrinkles.
The pink color fades over a period of 3- 6 months. The pink color can be camouflaged with makeup during this healing period.
The healing skin is very vulnerable to sun exposure during the first 6 months after surgery. Sun exposure during this time may produce increased pigmentation in the dermabraded areas which may persist for years. For this reason, dermabrasion is often done in the late fall to early spring seasons.
Dr.Giuffre strongly recommends sun block protection during the healing period following a dermabrasion.
Chemical Face peel:
This procedure involves “painting” on to the wrinkled facial areas, a chemical that produces a superficial burn to the skin.
There are different types and concentrations of chemicals that can be used.
Examples of chemical peels are a TCA (trichloracetic acid) peel and a Phenol peel.
The stronger the chemical, the deeper the skin burn and the better the result but if the skin is injured too deeply, scarring can result, therefore this technic must be used by a trained physician and the chemicals require a prescription.
Over the counter “peel” products purchased in the cosmetic section of a retail store can produce a mild inflammation (redness and swelling) to the areas treated for up to three weeks. There is no permanent effect on the skin from these OTC peels once the inflammation disappears.
After the procedure is completed, a special dressing and moisturizers are applied until the peeled areas heal. It takes 7 – 10 days for all the scabbing to disappear.
The patient is left with fairly bright red – pink healed fresh skin which is smoother and free of superficial wrinkles and improved deeper wrinkles.
The pink color fades over a period of 3- 6 months. The pink color can be camouflaged with makeup during this healing period.
The healing skin is very vulnerable to sun exposure during the first 6 months after surgery. Sun exposure during this time may produce increased pigmentation in the peeled areas which may persist for years. Dr.Giuffre strongly recommends sun block protection during the healing period following a chemical peel.
The deeper the chemical peel, the more likely that the patient may experience varying degrees of decreased pigmentation to the areas treated. This takes many years to develop (5-10 years).
Laser resurfacing:
A laser is a very sophisticated piece of equipment designed to concentrate light into an energy beam which can be used for various surgical procedures.
Certain lasers are designed to treat skin scars and facial wrinkling.
The use of these lasers requires special training.
The effect of laser resurfacing is to create a burn on the superficial layer of the skin being treated, similar to the chemical burn created using a chemical peel, or mechanically removing this layer with a dermabrasion technique.
After the procedure is completed, a special dressing and moisturizers are applied until the peeled areas heal. It takes 7 – 10 days for all the scabbing to disappear.
The patient is left with fairly bright red – pink healed fresh skin which is smoother and free of superficial wrinkles and improved deeper wrinkles.
The pink color fades over a period of 3- 6 months. The pink color can be camouflaged with makeup during this healing period.
The healing skin is very vulnerable to sun exposure during the first 6 months after surgery. Sun exposure during this time may produce increased pigmentation in the laser treated areas which may persist for years.
Dr.Giuffre strongly recommends sun block protection during the healing period following a laser resurfacing.
The deeper the depth of the laser resurfacing, the more likely that the patient may experience varying degrees of decreased pigmentation to the areas treated. This takes many years to develop (5-10 years).