Skin Rejuvenation

Rejuvenation of Sun-Damaged Skin

Sun Protection Video (you will need Flash Media Player) Low-Res | Hi-Res

Sun Damage Video (you will need Windows Media Player) Hi-Res | Low-Res

1. Most of the characteristics that we associate with an aged appearance actually result from long-term sun exposure.   These unwanted changes include extra blood vessels on our face (commonly referred to as broken blood vessels), brown spots, enlarged pores, and most distressingly wrinkles and sagging skin in sun exposed areas.   Proof that these changes result from long-term sun exposure can be easily acquired when looking at sun-damaged and sun protected skin in the same individual.   It is very difficult to differentiate sun protected skin from a seventy year old from sun protected skin taken from a twenty year old, when looking at it under the microscope, but skin taken from sun damaged sites tells the true story.

2. The changes that we associate with aging truly do result from long-term sun exposure, or in some instances smoking.   Evidence of this is the fact that most people are aged more severely on the side of their face that faces the window in the car.   Thus, drivers will be more aged on the left side while passengers will be more aged on the right side.   This also illustrates the fact that skin aging is a daily process that sadly does not occur on the beach, but more often in the car.  

This is because we spent the majority of our time outside in the car.   Patients with significant sun damage around the mouth are often smokers, and I can identify these people before they tell me their smoking history.   This is not, as commonly believed, due to pursing ones lips to draw upon a cigarette.   Instead, this aging is from the formation of free radicals, which occur when smoke is absorbed directly into the skin. In addition to free radicals   causing skin damage as a result of smoking, approximately 50% of sun damage is due to the formation of free radicals.   This damaged skin then becomes furrowed where our facial expression lines move our skin.

If we didn't smoke or never went into the sun, we could move our mouths, foreheads, and brows as much of we like without getting permanent creases in our skin.   These creases only occur because our skin becomes permanently changed by long-term sun-exposure and smoking.

A microscope slide of normal sun-protected skin on the left shows collagen in read and elastic fibers in green. On the right is sun-damaged skin from the same individual showing how the sun destroys the normal arrangement of collagen and elastin in the skin.

3. Because the sun can not only age our skin, but make us more likely to get side effects from laser, sun avoidance during a series of laser treatments and sun-protection by wearing the appropriate sunscreen EVERY DAY is critical. This is STEP ONE before starting non-ablative laser treatments. In addition, using a   topical AHA or Retin-A type product can help repair the skin and prepare it for laser treatments. They do this by slightly decreasing over-pigmented areas, reducing the dead skin layer on the surface of our skin (both of which can interfere with the laser light reaching it's target), and by increasing cell turnover and collagen production in the skin. The last part is important for getting the most out of non-ablative laser treatments.

normal skin	sun-damaged skin

4. There are five main types of non-ablative laser treatments:

• visible light lasers
• intense pulsed-light sources
• infrared lasers
• photodynamic therapy (PDT)
• radiofrequency devices

5. In my practice I use two types of visible light lasers as well as an infrared laser for non-ablative rejuvenation of photodamaged skin and treatment of acne scarring. I use these treatments because I feel they most safely address the five areas of photodamage:

•  broken (extra) blood vessels
•  brown spots/freckles
•  enlarged pores
•  wrinkling
•  sagging

6. Sagging is the hardest to affect with non-ablative laser treatment. Laser resurfacing and surgical intervention work best for severely sagging skin. The visible light lasers are capable of improving redness, brown spots, enlarged pores and wrinkling. In the case of wrinkling, I emphasize that wrinkles will be IMPROVED not REMOVED in most cases.

7. WHO IS A CANDIDATE? People with mild-moderate photodamage, enlarge pores, or acne scarring with or without acne   will benefit best from non-ablative laser treatments. Very dark skinned or tan patients may not be a candidate since dark pigmentation may interfere with laser treatments. People who have taken isotretinoin or Accutane in the 6 months preceeding treatment may have to wait for laser treatment. Also, you should not be treated if you have an active cold sore.

8. WHAT DOES THE TREATMENT FEEL LIKE? People often feel a mild tingling after applying our antioxidant AHA lotion. This often decreases over time. Some people will not experience any tingling or irritation and can move up to a stronger formulation. I recommend patients start using our products every other night to determine if they are going to be too sensitive to this product. If not after about a week, increase to nightly use. After using the face lotion for a month, you can consider moving up to the higher strength lotion. This should be alternated for a week or two every other night with the face lotion to determine if the stronger product is right for you. In addition, some people often need to decrease the strength of their face lotion during dry, winter months. Some products such as the strongest AHAs or Retin-A may need to be discontinued or used less frequently during the winter. Dry skin is more sensitive, and the dry winter air holds a lot less water than in other times of the year.

The lasers differ with respect to the way they feel. The vascular lasers feel like a pin-prick and are the least uncomfortable. The infra-red lasers can be a little more uncomfortable, so we often use a numbing cream before treatment. The cream must be left on for 40 minutes before treatment. A number of people feel that these lasers are not significantly uncomfortable and choose not to have the numbing cream applied.

9. WHAT CAN I EXPECT? Following initial use of the skin products, ones skin will feel softer and smoother almost immediately or within a few days. This effect is due to the ability of the AHAs to remove the dead skin layer (called the stratum corneum). Removing this layer makes our skin more healthy looking, vibrant and supple. It also helps hide shadows on our skin better, and shadows are what cause fine lines, wrinkles and acne scars to show. These skin problems (unlike brown spots and spider veins) are the same color as our surrounding skin, so the reason we see them is that they cast shadows on our skin. Getting rid of the surface dead skin makes our skin more reflective, hiding fine lines, wrinkles and acne scars. Continued use of AHAs can actually cause an increase in skin thickness, generating new skin formation. Work done in our laboratory has demonstrated an increase in GAGs in skin treated twice daily with certain AHA lotions. GAGs are the sugars in our skin that babies are loaded with. They are also the one of the first components of new skin formation in a healing wound. Products like AHAs and Retin-A produce a healing response in the absence of an actual wound. Thus, continued use of these products should improve the appearance of fine lines and wrinkles initially through surface changes, and eventually through changes throughout the skin.

The non-ablative lasers produce a gradual improvement of unwanted blood vessels and brown spots in the case of the vascular lasers, and fine lines wrinkles and enlarged pores when using both the vascular and infrared lasers. A series of 3-4 treatments usually produces the best results.

Please also visit The Patient’s Guide to Collagen located at www.collagen.org. The Patient’s Guide is an informational resource for skin rejuvenation treatment options, pricing and provides a list of pre-qualified providers nationwide.

To answer your specific questions or schedule a consultation, call Dr. Bernstein today at 610-581-7400.