3 Skin Anatomy There are 3 skin layers: Epidermis Dermis Subcutaneous layer3
4 Basal LayerEpidermis: The epidermis is the outermost layer and is primarily protective. It consists of 4 layers Stratum corneum, Stratum granulosum, Stratum spinosum, Stratum basale better known as the basel layer. Cells in the basal layer quickly respond to damage resulting in a process known as reepithelialization.Dermis: The layer of skin that lies just below the epidermis and is the connective tissue (collagen) layer of the skin that contains hair follicles, sweat glands, blood vessels and nerve endings. The dermis consists of two layers, the papillary layer which consist of finely textured collagen fibers which indent the base of epidermis and the reticular layer which contain course textured collagen fibers. Collagen fibers are the “strength of the skin”If the surface of the epidermis has been damaged over an extensive area it can grow back from epithelial cells which remain deep in the cutaneous adnexal structures (hair follicles, sweat and sebaceous glands).4
5 What is skin aging? Collagen production slows (skin gets thinner) Elastin fibers break down (skin loses its ability to snap back after stretching)Subcutaneous fat decreases (skin looks less plump and smooth)Turnover of skin cells slows downSkin becomes dryer
7 What causes skin to age?Sun (ultraviolet light)—damages elastin and collagen fibers, causing wrinkles, and producing mottling and brown spotsCigarette smoking—damages elastin and decreases blood flow to skinGravity—pulls on our bodies and with loss of elastin and collagen, causes saggingSleeping positions—cause creasesFacial expressions—muscles produce grooves in skin which gradually become etched in face
9 Prevention of skin aging AVOID ULTRAVIOLET LIGHT!!!!!Avoid deliberate tanningStay out of sun between 10AM and 4PMWear protective clothing (hats, long sleeves)Apply broad spectrum (UVA and UVB) sunscreen (SPF 25 or greater) year round
20 Peels and Microdermabrasion Light “lunchtime” peels: glycolic, beta, JessnerMedium depth peels: trichloroacetic acidMicrodermabrasion: high pressure crystals delivered to skin which remove dead skin cells
21 ThermageRadiofrequency waves delivered to deeper skin layer which causes tightening of skinProduces heat in deeper layers of skin while maintaining cool on surface of skinLittle recoveryNot successful in all patients!
24 LaserVascular lasers and intense pulsed light remove tiny blood vessels and brown spotsQ switched lasers (Ruby, Versapulse, Medlite) remove brown spotsFraxel (fractionated erbium laser)Fractional CO2 (fractionated CO2 laser)
25 Intense Pulsed LightIntense Pulsed Light uses different wavelengths of light to target “broken” blood vessels and superficial brown spots. The light energy is changed to heat energy, which gradually fades the targeted pigment or vessels.
28 FraxelMultiple tiny microscopic columns of erbium laser light treat a fraction of the skin at one treatment, making recovery much easier than resurfacing treatments.Requires multiple treatmentsDecreases fine lines, wrinkles, scars and skin blotchinessNot good for deep lines and sagging skin
31 Fractional CO2 (Active FX) Columns of high energy CO2 laser light interact with skinOnly a fraction of the skin’s surface is treated, leaving small “bridges” of untreated skinCollagen in skin shrinks immediatelyStimulates collagen remodeling over timeDowntime usually less than one weekSingle treatment
32 Fractional CO2 (Active FX) Primary Targets: Fine lines and wrinkles of the faceCrow’s feet around eyesPucker marks (“smoker lines”) and frown linesBrown spots and blotchy, uneven skin toneScars, especially acne scars
33 Fractional Resurfacing - Clinical Results Day 1Day 7Before