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AGING GRACEFULLY NANCY SILVERBERG, MD NANCY SILVERBERG, MDChair, Department of Dermatology, Hoag Hospital Memorial Presbyterian Associate Clinical Professor.

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Presentation on theme: "AGING GRACEFULLY NANCY SILVERBERG, MD NANCY SILVERBERG, MDChair, Department of Dermatology, Hoag Hospital Memorial Presbyterian Associate Clinical Professor."— Presentation transcript:

1 AGING GRACEFULLY NANCY SILVERBERG, MD NANCY SILVERBERG, MDChair, Department of Dermatology, Hoag Hospital Memorial Presbyterian Associate Clinical Professor of Dermatology, UCI of Dermatology, UCI

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3 There are 3 skin layers: EpidermisDermis Subcutaneous layer Skin Anatomy

4 Basal Layer

5 What is skin aging? Collagen production slows (skin gets thinner) Collagen production slows (skin gets thinner) Elastin fibers break down (skin loses its ability to snap back after stretching) Elastin fibers break down (skin loses its ability to snap back after stretching) Subcutaneous fat decreases (skin looks less plump and smooth) Subcutaneous fat decreases (skin looks less plump and smooth) Turnover of skin cells slows down Turnover of skin cells slows down Skin becomes dryer Skin becomes dryer

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7 What causes skin to age? Sun (ultraviolet light)damages elastin and collagen fibers, causing wrinkles, and producing mottling and brown spots Sun (ultraviolet light)damages elastin and collagen fibers, causing wrinkles, and producing mottling and brown spots Cigarette smokingdamages elastin and decreases blood flow to skin Cigarette smokingdamages elastin and decreases blood flow to skin Gravitypulls on our bodies and with loss of elastin and collagen, causes sagging Gravitypulls on our bodies and with loss of elastin and collagen, causes sagging Sleeping positionscause creases Sleeping positionscause creases Facial expressionsmuscles produce grooves in skin which gradually become etched in face Facial expressionsmuscles produce grooves in skin which gradually become etched in face

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9 Prevention of skin aging AVOID ULTRAVIOLET LIGHT!!!!! Avoid deliberate tanning Avoid deliberate tanning Stay out of sun between 10AM and 4PM Stay out of sun between 10AM and 4PM Wear protective clothing (hats, long sleeves) Wear protective clothing (hats, long sleeves) Apply broad spectrum (UVA and UVB) sunscreen (SPF 25 or greater) year round Apply broad spectrum (UVA and UVB) sunscreen (SPF 25 or greater) year round

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11 Treatment of Aging Skin Products Products Fillers and injectables Fillers and injectables Peeling and microdermabrasion Peeling and microdermabrasion Thermage Thermage Lasers Lasers Fraxel Fraxel Fractional CO2 Fractional CO2

12 Products Sunscreen Sunscreen Moisturizers Moisturizers Tretinoin Tretinoin Everything else Everything else

13 Injectables and Fillers Botox cosmetic, Dysport Botox cosmetic, Dysport Zyderm (bovine collagen) Zyderm (bovine collagen) Restylane (hyaluronic acid) Restylane (hyaluronic acid) Juvederm (hyaluronic acid) Juvederm (hyaluronic acid) Radiesse (hydroxyapatite) Radiesse (hydroxyapatite) Evolence (porcine collagen) Evolence (porcine collagen) Sculptra (poly-L-lactic acid) Sculptra (poly-L-lactic acid)

14 Botox

15 Restylane

16 Restylane

17 Juvederm

18 Juvederm Juvederm

19 Sculptra Sculptra

20 Peels and Microdermabrasion Light lunchtime peels: glycolic, beta, Jessner Light lunchtime peels: glycolic, beta, Jessner Medium depth peels: trichloroacetic acid Medium depth peels: trichloroacetic acid Microdermabrasion: high pressure crystals delivered to skin which remove dead skin cells Microdermabrasion: high pressure crystals delivered to skin which remove dead skin cells

21 Thermage Radiofrequency waves delivered to deeper skin layer which causes tightening of skin Radiofrequency waves delivered to deeper skin layer which causes tightening of skin Produces heat in deeper layers of skin while maintaining cool on surface of skin Produces heat in deeper layers of skin while maintaining cool on surface of skin Little recovery Little recovery Not successful in all patients! Not successful in all patients!

22 Thermage

23 Thermage

24 Laser Vascular lasers and intense pulsed light remove tiny blood vessels and brown spots Vascular lasers and intense pulsed light remove tiny blood vessels and brown spots Q switched lasers (Ruby, Versapulse, Medlite) remove brown spots Q switched lasers (Ruby, Versapulse, Medlite) remove brown spots Fraxel (fractionated erbium laser) Fraxel (fractionated erbium laser) Fractional CO2 (fractionated CO2 laser) Fractional CO2 (fractionated CO2 laser)

25 Intense Pulsed Light Intense 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. Intense 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.

26 Intense Pulsed Light

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28 Fraxel Multiple tiny microscopic columns of erbium laser light treat a fraction of the skin at one treatment, making recovery much easier than resurfacing treatments. Multiple 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 treatments Requires multiple treatments Decreases fine lines, wrinkles, scars and skin blotchiness Decreases fine lines, wrinkles, scars and skin blotchiness Not good for deep lines and sagging skin Not good for deep lines and sagging skin

29 Fraxel

30 Fraxel

31 Fractional CO2 (Active FX) Columns of high energy CO2 laser light interact with skin Columns of high energy CO2 laser light interact with skin Only a fraction of the skins surface is treated, leaving small bridges of untreated skin Only a fraction of the skins surface is treated, leaving small bridges of untreated skin Collagen in skin shrinks immediately Collagen in skin shrinks immediately Stimulates collagen remodeling over time Stimulates collagen remodeling over time Downtime usually less than one week Downtime usually less than one week Single treatment Single treatment

32 Fractional CO2 (Active FX) Primary Targets: Fractional CO2 (Active FX) Primary Targets: Fine lines and wrinkles of the face Fine lines and wrinkles of the face Crows feet around eyes Crows feet around eyes Pucker marks (smoker lines) and frown lines Pucker marks (smoker lines) and frown lines Brown spots and blotchy, uneven skin tone Brown spots and blotchy, uneven skin tone Scars, especially acne scars Scars, especially acne scars

33 Before Day 1 Day 7 Fractional Resurfacing - Clinical Results

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41 Pre-Treatment6 Weeks post Treatment

42 Scar Revision Fractional Resurfacing - Clinical Results

43 TotalFX and Juvederm Combo Treatment Fractional Resurfacing - Clinical Results

44 Thank You

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