3 Months Post 1 CO₂RE Treatment Photos: Dinesh Maini, MD, UK

Before and 1 month after 1 CO2RE Treatment

3 Months Post 1 CO₂RE Treatment Photos: Dinesh Maini, MD, UK

Post Treatment Progression Upper Orbital – Light/50%/45mJ Upper Mouth – MID/35%/90mJ Lower Orbital MID/35%/60mJ Baseline 4-7 days Post Tx.1 4-6 wk FU 12 wk FU E. Victor Ross MD

Post Treatment Progression ALL FACE – Light/50%/60mJ Cheeks – Mid/40%/90mJ Peri-Orbital & Peri-Oral Fusion/40%/90mJ Baseline Baseline 4-6 wk FU 4-6 wk FU E. Victor Ross MD

Post-Treatment Progression Lower Cheeks/Forehead Mid/30%/75mJ Nose & Upper Cheeks Mid/40%/90mJ Peri-Oral Fusion/40%/90mJ Baseline 4-7 days Post Tx.1 4-6 wk FU E. Victor Ross MD

Post-Treatment Progression Lower Cheeks/Forehead Mid/30%/75mJ Nose & Upper Cheeks Mid/40%/90mJ Peri-Oral Fusion/40%/90mJ Baseline Baseline 4-6 wk FU 4-6 wk FU E. Victor Ross MD

Post-Treatment Progression #6 Lower Cheeks/Forehead Mid/30%/75mJ Nose & Upper Cheeks Mid/40%/90mJ Peri-Oral Fusion/40%/90mJ Baseline 4-7 days Post Tx.1 4-6 wk FU 12 wk FU E. Victor Ross MD

Post-Treatment Progression Peri-Oral & Chin Fusion/40%/90mJ Peri-Orbital Fusion/30%/70mJ Forehead/Nose/Cheeks Mid/40%/90mJ Jawline Light/50%/60mJ Baseline 4-7 days Post Tx.1 4-6 wk FU E. Victor Ross MD

Post-Treatment Progression Peri-Orbital/Peri-Oral/Cheeks Fusion/25%/70mJ Forehead Light/40%/45mJ Baseline 4-7 days Post Tx.1 4-6 wk FU E. Victor Ross MD 12 wk FU

Steven Eubanks MD Denver, CO Peri-orbital areas with the mid setting: 40% FRACTIONAL COVERAGE, RING SIZE 1, 70-75 mJ, 0.75 SEC REPEAT.

Texture Steven Eubanks MD Cheeks CORE MID: 30% FRACTIONAL COVERAGE, RING SIZE 3, 70-75 mJ, 0.75 SEC REPEAT 3 weeks post procedure

Pigment, Texture, and Laxity Steven Eubanks MD Denver, CO Fusion settings: 25-30% FRACTIONAL COVERAGE, RING 70mJ, CORE 65 mJ, 0.75 SEC REPEAT.

Texture and Laxity Steven Eubanks MD Denver, CO Cheeks CORE MID: 30% FRACTIONAL COVERAGE, RING SIZE 3, 70-75 mJ, 0.75 SEC REPEAT

Texture and Laxity Steven Eubanks MD Denver, CO Cheeks CORE MID: 30% FRACTIONAL COVERAGE, RING SIZE 3, 70-75 mJ, 0.75 SEC REPEAT Jawline and deep folds CORE Deep: 2% Fractional 45mJ, .75 SEC Repeat

Steven Eubanks MD Denver, CO Pigment and Texture Forehead CORE mid setting: 30% FRACTIONAL COVERAGE, RING SIZE 2 70-75 mJ, 0.75 SEC REPEAT

3/27/2012 2/28/2012 Jill Waibel MD Miami, FL CO2RE light 30% Ring size: 1    Ring: 25.5 MJ   Pattern size: 8.0x9.1 D: 9.0mm Shape: Hex Treatment: 1 3/27/2012 2/28/2012

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Clinical Results Before Post Treatment Fusion: 40% fractional coverage, Ring 1, 50mJ, CO2RE 70mJ

Texture/Pigment CO2RE Mid, Ring 3: 111mJ: 30% 5 days post Dr. Susan Tanne, Livingston NJ

Texture/Pigment CO2RE Mid, Ring 3: 111mJ: 30% 5 days post Dr. Susan Tanne, Livingston NJ

Peri Oral: CO2RE Fusion: 50mJ Ring: 55mJ Core: 36% Cheeks: CO2RE Mid, Ring 3: 128mJ: 34% Forehead: CO2RE Mid, Ring 3: 110mJ: 34% 5 Days Post Dr. Susan Tanne, Livingston NJ

Cheeks: CO2RE Mid, Ring 3: 128mJ: 34% 7 Days Post Dr. Susan Tanne, Livingston NJ

Why does skin wrinkle with age? Chronological Aging and Wrinkles As a person ages the epidermal cells become thinner and less sticky. The thinner cells make the skin look noticeably thinner. The decreased stickiness of the cells decreases the effectiveness of the barrier function allowing moisture to be released instead of being kept in the skin. This causes dryness. The number of epidermal cells decreases by 10% per decade and they divide more slowly as we age making the skin less able to repair itself quickly. The effects of aging on the dermal layer are significant. Not only does the dermal layer thin, but also less collagen is produced, and the elastin fibers that provide elasticity wear out. These changes in the scaffolding of the skin cause the skin to wrinkle and sag. Also, sebaceous glands get bigger but produce less sebum, and the number of sweat glands decreases. Both of these changes lead to skin dryness. The rete-ridges of the dermal-epidermal junction flatten out, making the skin more fragile and making it easier for the skin to shear. This process also decreases the amount of nutrients available to the epidermis by decreasing the surface area in contact with the dermis, also interfering with the skin's normal repair process. In the subcutaneous layer the fat cells get smaller with age. This leads to more noticeable wrinkles and sagging, as the fat cells cannot "fill in" the damage from the other layers. Suzan Obagi, assistant professor in dermatology at the University of Pittsburgh and director of the Cosmetic Surgery and Skin Health Center, explains. Normal healthy skin has a nice epidermis with a smooth cornified, or outer, layer that acts as a good barrier to water and environmental injury. Skin color and tone is even and unblemished. Components such as collagen (which provides skin firmness), elastin (which supplies skin elasticity and rebound) and glycosaminoglycans or GAGs (which keep the skin hydrated) are all abundant. It is interesting to note that under a microscope a biopsy of a wrinkle exhibits no telltale signs that reveal it to be a wrinkle. So what causes the skin to look wrinkled? It is probably a multi-factorial process of intrinsic aging and extrinsic aging. Intrinsic aging is the natural aging process that takes place over the years regardless of outside influences. After the age of 20, a person produces about 1 percent less collagen in the skin each year. As a result, the skin becomes thinner and more fragile with age. There is also diminished functioning of the sweat and oil glands, less elastin production, and less GAG formation. Wrinkle formation as a result of intrinsic aging is inevitable, but it will always be slight. Extrinsic aging occurs in addition to intrinsic aging as a result of sun and environmental damage (tobacco use and exposure to pollution, for example). Extrinsic aging shows up as thickening of the cornified layer, precancerous changes such as lesions called actinic keratosis, skin cancer (including basal cell carcinoma, squamous cell carcinoma, lentigo maligna melanoma), freckle and sun spot formation, and exaggerated loss of collagen, elastin, and GAGs. Alone or in concert, these processes give the skin the appearance of roughness, uneven tone, brown patches, thin skin and deep wrinkles. Effects of Sunlight, Free Radicals, Hormones, Muscle Use, and Gravity From Heather Brannon, MD,

Aging Effects of the Sun and Wrinkles Exposure to ultraviolet light, UVA or UVB, from sunlight accounts for 90% of the symptoms of premature skin aging. Most of the photo aging effects occur by age 20. The amount of damage to the skin caused by the sun is determined by the total lifetime amount of radiation exposure and the person's pigment protection. Changes in the connective tissue reduce the skin's strength and elasticity. This is known as elastosis and is especially pronounced in sun-exposed areas. Effects of Sunlight, Free Radicals, Hormones, Muscle Use, and Gravity From Heather Brannon, MD