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

3. Skin Anatomy There are 3 skin layers: Epidermis Dermis
Subcutaneous layer 3

4. Basal Layer
Epidermis: 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 down
Skin becomes dryer

7. What causes skin to age?
Sun (ultraviolet light)—damages elastin and collagen fibers, causing wrinkles, and producing mottling and brown spots
Cigarette smoking—damages elastin and decreases blood flow to skin
Gravity—pulls on our bodies and with loss of elastin and collagen, causes sagging
Sleeping positions—cause creases
Facial expressions—muscles produce grooves in skin which gradually become etched in face

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

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

12. Products
Sunscreen
Moisturizers
Tretinoin
Everything else

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

14. Botox

15. Restylane

16. Restylane

17. Juvederm

18. Juvederm

19. Sculptra

20. Peels and Microdermabrasion
Light “lunchtime” peels: glycolic, beta, Jessner
Medium depth peels: trichloroacetic acid
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
Produces heat in deeper layers of skin while maintaining cool on surface of skin
Little recovery
Not successful in all patients!

22. Thermage

23. Thermage

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

26. Intense Pulsed Light

27. Intense Pulsed Light

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.
Requires multiple treatments
Decreases fine lines, wrinkles, scars and skin blotchiness
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
Only a fraction of the skin’s surface is treated, leaving small “bridges” of untreated skin
Collagen in skin shrinks immediately
Stimulates collagen remodeling over time
Downtime usually less than one week
Single treatment

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

33. Fractional Resurfacing - Clinical Results
Day 1
Day 7
Before

34. Fractional Resurfacing - Clinical Results34

35. Fractional Resurfacing - Clinical Results
Active FX: 1 treatment: CPG 3-6-3, 125 Hz, 100 mJ, double passage on crow’s feet; 6 months follow-up 35 35

36. Fractional Resurfacing - Clinical Results
Right crow’s feet region of the previous patient before and after (6 months) 36 36 36

37. Fractional Resurfacing - Clinical Results
Active FX: CPG settings: 3-6-3; 100 mJ fluence; 125 Hz; double passage on periorbital region 37 37 37

38. Fractional Resurfacing - Clinical Results38 38

39. Fractional Resurfacing - Clinical Results

40. Fractional Resurfacing - Clinical Results40 40

41. Fractional Resurfacing - Clinical Results
Pre-Treatment
6 Weeks post Treatment

42. Fractional Resurfacing - Clinical Results
Scar Revision

43. Fractional Resurfacing - Clinical Results
TotalFX and Juvederm Combo Treatment

44. Thank You