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

AGING GRACEFULLYAGING GRACEFULLY

NANCY SILVERBERG, MDNANCY SILVERBERG, MDChair,Chair,

Department of Dermatology,Department of Dermatology,Hoag Hospital Memorial Hoag Hospital Memorial

PresbyterianPresbyterianAssociate Clinical ProfessorAssociate Clinical Professor

of Dermatology, UCIof Dermatology, UCI

There are 3 skin layers: There are 3 skin layers: EpidermisEpidermisDermisDermisSubcutaneous layerSubcutaneous layer

Skin AnatomySkin Anatomy

Basal Layer

What is skin aging?What is skin aging?

• Collagen production slows (skin gets Collagen production slows (skin gets thinner)thinner)

• Elastin fibers break down (skin Elastin fibers break down (skin loses its ability to snap back after loses its ability to snap back after stretching)stretching)

• Subcutaneous fat decreases (skin Subcutaneous fat decreases (skin looks less plump and smooth)looks less plump and smooth)

• Turnover of skin cells slows downTurnover of skin cells slows down• Skin becomes dryerSkin becomes dryer

What causes skin to What causes skin to age?age?

• Sun (ultraviolet light)—damages elastin Sun (ultraviolet light)—damages elastin and collagen fibers, causing wrinkles, and collagen fibers, causing wrinkles, and producing mottling and brown spotsand producing mottling and brown spots

• Cigarette smoking—damages elastin and Cigarette smoking—damages elastin and decreases blood flow to skindecreases blood flow to skin

• Gravity—pulls on our bodies and with loss Gravity—pulls on our bodies and with loss of elastin and collagen, causes sagging of elastin and collagen, causes sagging

• Sleeping positions—cause creasesSleeping positions—cause creases• Facial expressions—muscles produce Facial expressions—muscles produce grooves in skin which gradually become grooves in skin which gradually become etched in faceetched in face

Prevention of skin Prevention of skin agingaging

AVOID ULTRAVIOLET LIGHT!!!!!AVOID ULTRAVIOLET LIGHT!!!!!•Avoid deliberate tanning Avoid deliberate tanning •Stay out of sun between 10AM and Stay out of sun between 10AM and 4PM4PM

•Wear protective clothing (hats, Wear protective clothing (hats, long sleeves)long sleeves)

•Apply broad spectrum (UVA and Apply broad spectrum (UVA and UVB) sunscreen (SPF 25 or UVB) sunscreen (SPF 25 or greater) year roundgreater) year round

Treatment of Aging Treatment of Aging SkinSkin

• ProductsProducts• Fillers and injectablesFillers and injectables• Peeling and microdermabrasionPeeling and microdermabrasion• ThermageThermage• LasersLasers• FraxelFraxel• Fractional CO2Fractional CO2

ProductsProducts

•SunscreenSunscreen

•MoisturizersMoisturizers

•TretinoinTretinoin

•Everything elseEverything else

Injectables and Injectables and FillersFillers

• Botox cosmetic, DysportBotox 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)

BotoxBotox

RestylaneRestylane

RestylaneRestylane

JuvedermJuvederm

JuvedermJuvederm

SculptraSculptra

Peels and Peels and MicrodermabrasionMicrodermabrasion

•Light “lunchtime” peels: Light “lunchtime” peels: glycolic, beta, Jessnerglycolic, beta, Jessner

•Medium depth peels: Medium depth peels: trichloroacetic acidtrichloroacetic acid

•Microdermabrasion: high Microdermabrasion: high pressure crystals delivered to pressure crystals delivered to skin which remove dead skin skin which remove dead skin cellscells

ThermageThermage

•Radiofrequency waves delivered Radiofrequency waves delivered to deeper skin layer which to deeper skin layer which causes tightening of skincauses tightening of skin

•Produces heat in deeper layers Produces heat in deeper layers of skin while maintaining cool of skin while maintaining cool on surface of skinon surface of skin

•Little recoveryLittle recovery•Not successful in all patients!Not successful in all patients!

ThermageThermage

ThermageThermage

LaserLaser

•Vascular lasers and intense pulsed Vascular lasers and intense pulsed light remove tiny blood vessels light remove tiny blood vessels and brown spotsand brown spots

•Q switched lasers (Ruby, Q switched lasers (Ruby, Versapulse, Medlite) remove brown Versapulse, Medlite) remove brown spotsspots

•Fraxel (fractionated erbium laser)Fraxel (fractionated erbium laser)•Fractional CO2 (fractionated CO2 Fractional CO2 (fractionated CO2 laser)laser)

Intense Pulsed Intense Pulsed LightLight

Intense Pulsed Light uses Intense Pulsed Light uses different wavelengths of light different wavelengths of light to target “broken” blood to target “broken” blood vessels and superficial brown vessels and superficial brown spots. The light energy is spots. The light energy is changed to heat energy, which changed to heat energy, which gradually fades the targeted gradually fades the targeted pigment or vessels. pigment or vessels.

Intense Pulsed Intense Pulsed LightLight

Intense Pulsed Intense Pulsed LightLight

FraxelFraxel

• Multiple tiny microscopic columns of Multiple tiny microscopic columns of erbium laser light treat a fraction erbium laser light treat a fraction of the skin at one treatment, making of the skin at one treatment, making recovery much easier than recovery much easier than resurfacing treatments.resurfacing treatments.

• Requires multiple treatmentsRequires multiple treatments• Decreases fine lines, wrinkles, Decreases fine lines, wrinkles, scars and skin blotchinessscars and skin blotchiness

• Not good for deep lines and sagging Not good for deep lines and sagging skinskin

FraxelFraxel

FraxelFraxel

Fractional CO2 (Active Fractional CO2 (Active FX)FX)• Columns of high energy CO2 laser Columns of high energy CO2 laser light interact with skinlight interact with skin

• Only a fraction of the skin’s surface Only a fraction of the skin’s surface is treated, leaving small “bridges” is treated, leaving small “bridges” of untreated skinof untreated skin

• Collagen in skin shrinks immediatelyCollagen in skin shrinks immediately• Stimulates collagen remodeling over Stimulates collagen remodeling over timetime

• Downtime usually less than one weekDowntime usually less than one week• Single treatmentSingle treatment

Fractional CO2 (Active Fractional CO2 (Active FX)FX) Primary Primary Targets:Targets:•Fine lines and wrinkles of the Fine lines and wrinkles of the faceface

•Crow’s feet around eyesCrow’s feet around eyes•Pucker marks (“smoker lines”) Pucker marks (“smoker lines”) and frown linesand frown lines

•Brown spots and blotchy, uneven Brown spots and blotchy, uneven skin toneskin tone

•Scars, especially acne scarsScars, especially acne scars

Before Day 1 Day 7

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Fractional Resurfacing - Clinical Results

Pre-Treatment 6 Weeks post Treatment

Scar Revision

Fractional Resurfacing - Clinical Results

TotalFX and Juvederm Combo Treatment

Fractional Resurfacing - Clinical Results

ThankThank You You