In this presentation Naheed R. Abbasi, MD, MPH, FAAD, Summit Medical Group Department of Dermatology, shares how an understanding of the skin helps to identify technologies most likely to be effective in improving pigment, lines, volume loss and skin laxity. Dr. Abbasi explains numerous minimally invasive technologies available that pose minimal risk and produce little downtime and how surgery can be avoided or postponed through less invasive techniques.

1. Minimally Invasive Techniques
In Facial Rejuvenation
Naheed R. Abbasi, MD, MPH, FAAD
Summit Medical Group
Department of Dermatology
February 23, 2011

2. Background and Practice Overview
 Education
• B.A .Harvard College
• MD and MPH from UC Berkeley-UCSF Joint Medical Program
 Training
• Internal Medicine internship at St. Vincent’s Manhattan
• Dermatology residency and chief residency at New York
University
• Cosmetic and Laser fellowship at SkinCare Physicians in
Boston, affiliated with Harvard/Yale/Dartmouth
 Practice
• Medical dermatology
• Cosmetic dermatology (Toxins, Fillers, etc.)
• Lasers for both medical and cosmetic indications

3. Why Rejuvenate the Face?
 Appearances matter
 The effects of sun, smoking and time itself can make
the skin lackluster
 Aging itself produces volume loss which is manifest as
“sagging skin”
 There are minimally invasive techniques designed to
rejuvenate the face with little downtime and little risk

4. Overview of the Skin

5. The Faces of Aging

6. How can we reverse the visible effects of photoaging?
• Toxins
• Fillers
• Superficial and Deep
Peels
• Lasers

7. Toxins
• Botulinum toxins have been used for decades to decrease
unwanted muscle movement
 Botox®: Allergan
 Dysport®: Medicis
• Toxins inhibit unwanted muscle movement making “dynamic
lines” softer
• Effects typically last between 4.5 and 6 months
• Toxins are used for treatment of wrinkles and also for migraine
headaches, hyperhidrosis

8. Study Subject with single injection

9. Dermal Fillers
• Help remedy the loss of facial volume that is characteristic
of aging
• There are two types:
 Hylaurinic acid: 6-9 months duration of effect on average
• Restylane®
• Juvederm®
 Non-HA
• Radiesse®
• Sculptra®
• Collagen
• Silicon

10. Before and After Juvederm®

11. Superficial and Deep Peels
 Chemical peels use various agents (e.g. salicylic acid,
glycolic acid, vitamin C, kojic acid, TCA etc.) to induce
changes in the superficial to mid-levels of skin.
 Most peels are superficial and thus target pigment and
texture for a short-term basis.
 Superficial peels are not the gold-standard therapy for
wrinkles, significant volume loss, or scars, but can greatly
improve skin luster and pigment.
 Superficial peels can also improve acne, at least for the
short-term.
 Deep peels can induce more significant changes in collagen
but come with greater risk.

12. Lasers
 LASER= Light amplification by stimulated emission of
radiation
 Selective photothermolysis is the concept explaining how a
laser can induce selective injury to a skin structure while
minimizing damage to surrounding normal tissue
 At SMG we commonly use the following lasers to achieve
specific endpoints:
 Long-pulsed alexandrite and Nd:Yag (GentleLase and GYag) for hair removal
 Pulsed dye laser to treat broken blood vessels, rosacea, vascular birthmarks,
certain scars
 Q-switched lasers for treatment of brown spots and tatoos
 Fractional resurfacing laser for treatment of sun damage, texture, acne scars,
pigment, etc.

13. Laser Hair Removal
• Safe in all skin types
• Typically 4-10
treatments required
• Common reasons to
treat include ease of
skin maintenance,
ingrown hairs, hormonal
or age-related hair
changes
Photos courtesy of Candela Medical

14. Pulsed Dye Laser
• Treats unwanted redness
including that from
rosacea, broken blood
vessels, scars, and
birthmarks
Courtesy of Tom Rohrer, MD and emedicine.com

15. Q-switched Lasers
• Target brown spots such as
freckles
• Gold-standard for treatment
of tatoos of every color,
with black tatoos easiest to
treat
• Brown spots typically
respond to 1-3 treatments
while tatoos require more
sessions

16. Fractional Resurfacing Lasers
• Stimulate collagen, improve
fine lines, improve pigment,
and recontour scars
including those from acne
• Many results are permanent
• Studies show microscopic
reversal of sun damage
Images from Solta Medical Aesthetic Clinic

17. ThermaCool (Thermage)
• Monopolar radiofrequency
device that can induce skin
tightening without surgery
• Remodels and tightens
collagen in the deep dermis
without injuring the skin
• Commonly used on cheeks,
mandible, upper neck
Images from Solta Medical

18. Conclusions
• An understanding of the skin helps to identify technologies
most likely to be effective in improving pigment, lines,
volume loss and skin laxity.
• There are numerous minimally invasive technologies available
that pose minimal risk and produce little downtime.
• Surgery can be avoided or postponed through less invasive
techniques.