The ABC's of plastic surgery:
Younger-looking skin: facial rejuvenation through photorejuvenation.
By Dr. Mathew C. Mosher

Large numbers of patients are interested in improving and rejuvenating their appearance. One of the most exciting techniques available today is photorejuvenation, a treatment using intense pulse light (IPL™) to restore skin to a younger look.

During the past decade our understanding of the skin’s visible aging process has grown tremendously. We see these changes as a combination of features developing to different degrees in all of us. Take a look at your childhood photos or better yet, look at the skin of your children or grandchildren. You’ll usually see clear skin with smooth texture and no wrinkles, aside from the acne appearing in the second decade of life. Old-looking skin has features like mottled pigmentation, blotchy redness, visible small capillaries called telangiectasias, and eventually, wrinkles, unwanted facial hair, large visible pores and loss of tone.

Aging skin changes are influenced by sun exposure (UV or photo-damage), genetic factors, environmental exposure such as smoke and pollution, skin diseases like rosacea and many other causes. Solar damage is an extremely important factor. Although awareness of this fact is improving, increased outdoor activities and a thinning ozone layer contributes to seeing these unwanted skin changes more often—even in patients in their 20s and 30s.

Intense pulse light treatments have been available for more than a decade. This office-based treatment fits well with today’s active lifestyles and patients’ requests for procedures with no “downtime.”

“Old-looking skin has features like mottled pigmentation, blotchy redness, visible small capillaries called telangiectasias, and eventually, wrinkles, unwanted facial hair, large visible pores and loss of tone.”

How it works:

The light energy delivered during an IPL™ treatment is preferentially absorbed by targets in the skin called chromophores. The most abundant chromophore in the skin is melanin, which gives our skin varying degrees of color. When unwanted clusters of pigment are present, they will absorb more light energy than the nearby normal skin. The clusters break up from this energy absorption, resulting in a more uniform distribution of pigment and clearer skin.

Another chromophore is hemoglobin. A cluster of hemoglobin occurs in dilated and broken capillaries within the upper skin layer and will fade away after treatment. This improvement is particularly helpful for people with the facial redness associated with rosacea, a skin condition affecting nearly 10 per cent of the Caucasian population. Other targets for the IPL™ treatments are collagen and elastin. The light energy helps to stimulate replacement of damaged collagen and elastin fibers with younger and healthier ones, resulting in diminished fine lines, smaller pores and improved texture.

In most cases, a series of three to six treatment sessions will be recommended, performed at intervals of about three weeks. These treatments take about 45 minutes and allow patients to return to their lifestyles on the same day. The average cost of a single photorejuvenation treatment is between $350 and $500.

Risks and rewards:

Anyone considering photorejuvenation treatments should have a consultation by a plastic surgeon or dermatologist specializing in cosmetic skin care. Adverse effects from IPL™ treatments should be minimal and are very uncommon when performed by trained and experienced personnel.

While all laser and light treatments carry some risk of creating small burns on the skin’s surface, this risk is proportional to the amount of light energy delivered. The latest technology available is from the Aurora SR from Syneron Inc. This machine combines intense pulse light with conducted radio-frequency energy to rejuvenate the skin. This patented system is unique and exciting. The conducted radio-frequency energy also stimulates rejuvenative changes in the skin and assists the changes occurring with IPL™ alone. Less IPL™ energy is usually needed to achieve the same results on skin color, resulting in a more comfortable procedure with less risk of light-induced burning of the skin surface.

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“The goal of treatment is harmony of color and texture—damaged
areas improve the most but other regions also benefit.”

Recent studies have demonstrated similar improvements in redness and excess pigmentation when intense pulse light and radio-frequency energies are used together, compared to the use of intense pulse light alone. Early reports also indicate more improvements achieved on wrinkles, enlarged pores and texture. It remains to be seen if this newer technology sets a higher standard for photorejuvenation of the skin.

Photorejuvenation is best suited to patients with lighter skin colors but can be safely used on brown skin as well. Lighter skin frequently shows the most dramatic age-related changes and therefore often benefits the most from this approach. Darker skin has more natural pigment; this can interfere with targeting only the unwanted pigment clusters. Fotofacial treatments generally treat the entire face or neck while Fotobody treatments target the arms, etc., to avoid patches of lightening. This is why photorejuvenation (the umbrella term for Fotofacial/Fotobody treatments) is rarely used to treat isolated spots; there are better-suited laser technologies for this purpose. The goal of treatment is harmony of color and texture—damaged areas improve the most but other regions also benefit.

Photorejuvenation is recognized today as a comfortable and convenient treatment producing excellent long-term results with a high degree of patient satisfaction. It is important to combine treatments with therapeutic skin care products and a healthy lifestyle to see the maximum results.

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