SKIN REJUVENATION AND PHOTO-AGING

TRAINING COURSE

WHAT IS SKIN REJUVENATION?

WHAT IS PHOTO-AGING?

Photo-aging is a complex biological process:

- Intrinsic Aging: A result of the natural, normal aging process. Skin begins to show sagging due to breakdown of collagen due to slow and irreversible tissue degeneration

- Extrinsic Aging or Photo-Aging: The result of damaging exposure to elements outside of our bodies (wind, sun, UV, pollution, smoking, etc.)

Damage includes loss of collagen and sagging plus pigment & vascular deposits

WHAT IS PHOTO-AGING?

Results of Photo-aging:

- reduced rate of synthesis of collagen and elastin (loss of elasticity), skin laxity, mild to moderate wrinkles.

- skin becomes rough and wrinkled (lines and wrinkles), poor skin texture.

- enlarged pores, acne scarring.

- pigmentation changes, telangiectasia (thread veins) occurs.

COMPONENT OF PHOTO-AGING

• The exact mix of these elements will depend upon age, sex and ethnic background.

• Asians generally exhibit pigmentary dischromia, whereas Caucasians have Telangiectasia as the primary component of photo-aging.

• Specific “macro” vascular and pigmented conditions like spider nevi, telangiectesia, age spots are often the results of age and sun damage.

TREATMENT PROGRAM

• They should be treated separately before undertaking a treatment program of skin rejuvenation.

• Each condition should be treated separately within a comprehensive treatment program of skin rejuvenation. This treatment programme should be discussed and explained to the customer at the initial consultation.

• However, with Caucasian skin type, it probably matters very little which specific condition is targeted first as broadband light contains wavelengths that will impact to some degree both pigmented and vascular abnormalities.

WHAT CAN ONE TREAT WITH iPulse IPL?

SUPERFICIAL PIGMENTATIONFirst step

• The treatment of superficial epidermal pigmented lesions in darker skin types is undertaken with the IPL as the first IPL treatment step as reduction of pigmented dischromia in the epidermis will allow deeper penetration of IPL at subsequent treatments using settings for vascular lesions and collagen stimulation.

Skin/Light Interaction

• For Pigmented blemishes, the light energy is absorbed by the superficial pigment (chromophore). The light energy then converts into heat, targeting the pigment based on the targets thermal-relaxation time (TRT).

• The light / heat energy causes non-specific thermal necrosis of the melanin-containing pigment.

PIGMENTED BLEMISHES

• IPLs just damage pigmented blemishes they can reach (mostly epidermal) by non-specific thermal necrosis. This means you have to use enough energy (higher fluence settings) especially where skin / pigmented blemish color contrast is weak.

• However, care must be taken to avoid damaging the surrounding unblemished skin when treating pigmented lesions. Careful use of cooled gel, post-treatment skin cooling and calming lotions (like Aloe Vera) can minimize side effects. Moderate to severe erythema can be treated with a single use of steroid ointment.

SKIN TYPES?

• Most successful treatments of mottled blemishes are of epidermal pigmentation.

• Combined treatments with pigment lightening creams give better results.

• Can treat successfully Skin types I/IIIa.• Similar results are achievable with Skin Types IIIb/IV/V

but the natural melanin density competes with the pigmented lesion, increasing the risk of hypo or hyper- pigmentation.

HOW MANY TREATMENTS?• From 3 to 5+ treatments are standard, depending on the

degree of pigmented blemishes on the skin. Only a proper diagnosis with a Wood’s Lamp can determine how superficial the pigment is.

• Gap between treatments: 3-4 weeks(Always test patch to avoid hyper-pigmentation, particularly on skin types 3+)

• Where the target is pigment only (i.e. NOT general skin rejuvenation) a “pressure” technique should be used. That means, the iPulse operator should use the same firm pressure on the applicator / glass block on the skin surface that they would use for hair removal. Compression of the skin will remove blood from the capillaries therefore reducing competition for the iPulse IPL energy.

RESULTS• The optimal successful endpoint of a treatment is

darkening of the pigmented area (usually within 20mins), followed by further darkening over 2 days and natural exfoliation of the darkened area in the next 7-21 days.

• IT IS NOT NECESSARY TO CREATE CRUSTING TO GET GOOD PIGMENT REDUCTION ALTHOUGH CRUSTING USUALLY INDICATES THAT SIDE-EFFECT THRESHOLD FLUENCES HAVE BEEN USED.

• This treatment leaves a lightly de-pigmented area, which becomes normal in the next few weeks.

• The sensitive new skin must be protected! Use of sun block (SPF +30) daily is a must.

Skin Rejuvenation Parameters Skin Types 1- 3

FitzpatrickSkin Type

PigmentColor

Program Joules/cm2

1 Light 3 14 – 17

1 Medium 4 14 – 17

1 Dark 10 14 – 17

2 Light 3 14 – 17

2 Medium 4 14 – 17

2 Dark 10 14 – 17

3a Light 4 14 – 17

3a Medium 5 14 – 17

3a Dark 6 14 – 17

3b Light 6 14 – 17

3b Medium 7 14 – 17

3b Dark 10 14 – 17

Skin Rejuvenation ParametersSkin Types 4 & 5

FitzpatrickSkin Type

PigmentColor

Program Joules/cm2

4a Light 10 13 – 17

4a Medium 15 13 – 17

4a Dark 16 12 – 17

4b Light 10 13 – 16

4b Medium 12 12 – 16

4b Dark 15 12 – 16

5 Light 10 13 – 16

5 Medium 12 13 – 16

5 Dark 15 12 – 16

6 n/a n/a n/a

Epidermal Pigmentation

Solar Lentignes (Pigmentation)

Pigmented Lesions

Pigmentary Dischromia

Melasma: Female, 30 yrs, skin type IV, before and 7 weeks after (5 treatments at weekly intervals),

13 J/cm2, triple sub-pulses 10 ms on, 20 ms off.

Pigmentation on Skin Types 4 & 5

Hyper-Pigmentation on Skin Type 5

BEFORE & AFTER 1 iPulse Treatment

AGE SPOTSBefore & After 2 iPulse

Treatments

PIGMENTATION

Facial rejuvenation: Female, 75 yrs, skin type III, 17 J/cm2, 5 treatments every 2 weeks.

MELASMA: Very Difficult to Treat!

• Facial Melasma (Chloasma / Mask of Pregnancy) includes dermal & epidermal hyper-pigmentation, iPulse treats only surface, or epidermal pigmentation.

• The successful endpoint of this treatment may include lightening of the pigmented lesion (but may not include any color changes in the deeper located pigment).

MELASMA: POOR RESULTS

ACTINIC KERATOSIS AND NASAL MELASMA

Female, 34 yrs, skin type III, before and after 3 iPulse treatments only, 17 J/cm2 showing resolution of the AK and significant reduction in epidermal melasma elements, improved skin texture and pore size reduction.