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Fundamental Concepts About Facial Photoaging Treatments

Wrinkles, tiny blood vessels and brown spots are very typical signs of aging and can add years to your facial appearance. While many feel that these are just the effects of aging, in reality they are the long-term effects of unseen sun damage from years ago.What may have been a love affair with the sun in our early years eventually appears as something we hate decades later.

Fortunately, there are numerous treatments to help treat these chronic signs of sun damage known as photoaging. Lasers, peels and light treatments, and many combinations thereof, can help offset the damaging effects of our lifelong exposure to ultraviolet light.

While there are many available skin treatments, their sheer number makes it very confusing to patients. Here is a brief overview:

PEELS. For patients with light skin damage and fine wrinkles, a chemical peel can be a great treatment. By removing several superficial layers of outer skin, one can smooth the skin and get rid of some brown spots. There are many types of peels but those that provide real therapeutic benefit are light TCA and the newer Vi peel. These peels are usually combined with a microdermabrasion which helps prep the skin to receive the peel. In general, peels help most with pigmented skin problems and less for significant wrinkle issues.

LIGHT and LASERS. Light treatments, known as IPL or BBL, are excellent for brown spots and telangectasias. They work by emitting a polychromatic light with multiple absorption targets. (melanin in brown spots and hemoglobin in telangectasias) Since they pass through the skin and only hit the target, there is no real downtime. Lasers work by burning off the top layers of skin. As of now, there are two fundamental laser skin resurfacing approaches, micropeeling and fractional. Micropeeling removes 100% of the outer surface at a set depth. Fractional punches holes in the skin but only treats about 10% of the surface area in a single treatment. When it comes to which is better for skin resurfacing, the jury is still out. Fractional is the newest laser toy so it receives a lot of press, but it is not magic and the choice between the two (or combination) is up to the practitioner’s experience.

COMBINATION APPROACHES. If a patient has significant wrinkles or skin texture problems, then I would recommend a laser resurfacing with the depth based on how much recovery they can allow. This is often combined with some Botox for muscle action decrease and injectable fillers for volume loss. If the photoaging damage is less, then BBL and chemical peels can suffice.

Many times, the combination of BBL for brown spots, laser resurfacing for wrinkles and texture and Skin Type (for tightening some loose skin) can be safely combined in a single treatment. While this will not create the same results as a facelift, for those with lesser amounts of skin laxity it can create a really significant improvement with much less recovery.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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