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Skin Rejuvenation Devices in the Medical Spa

By: Steven H. Dayan, MD, FACS; Tracy L. Drumm; and Terri A. Wojak
Posted: February 28, 2012, from the March 2012 issue of Skin Inc. magazine.
light-based device

Skin rejuvenation devices, both in the skin care facility and at-home, are becoming a must-have for savvy skin care clients. By understanding the purposes of the various device options, what they are purported to do and who can operate them, you can decide whether to incorporate skin rejuvenation devices into your menu of services, and which ones will work best for your clients ... and your skin care professionals.

Physician’s point of view: Steven H. Dayan, MD, FACS

Device-based nonsurgical cosmetic procedures are growing at an exorbitant rate, far surpassing the growth of cosmetic surgical procedures. Today’s clients want to undergo procedures that will make them look good fast, and they do not want the downtime, the risks or the perceived inconveniences that come with surgery. Since the late 1990s, the medical industry has responded to this demand by developing several new technologies. The creation and promotion of these devices and products has been rapid and, at times, the enthusiasm for new devices has outpaced the promised results.

In the face and neck region, nonsurgical treatments aimed at treating the dermal structures are important to achieve complete rejuvenation and are frequently used in tandem with surgical treatments. The technique for working in this area is now known as dermal remodeling, skin-tightening or nonablative skin rejuvenation, during which no damage is made to the outer layers of skin. In nonablative treatments, all injury is taking place in the lower layers of the skin and nothing is seen on the surface. This method is commonly used to stimulate collagen reformation below the skin’s surface without burning the top layers of the skin, as ablative lasers do. The most popular of the medical devices used for nonablative skin rejuvenation are visible light lasers, intense pulsed light (IPL) and radio frequency.

Visible light lasers and IPL. Initially, visible light lasers and IPL devices were used to achieve skin-tightening. The prevailing theories regarding these devices was that specifically designed lasers in the mid-to-near infrared spectrum of light will skip over the outer layers of skin, and penetrate deep into the dermis where they deposit energy and denature proteins. This heat then stimulates collagen proliferation, resulting in a thickening of the healthy skin layers, gradually ridding the skin of superficial wrinkles. A second idea is that, by targeting and injuring microcapillaries, visible light lasers and IPLs will increase the permeability of these tiny dermal vessels, prompting the release of inflammatory mediators. These mediators then stimulate fibroblasts to produce collagen, which also results in wrinkle reduction.

Although there is no doubt that IPL and visible light laser devices improve the appearance of dyschromias—brown and red discolorations of the skin—their ability to remove wrinkles and tighten skin is less consistent. Patients expecting wrinkle-reduction from these devices often need several treatments to see results; at least four to six treatments performed on a monthly basis are recommended. Those undergoing the treatments must be patient, because improvements on the skin’s surface will be gradual and subtle. Collagen formation continues for months following treatments, after which patients can expect a smoother and healthier-looking facial appearance.

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