Skin-lightening Challenges

By: Zoe Diana Draelos, MD

Posted: June 2, 2009, from the June 2009 issue of Skin Inc. Magazine.

Photosensitivity related to Laser & Light Based Skin Procedures

Cosmetic Reactions

Despite product testing by cosmetic companies before new product releases to the public, adverse reactions are still experienced by consumers of cosmetics. Cosmetics can cause reactions such as, but not limited to, irritant contact dermatitis, allergic contact dermatitis, photocontact dermatitis, contact urticaria, pigmentary changes and acneiform reactions.

Source: Skin & Aging
Volume 17 - Issue 3 - March 2009
MARIA ELENA MIYAR, BA, AND LESLIE BAUMANN, MD

After completing this workshop, participants will leave with a comprehensive business plan for their aesthetic medicine practice. This program will cover all aspects of creating a business plan for a profitable medical spa, including:

•    Financing options for physicians;
•    Target demographics for tailored aesthetic procedures;
•    Developing a menu of treatments and pricing strategies;
•    Establishing aesthetic practice protocols and HR for aesthetic practitioners;
•    Creating an effective marketing plan;
•    Finding the right location;
•    Staffing;
•    Federal and state legal and regulatory issues; and
•    Startup costs and reading financials.

Advanced Skin Care with Laser based technology for skin rejuvenation may include ablative procedures that produce laser plume or Laser Generated Airborne Contaminants. It is important that with each skin care treatment that treatment providers observe universal precautions.


Infection Control

Adequate and effective means to prevent the spread of infection shall be taken utilizing standard precautions as in 29CFR 1910.30

Laser Generated Airborne Contaminants (LGAC)

In operations using laser that produce vaporized target tissue through the disruption of cells, LGAC is a resulting hazard, requiring appropriate management. 

Infection Control-LGAC Pathogens

LGAC can contain blood, blood by-products and pathogens. Laser users need to be aware of the potential exposureto such products during any laser procedures, and shall use control measures, such as universal precautions, that are covered by the Blood-Borne Pathogen Standard
(29 CFR 1910.1030)

Source: ANSI Z136.3-2005  7.3; 7.4; 7.4.1
 

Exposures to blood and other body fluids occur across a wide variety of occupations. Health care workers, emergency response and public safety personnel, and other workers can be exposed to blood through needlestick and other sharps injuries, mucous membrane, and skin exposures. The pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Workers and employers are urged to take advantage of available engineering controls and work practices to prevent exposure to blood and other body fluids.
 

Sun damage is a primary cause of wrinkles

Premature aging of the skin is most often the product of years of unprotected sun exposure combined with your genetic makeup. The process of aging causes the skin to thin, become less elastic and more fragile. Your body also produces less natural protective oils, which makes the skin drier. In addition, the fat located in the deeper layers of the skin, that gives your skin a plump appearance, starts to diminish over time. The combination of these factors causes loose, saggy and wrinkly. 

It is very important that to protect the skin from sun exposure. Skin Rejuvenation with Laser based technology can address pigmented lesions, facial veins and Skin Tightening. Lasers are part of advanced skin care but most importantly the skin has to be protected from further damage that causes the pigmented lesions, facial veins and skin laxity.  
 
Sun Care

Skin Care Treatment and Skin Rejuvenation

Proactive Protection for the Skin

We may not always realize it, but our skin provides protection from outside elements. In a single lifetime, numerous environmental insults work to damage and alter this fine sheath. In fact, 85 percent of visible changes that age the skin come from outside factors, such as the sun, detergents and pollutants.

Physicians have numerous tools to reverse these effects, including retinoids, light energy devices, fillers and surgery. However, research has recently shifted to more preventive measures. By fighting chronic inflammation and maintaining skin barrier function, we may be able to prevent and reverse the visible signs of photoaging.

Advanced skin care and skin rejuvenation of aging skin requires restoring barrier function of the skin and decreasing the inflammatory process that may be present.

The success of an advanced skin care treatment plan is based on proper evaluation and management of patient expectations. It is important to identify patient goals and expectations in order to set proper patient expectations of treatment results. Treatment "failures" in skin rejuvenation are often accompanied by unrealistic patient expectations that Laser based technology will completely reverse skin damage that occurred over many years. Too often, client's perception of the treatment outcome does not match actual treatment results due to unrealistic patient expectations. Patient education is very important not only to manage patient expectations but also to empower the patient with a sense of responsibilty toward a favorable outcome. What the patient does everyday has the biggest impact on the final outcome of the treatment provided.

Unrealistic Patient Expectations Create Physician Backlash

Chronological aging and changes in the skin are part of the natural aging process. Genetic factors and hormones influence the skin quality and durability over time. Thicker, darker skin tends to wrinkle less.

Environmental factors such as sun exposure, prolonged exposure to wind, cold and pollution cause cumulative damage to the skin over time.

Smoking also causes skin damage over time. Nicotine causes constriction of the blood vessels that decreases the blood flow to the skin. Toxic substances from smoking affect the skin through the circulatory system and may damage collagen and elastin fibres.

Degeneration of elastin fibres and collagen fibres causes the skin to lose it's strength with subsequent loosening of the skin. These changes in the skin lead to the appearance of fine lines, wrinkles, deep facial expression lines and skin laxity. Fine lines and wrinkle are caused by the decline in the quantity and quality of the elastin fibres.

Additional changes in the skin is the gradual thinning of all layers of the skin (epidermis, dermis & subcutaneous layers). Loss of subcutaneous fat is seen in areas of the face and hands. The skin becomes drier due to the gradual decline in the activity of the sebacious glands. There are changes in hair growth with thinning of the hair on the body.

Sun exposure is the primary environmental cause of skin damage along with prolonged exposure to cold and wind. Sun exposure degenerates the elastin in the skin leading to the formation of wrinkles and loss of elasticity. Sun exposure also creates uneven pigment, formation of solar lentigines, dilated blood vessels (telangiectases), wrinkles and skin laxity.

Advanced Skin care and skin rejuvention may include skin tightening with Titan to address laxity. Laser Genesis to address texture and diffuse redness. Laser vein treatment for dilated blood vessels. LimeLight facial to address pigmented lesions but may also treat vascular issues. These treatment modalities may be combined with both Pearl and Pearl Fractional Laser treatments to address both epidermal & dermal changes. Cutera Laser based technology has been optimized to address the many issues of aging skin.

Causes of Aging Skin

Reference: "Handbook of Cosmetic Skin Care"; Avi Shai; Howard I Maibach; Robert Baran