Nonsurgical Facial Rejuvenation and Skin Resurfacing Flashcards
Treatment of skin wrinkles requires ablative therapy
through the dermal-epidermal junction into a variable
depth of the reticular dermis.
F Treatment of skin wrinkles requires ablative therapy
through the dermal-epidermal junction into a variable
depth of the papillary dermis.
The precision and outcomes ofchemical peeling and dermabrasion are more technique dependent than their laser
counterparts
T
The epidermis is principally responsible for
protection from the sun and acts as a lipid barrier for water exchange
T
The papillary dermis begins
at the type III collagen-rich basement membrane and is composed of
loose areolar tissue with a dense capillary network that nourishes the
overlying epidermis
T
This capillary network in papillary is also important for heat
exchange with the environment and helps distinguish this layer from
the underlying reticular layer
t
The reticular dermis, primarily composed of type I collagen, accounts for the majority of skin thickness.
t
Fibroblasts, macrophages, and mast cells are all found in the papillary
layer and are key players in skin healing
F Fibroblasts, macrophages, and mast cells are all found in the reticular
layer and are key players in skin healing
Dermal appendages, including hair follicles and sebaceous glands are found in higher concentration
in the papillary dermis. Thus, efficiency ofhealing is inversely related
to depth of injury.
T
skin depth was
measured at 0.2 cm at the forehead, 0.5 cm at the menton, and 0.1 cm
at the zygomatic process and cheek and nasolabial fold regions
T
Solar damage causes actinic irregularities that are characterized
histologically by epidermal hyperplasia and keratinocyte proliferation forming seborrheic and actinic keratoses
T
In lentigines Both an increased number of basal melanocytes and increased deposition of melanin in
keratinocytes are observed.
T
Elimination of these pigmented lesions
requires targeted destruction of melanocytes in the basal layer of the epidermis
T
Melasma is a condition characterized by a symmetric hyperpigmented patches with an irregular outline
T
A Wood lamp can help distinguish melasma from other more
superficial skin pigmented lesions
T
The treatment of melasma is targeted at blocking melanin production with topical tretinoin, hydroquinone (HQ) 2% to 4%,
and topical corticosteroids
T
Additionally, dermal chemical peels, IPL,
and nonablative and ablative laser treatments may improve but not
fully eliminate melasma.
T
Loss of elastic fibers in the superficial dermis and elastotic thickening of the remaining elastic fibers
gives the skin a thickened and fissured appearance
T
Degeneration of
elastic fibers and reduction in glycosaminoglycans in the reticular dermis contributes to dermal thinning.
F Degeneration of
collagen fibers and reduction in glycosaminoglycans in the reticular dermis contributes to dermal thinning.
A loss of oxytalan fibers
at the DEJ that normally form vertical attachments between the
two layers of skin leads to laxity and also contributes to cutaneous
lines
T
underlying bony resorption, soft tissue volume loss, and
weakened osseocutaneous connections result in deflation and, thus,
the more prominent appearance of wrinkles
T
treatment of skin wrinkles requires ablative therapy
of the DEJ into the papillary dermis
T
Although both of these classification systems
are useful, they do not provide the physician with all the information
needed to select the ideal patient-specific treatment
T
FITZPATRICK SKIN TYPE 3 Sometimes burns, always tans, medium complex.ion
T
FITZPATRICK SKIN TYPE 5 Never burns, always tans, markedly dark brown/black
complexion
F Never. burns, always tans, medium brown complexion
Advanced GLOGAU SCALE Wrinkles in motion Usually needs makeup
Early keratosis, sallow complexion
F Wrinkles at rest
Many actinic keratosis, telangiectasia
Always wears makeup
Severe GLOGAU SCALE All wrinkles Severe keratosis, severe photoaging
Wears makeup with poor coverage
T
Special attention should be taken while treating patients with
freckles, melasma, or postinflammatory hyperpigmentation (PIH).
Regardless ofethnic background or skin type, a history of these signs
heralds the risk of PIH
T
the mechanism and depth of insult after which permanent
scarring occurs remain unclear and vary by modality
T
Deeper injuries within the dermal layer stimulate
fibroblast production ofnew collagen via the classic inflammation,
proliferation, and remodeling phases of wound healing
T
Areas prone to scar include the neck and mandibular border that
have thinner underlying dermis and fewer adnexal skin structuresfor
efficient re-epithelialization.
T
Skin conditioning should begin at least 6 weeks (or 8-12 weeks in
darker individuals) prior to chemical resurfacing
T
Vitamin A and its derivatives (tretinoin) are effective for reversing
actinic sun damage, reducing fine lines, improving skin texture, and
increasing collagen synthesis
T
decreased thickness of stratum corneum
keratinized cells occure with tretinoin treatment
T
decreased adherence of epithelial cells within
dermal appendages with Vitamin A and its derivatives (tretinoin)
T
tretinoin suppresses melanocyte
activity
T
It is often used as pretreatment for chemical peels to
ensure even depth oftreatment penetration and faster postprocedure
healing
T
erythema similar to a sun burn occurs with tretinion
T
It is the only therapy proven to
repair photodamage with benefits persisting even after discontinuation of use
T
A 6- to 12-week pretreatment
with tretinoin and HQ can help prevent pigmentation irregularities
following a chemical resurfacing procedure.
T
Salicylic acid is a-Hydroxy Acids Superficial Peels
F B-Hydroxy Acids
Treatment end point for
Glycolic is an indistinct frosting followed by a water rinse
T
Glycolic is the most widely used acid of the a-Hydroxy Acids because it penetrates the epidermis most easily owing to the fact that it is a small
molecule (two carbon chain)
T
The Food and Drug Administration
suggests a limit of30% concentration of Glycolic
T
Both the concentration and pH affect the penetration depth of glycolic acid
T
There is a risk of tinnitus
at higher concentrations with Salicylic acid
t
The treatment end point for salicylic acid is
a much more distinct white frost
T
Glycolic acid is superficial chemical peeling used and has demonstrated particular
effectiveness in acne patients
F Salicylic acid is superficial chemical peeling used and has demonstrated particular
effectiveness in acne patients
Salicylic acid is the most commonly used superficial peeling agent
F Jessner Solution
Jessner Solution combines both a-hydroxy and
P-hydroxy acids in low concentrations to take advantage ofthe benefits ofeach while limiting side effects
T
Jessner Solution required neutralization with water
F it does not require neutralization owing to its rapid volatility. The depth oftreatment is controlled by number oflayers applied
Jessner solution can be used in isolation as a superficial chemical peel
or as a prelude to a deeper peel, such as TCA
T
Trichloroacetic Acid is deep peeling agent
F Medium-Depth Peels
TCA causes protein coagulation and denaturation and can
be used to reach a variety ofdepths
T
TCA needs water for denaturalization
F It is self-neutralizing
TCA penetration increase with increasing the concentration
F regardless of concentration, the acid can drive
deeper into the skin with repeated application
Papillary dermis: white frost with pink beneath
T
The progression of the frosting color from pink to uniform white signifies entry
into the papillary dermis, and the subsequent gray hued frost denotes
the reticular dermis
T
Once the desired depth ofpeel is reached, the acid
is diluted with water, which helps to dissipate the heat generated with TCA
T
Erythema may persist for several days while collagen remodeling
proceeds
f Erythema may persist for several months while collagen remodeling
proceeds
Phenol, or carbolic acid are mediam peeling , causes rapid coagulation and destruction of
surface keratin
F Deep peeling
Phenol predictably penetrates the upper reticular dermis
for a relatively deep chemical peel to treat fine lines, wrinkles, and
dyschromias
T
phenol with croton oil for severely sun-damaged and thickened
skin
T
Phenol is the active ingredient for deep peeling in the Baker-Gordon formula
F croton oil
The end
point for phenol/croton oil is similar to the TCA frosting, but it
appears more gray-white
t
the phenol elicits an erythematous response, which can skew the appearance of the frost
F the croton oil elicits an erythematous response, which can skew the appearance of the frost
Phenol can cause scarring and hypopigmentation
T
Completely gray could indicate
full thickness skin destruction
T
re-epithelialization in 10 to 14 days
T
common complication from TCA peels is PIH especially in lighter
skinned patients
F common complication from TCA peels is PIH especially in darker
skinned patients
PIH came from increase the number of the melanocyte
F over production of
melanin from newly regenerated melanocytes
Pretreatment with
isotretinoin (Accutane) may increase the risk of hypertrophic scarring
T because it interferes with the re-epithelialization process and
keratinocyte adherence along dermal adnexal structures
Complications of phenol/croton peels include hypopigmentation due to decreased melanocytes
T
Cardiac monitoring and easily accessible resuscitation equipment are recommended in case of arrhythmia
for phenol peels
T
TCA hyperpigmentation phenol hypopigmentation
T
DERMABRASION involves mechanical abrasion and
complete obliteration of the epidermis with varying depth of dermal
penetration depending on the desired effect
T
Dermabrasion is most commonly used to reduce raised scars,
especially acne scars, to bring them to the same level as the surrounding skin
T
Histological
studies have demonstrated a permanent reduction in dermal thickness
following dermabrasion,
T which is distinct from the compensatory
dermal thickening that occurs following chemical peels and coagulative lasers.
The challenge with dermabrasion is the technical demands of uniform treatment
T
Temporary freezing techniques may increase tissue stiffness to facilitate ease of treatment
T
. Laser treatments targeting water produce histological changes similar to those of phenol peels
T
Complete photorejuvenation requires targeting water,
hemoglobin, and melanin
T
Laser light is monochromatic
T
The dermis is white making it a strongly scattering surface
T
shorter wavelengths
have a higher absorption coefficient and penetrate more superficially
compared with longer wavelengths
T
decreasing the spot
size will increase the power density. also
decreases the depth of penetration and increases scatter.
T
Molecular structural changes occur at temperatures from 43 to S0°C.
T
Epidermal damage is most likely with visible light (green-yellow,
IPL) treatments targeting dermal hair follicles and blood vessels.
T
Ablation refers to the uniform destruction of tissue within the epidermis and/or papillary dermis.
T
Ablative Lasers
erbium:YAG and carbon dioxide (CO
2)
Continuous CO
2 laser resurfacing remains the most effective
method of wrinkle removal.
T
CO2 laser effective against deep coarse fixed
perioral and periorbital rhytids
T
Co2 cause hyperpigmentation
F permanent hypopigmentation which has decreased the CO2 modality’s
popularity
The (Er:YAG) has an affinity for water that is nearly 12 to
15 times higher than that of the CO2 laser
T
(Er:YAG) cause less collateral damage
T
collagen contracture is less with Er:YAG
T
Newer Erbium devices have lengthened the laser pulse duration to induce better tissue contraction.
T
CO2 laser delivers either coagulation or cool ablation
F Er:YAG laser can be used to deliver either coagulation or cool ablation
The clinical endpoint of using the CO2 laser is a chamois color
seen with ablation of the reticular dermis
T
Erbium lasers create less coagulated tissue to absorb heat and
make it is easier to drill deeper wounds into the skin
T
With
each additional pass of the CO2 laser, there is a diminishing or plateaued response because the residual carbonized tissue acts as a heat
sink
T
Following CO2 laser treatment, the desiccated tissue should be wiped
off;
T after erbium laser treatment, the barrier is left in place
for faster healing and decreased posttreatment pigmentary changes.
Ablative lasers are also commonly used to treat acne scarring
T
elevated acne scars are more amenable to ablative resurfacing than ice-pick or nondistensible surface irregularities
T
ablative laser therapy carries the
risk of infection (bacterial, viral, and fungal) due to the absence of
the protective epidermal barrier
T
All patients should be treated prophylactically with antiviral medications to prevent herpetic infection
T
This treatment should begin I or 2 days before
laser treatment and continue for 2 weeks following
T
Fractional laser can be used on darker skinned patients.
T
One of the first
clinical applications of fractionated laser therapy was treatment of
facial melasma
T
Fractionated treatments have led to less dramatic
results than the unfractionated ablative devices
T
Hybrid Fractionated Lasers use both fractionated
Er:YAG and
diode laser
T
Nonablative facial skin rejuvenation refers to interventions that preserve the epidermis and generate selective dermal heating for wrinkle
reduction
T
purpuric reaction, can be avoided by delivering longer pulse
widths
T
Visible light (520-600 nm) has a very strong affinity for hemoglobin and melanin
T
infrared II can be used in patients with higher Fitzpatrick types
T infrared II has the weakest affinity for melanin rendering it safer to use in patients with higher Fitzpatrick types
The pulsed dye laser effective laser choice for treating vascular lesions (telangiectasias, capillary malformations, rosacea)
t
Longer
pulse durations (6-10 ms) are less effective In PDL laser
T
PDL can be used for darker skin people
This device should be used with
caution in patients with darker skin, as they may be prone to burns
and depigmentation
KTPis safest in patients with skin phototypes I-III as the
wavelength is also absorbed by melanin
t
KTP treatments under general anesthetic
T
Nd:YAG not attracted to a specific chromophore
T
Nd:YAG safer to use in darker skinned patients
T
Nd:YAG painful
T
Intense Pulsed Light emits noncoherent, noncollimated, polychromatic light
T
IPL is safest to use in patients with skin phototypes 1-111
T
