Treatment - Skin Rejuvenation

The concept of using Intense Pulse Light sources for the treatment of many skin conditions associated with the aging process is currently receiving considerable interest within the professional beauty industry and the general public. There exists today a rapidly growing demand for addressing the signs of aging with safe simple techniques. Until the recent introduction of Intense Pulsed Light (IPL™) and more recently Variable Pulsed Light (VPL™) treatment (initially, successfully developed for hair depilation), the only available treatments included surgery, chemical peeling, ablative and non-ablative resurfacing, microdermabrasion and various visible light and near IR laser treatments.

• Current treatments available include:
• Cosmeceuticals: hydrate the skin and induce minor surface changes
• Microdermabrasion: layers of skin are actually 'sanded away'
• Chemical peel: uses acid solution to burn away layers of skin
• Non-Ablative Lasers: good results can be obtained, but limited to what can be treated. Expensive equipment and procedures
• Laser Resurfacing: whilst providing the best results, there are significant side-effects associated with this procedure
• Surgery

VPL™skin treatment is a process that has many advantages over other treatment modalities as it effectively treats a combination of changes in the skin, from the signs of ageing, over exposure to the sun, broken facial capillaries, pigmentary abnormalities and cosmetic imperfections.

Sun Damaged Skin
Sun damaged skin occurs as the result of excessive exposure to ultraviolet (UV) light, which induces epidermal and dermal changes. Skin affected in this way is characterised by thinning of the epidermis and dermis, coarse skin texture, wrinkling, Telangiectasias and changes in pigmentation.

The overall appearance of sun-damaged skin relates to the resultant UV damage of structural components such as collagen and elastin fibres. Appearance is also affected by genetic factors, intrinsic factors, disease process such as Rosacea, and the overall loss of cutaneous elasticity associated with age. More people now have extended periods of sun exposure and, coupled with the thinning of the ozone layer and other factors, this has resulted in visible signs of ageing, damage and disease evident in ever-younger people. People in their twenties and thirties are now witnessing solar elastosis, Telangiectasia, solar lentigines and rhytide formation. >

Laser Techniques
Up until recently, the 'in vogue' techniques for reducing or eliminating facial rhytide or wrinkles included various topical agents such as glycolic acid, retinoids, ascorbic acid, a variety of chemical peeling agents, microdermabrasion, epidermabrasion and laser skin resurfacing. Of these techniques the most effective methods for improving photo-damaged skin were invasive, which had major disadvantages of requiring a significant recovery period following procedures such as laser skin resurfacing. In addition, scarring has become more commonplace with each of the invasive procedures including laser resurfacing.

Laser Resurfacing works on the principle of causing a controlled thermal burn, which results in the removal (or ablation) of the upper layers of skin. The associated thermal damage increases the rate at which new collagen is produced and thus improving the appearance of wrinkles. The process is not about resurfacing the skin with new tissue, but rather is about allowing a controlled scar to evolve that shrinks over time, a process called contracture. This controlled contracture is what gives the appearance of reduced wrinkling of the skin. Laser Resurfacing involves the use of general (or sometimes local) anesthesia, 2-3 days stay in a hospital and constant bandage changes for 3-4 weeks post-procedure. Research has shown that 80% of potential patients withdraw due to the high risk of side effects.

The thermal effects on tissue are both time and temperature dependent, as shown below:

• From 42 to 45 deg.C: reversible protein and membrane changes occur
• From 50 to 85 deg.C: denaturing the structure of cellular proteins
• From 75 to 80 deg.C: irreversible collagen coagulation takes place
• Above 100 deg.C: vaporization of tissue water occurs resulting in ablation and carbonization.

While good results can be obtained, these are often tempered by the presence of a number of complications. As the skin has been traumatised, its natural barrier protection to infection is significantly reduced, so great care must be taken until the area has healed completely. Postoperative hyperpigmentation occurs after almost any cutaneous laser procedure, regardless of type. It is particularly common in patients with darker skin and whilst in the majority of cases it will only last for three or four months, it can be permanent. Postoperative hypopigmentation is also possible, particularly after multiple treatments and is again common in darker skin types. Delayed permanent hypopigmentation is a well-recognised complication particularly to CO₂ laser skin resurfacing, as is persistent Erythema.

Blister formation (vesiculation) is caused by thermal trauma induced by the laser when excessive fluencies are used or the absorption of laser energy is increased due to the presence of an epidermal chromophore (e.g. melanin in a tan). Without appropriate postoperative care undesirable 'crusting' is also inevitable following laser resurfacing. Perhaps the most serious of laser complications is scarring. Cutaneous laser resurfacing carries the greatest risk of scarring because of the intended destruction of dermal tissue as well as the increased risk of infection in the de-epithelialized skin. Factors affecting scarring include the number of treatment passes and the energy used and it is worth noting that this complication occurs even when the treatment is performed by the most experienced surgeon or physician.

VPL™ Treatments
As a result of the problems and risks associated with lasers, there has been great interest in the development of non-invasive and non-ablative methods to effectively improve the appearance of problematic conditions of the skin, without the need for patient downtime. Recently, Nd:YAG lasers, pulsed dye lasers and electro-surgery have been used to treat selected skin conditions.

None of these methods can match the successful results achieved on many visible signs using Intense Pulsed Light sources, and in particular Variable Pulsed Light ( VPL™). It is clear that there is considerable demand for this new generation of non-ablative treatment which, even though it is a relatively new technology, has been shown to result in dramatic improvements to the visible signs of ageing, sun damage, with low risk and, perhaps most importantly, no Client 'downtime'.

A number of independent clinical studies have been undertaken with the findings confirming the efficacy of intense pulsed light treatments. Published results provide parameters which can be used to determine treatment settings and methods. Additional studies are currently underway across the world to establish in more detail how best to utilize the advantages of this new non-invasive technology.

Treatment Process
The ULTRA VPL™ System is suitable for full face, neck, chest and hands treatment to improve the visible signs of sun damage and ageing.

The treatment of sun-damaged skin includes treating both benign pigmented and vascular lesions. Exposure to UV light destroys skin cells thereby slowing down the growth of new skin and the production of collagen. The increase in blood flow as a result of the treatment to the region will also bring fresh supplies of oxygen and nutrients to the cells, which will assist in the removal of waste. By traumatizing the epidermis and dermis the skin will also be encouraged to go into 'repair mode' increasing cell turnover

Other treatments using the ULTRA VPL™ include the following:
The treatment of benign pigmented epidermal and cutaneous lesions including warts, scars and striae.
The treatment of benign cutaneous vascular lesions including port wine stains, Hemangiomas, facial, truncal and leg telangiectasias, Rosacea, melasma, angiomas and spider angiomas, poikiloderma of Civatte, leg veins, facial veins and venous malformations

Benign Pigmentation Treatment
Benign pigmented conditions are caused by the melanocytes having an irregular production of melanin. The treatment involves the 'disabling' of rogue melanocytes by directing energy of the correct fluency and wavelength to these over-producing melanocytes, which automatically absorb more energy than normal melanocytes because of their darker color. Following treatment the production of melanin will become normal and the skin will return to its ambient color. Energy fluency settings sufficient to cause erythema in the ambient skin areas are usually sufficient to disable those melanocytes in the darker skin pigmentation.

Number of treatment sessions required
Generally, between four to six treatment sessions are required, although it depends upon the treatment type and the area being treated. A good 'rule-of-thumb' is to assume one treatment for each decade of a person's life. The number of treatment sessions may increase when treating darker skin types. Normally, these treatment sessions are carried out at three week intervals.

3 Treatments at 3 week intervals