What’s New in Cosmetic Dermatology

The progression of medical advancements relies on ongoing scientific research. In the field of dermatology, science has come full circle, revisiting the study of basic anatomy and how the face ages.

Observing what happens to fat, muscle and bone as the face ages over time allows physicians to treat the face globally, and this concept has spurred breakthroughs in the way we address the signs of aging.

For example, a patient may come to my office wanting Botox® injections to treat forehead lines; however, there is generally more happening in the face than a wrinkle or two in the middle of the forehead. I’m fond of describing an aging face by saying that “the bloom is off the rose”—in essence, the face looks tired and has lost its youthful vitality.

Patients want to look refreshed and healthy looking, and this requires not just Botox® but volume replacement, intensive skin treatments and the introduction of skin care practices based on the patient’s specific skin conditions and the evolution of their skin over time.

NEW WAYS TO INJECT
To enhance a patient’s appearance, physicians must treat the face in its entirety. Rather than approach each injection with the goal of filling an individual fold, injecting the face anatomically allows us to restore volume in a more natural way while improving the silhouette of the face.

The deepening of nasolabial folds reflects an overall loss of facial volume. No part of the face operates in isolation. As the bony skeleton of the nose enlarges over time, the inferior area at top of the nasolabial fold also starts to sink, causing pockets to deepen.

I treat this area with a two-pronged approach, using a hyaluronic acid filler like Restylane® or Juvéderm® to fill the pocket along with Sculptra® to lift the top of the nasolabial fold and restore the position of the nose. While fairly new to Canada, Sculptra has a proven track record in the United States for its ability to deliver natural, subtle improvement as it stimulates collagen growth over time.

I have also found that patients can look unnaturally full when fillers and neurotoxins are injected only in the front of the face. Instead, I have started to inject in front of the ears, temples and jaw line to create a naturally refreshed appearance.

The preferred means of injecting has evolved as cannulas have begun to replace the standard needles typically used for injecting. Cannulas feature a blunt tip – this means a lower chance of bruising and more importantly, less risk of hitting a blood vessel.

Cannulas also allow us to inject into the deeper planes and fat pockets of the face, giving more natural restoration. And because the results are much more subtle, patients can avoid the dreaded, overdone “chipmunk” look.

ADVANCEMENTS IN SKIN CARE

Proper skin care can serve as an entryway to cosmetic treatments or as an ancillary that enhances the results—or minimizes the side effects—of in-office procedures. Regardless, good skin care practices should be a lifelong commitment.

Today’s skin care market has evolved to offer multi-benefit products. All-in-one topical treatments combine action ingredients to address multiple skin concerns. SkinMedica’s TNS Essential Serum® is a great example as it combines tried-and-true antioxidants with peptides along with the TNS® patented growth factor blend.

Furthermore, ongoing research and development has brought new star ingredients to the forefront. Twenty years ago, sunscreen was the main mode of preventative skin care available. Now, peptides and growth factors have gone mainstream. Extensive scientific data also supports the rejuvenating capabilities of today’s over-the-counter retinol products, which enhance skin texture through exfoliation.

Researchers have begun to explore the molecules that assist in the repair and protection of skin cells. Known as DNA repair enzymes, these molecules are purported to recreate the natural DNA repair that occurs in youthful skin; however, more research is needed to determine their true effectiveness and long-term safety.

LASER INNOVATIONS
While fractionated lasers are nothing new, expanded post-treatment protocol methods allow us to improve the skin’s collagen remodeling capabilities after treatment. 

Fractionated lasers create a pattern of microscopic injuries to the skin (known as micro-thermal zones of injury) that in turn stimulate collagen production. We are now having patients aggressively apply products to the skin after treatment to increase topical penetration and enhance the process of collagen synthesis.

Another way to boost the results of laser resurfacing is through the application of platelet rich plasma, or PRP. Though dermatological studies are still in their infancy, PRP has roots in orthopedics and sports medicine where it has been used to speed the healing of wounded tissue in athletes.

PRP is obtained by drawing a small amount of blood, then centrifuging the blood in a test tube to separate the plasma from red blood cells. The plasma contains high concentrations of platelets, which can be painted on the skin after a fractional laser treatment to encourage healing or injected to thicken the skin. While the results are very anecdotal, many patients have reported a marked improvement in skin rejuvenation and the reduction of acne scarring after the procedure.

Dermatologic treatment is a process, and recent years have seen an increase in patients who are managed by their doctors over the long term. The younger generation will really benefit from the advancements in nonsurgical rejuvenation emerging today. If you are open to the concept of maintenance and preventative care early on, you will slow the need for traditional surgery down the road.