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Cosmetic procedures are usually undertaken to reverse the visible signs of ageing, particularly facial rejuvenation. Similar procedures and techniques are also used to treat potentially disfiguring or distressing skin diseases such as acne scars, vascular birth marks along with skin growths and precancerous skin diseases.
What Causes Skin 'Ageing'?
In Australia and New Zealand sunlight plays a major role in the accelerated appearance of changes that we normally associate with skin ageing. These include wrinkles, lines and creases, uneven or blotchy colour changes such as sunburn freckles and 'liver spots', 'broken or burst capillaries', and other irregularities of the skin surface. Gravity, repeated movement of facial muscles, smoking and genetic characteristics also influence the appearance and severity of these changes.
Visit our section on how to maintain more youthful looking skin, which details ways to reduce the occurrence of visible changes of ageing.
The Scope of Cosmetic Dermatology
Dermatologists provide a wide range of treatments for skin ageing and other cosmetic problems. Treatments range from creams, injections and facial peels to cosmetic dermatologic surgery and laser therapy.
Careful consideration must be given to the type of cosmetic problem, the range of treatments available for different cosmetic problems, along with the relative benefits and disadvantages of different treatment methods. Cosmetic treatments need to be tailored for each individual.
The following sections detail some cosmetic dermatology treatments. Your dermatologist is best qualified to advise further about your suitability for various cosmetic procedures.
Creams, Lotions, Gels and General Skin Care
Creams are useful for milder changes of ageing including fine lines, wrinkles and minor irregularities in colour and texture. Tretinoin creams (vitamin A derivative or retinoid) and alpha hydroxy acids are commonly used.
Tretinoin creams can provide long term benefits if used regularly.
Alpha hydroxyacids cause superficial peeling of the skin and possibly other benefits to rejuvenate the skins appearance. These can be used as a cream and/or a facial peel.
The main disadvantage of these preparations is that they make the skin more susceptible to irritation and dryness potentially causing redness, scaling and stinging or even dermatitis. They also increase the skins sensitivity to sunlight and burning.
For more details about these and other creams, lotions, gels and general skin care measures visit maintain more youthful looking skin.
Botulinum Toxin (Botox, Dysport)
Botulinum toxin (Botox, Dysport), is used to reduce 'dynamic wrinkles'. These wrinkles are due to the repeated contraction of facial muscles and include 'crowsfeet' that occur next to the eyes and frown lines. Carefully placed injections temporarily paralyze the muscles that create these lines or wrinkles, reducing the appearance of these lines with time. The effect of Botulinum toxin is only temporary, and injections usually need to be repeated every 3-6 months for sustained benefit.
Other Injections and Filters
Dermatologists inject fillers to treat wrinkles, depressed scars, furrows or hollows to give the face a smooth, even appearance. Fillers are frequently used around the mouth and eyes, but can be used anywhere on the face. A range ofsubstances can be used. The choice from amongst a variety of natural or artificial products is based on a combination of factors including the type of cosmetic problem being treated, its location, the duration of effect (some injections need to be regularly repeated to maintain a sustained benefit), cost, inconvenience, and individual preferences. Products include collagen, hyaluronic acid, dermal grafts, autologous fat transfer (fat removed or harvested from elsewhere on the body), and Gore-tex®.
Sclerotherapy
Sclerotherapy is used to treat unwanted, dilated blood vessels or veins particularly on the legs. The dermatologist injects a small amount of a chemical solution, called a sclerosing solution, directly into the vein. This solution irritates and damages the vein which then usually fades and disappears. It may require several treatment sessions to achieve desired results. Go to our sclerotherapy page to learn more about spider or varicose veins and their treatment.
Vascular Lasers
Vascular lasers selectively target and damage unwanted or abnormal blood vessels in the skin. They are used by Dermatologists to treat 'broken capillaries', persistent facial redness, rosacea, burns, scars and vascular (red or purple) birth marks. Vascular lasers are most affective on the face, but can be used on other regions. Multiple treatments are often required to achieve the best results.
Facial Peels
Peels involve the application of a chemical solution to the face. There are many different peels available. Facial peels are divided into superficial, medium and deep. Very superficial peels, such as the ones performed by beauticians, only remove the top layer of dead skin cells and thus usually only have a short period of minor cosmetic benefit. Stronger superficial peels performed by dermatologists, usually need to be repeated on several occasions for a noticeable improvement in many of the signs of skin ageing.
A variety of medium depth and deep peels may also used by dermatologists to treat greater textural irregularities, uneven pigment such as 'age spots' and freckling, deeper wrinkles, some types of acne scaring and precancerous skin lesions.
The deeper the peel the greater and more long-lasting the benefits especially for deeper wrinkles, however the deeper the peel, the longer the recovery time and the greater the potential problems.
Chemical peels work by removing different layers of the skin. Deeper peels allow damaged cells to be removed and replaced by fresher new skin during healing.
Laser Resurfacing
Laser resurfacing has similar beneficial effects to a chemical peel and is also used by many dermatologists to treat wrinkles, age spots, scars, along with benign, cancerous and precancerous skin growths or lumps. A variety of carbon dioxide and erbium lasers are used in Australia and these have slightly different benefits and disadvantages.
The carbon dioxide laser is especially effective for treating enlarged bulbous noses (rhinophyma or 'potato nose') that can occur in males with rosacea, and for treating sun-damaged lips with precancerous changes.
Tattoos and Pigment Laser Therapy
Lasers have largely revolutionized the way dermatologists treat unwanted tattoos. Amateur and black tattoo's do best and usually respond well to a series of 4 to 6 treatments. Multi-coloured tattoos can also be treated. Several different lasers and more treatments sessions may be needed to treat all the colours, and some brighter colours may respond poorly.
A variety of 'Pigment' lasers can also be used to treat sunburn freckles and 'liver spots'.
Hair Transplantation
Baldness and thinning of scalp hair affects almost one-third of all men and some women. Hair transplantation is available from some specialist dermatologists. It can provide a more permanent solution for selected patients who suffer from baldness and thinning hair. There have been many advances in the technique of hair transplantation over the last half a century to try to produce a more natural look.
Based on information provided to the Australasian College of Dermatologists
by Dr John R Sullivan
Last Modified 4 March, 2001 / © 2001 Australasian College of Dermatologists
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