Skin, Hair, and Nail Health
Conventional Cosmetic Interventions
Although no treatment can entirely reverse the effects of aging, there are a number of treatment options for reducing the evidence of photodamage and other age-related skin changes. All of these therapies carry a risk of side effects, and most require multiple treatments to achieve and maintain results, some at considerable expense. A frank discussion with a healthcare provider about realistic expectations, risks, and costs is necessary before embarking on a course of anti-aging cosmetic therapy (Mayo Clinic 2014).
A chemical peel, also called chemexfoliation, is a minimally invasive method to improve the appearance of the skin. The process involves applying a chemical solution to the skin to intentionally cause minor damage and subsequent repair and rejuvenation of the skin surface. The new skin usually has a smoother texture with less wrinkles. Chemical peels can be used on the face, neck, and hands. They can be beneficial in a number of conditions including acne scars, aging skin, crow’s feet, scars, sun damaged skin, and wrinkles (ASPS 2016a; ASDS 2016a).
Different chemical formulations can reach different depths of the skin. Superficial peels can treat minor skin irregularities and shallow wrinkles, while deeper wrinkles and more pronounced irregularities may require deeper-peeling chemical formulations. Chemicals that may be used in chemical peels include alpha-hydroxy acids (such as glycolic and lactic acids), trichloroacetic acid, beta-hydroxy acids, and others (Hassan 2013).
Potential side effects of chemical peels include temporary or permanent change in skin color, scarring, and reactivation of cold sores (ASDS 2016a). Recovery time and potential for adverse effects depends on the strength of the chemical formulation and depth of exfoliation; side effects typically last for several weeks. With milder peels, multiple treatments are typically required before results are seen (Mayo Clinic 2014).
Dermabrasion. Similar to chemical peeling, dermabrasion causes exfoliation of the upper layers of skin, leading to growth of new skin. Dermabrasion uses mechanical or abrasive means to remove the top layers of skin. Skin dermabrasion procedures can be used for general anti-aging rejuvenation or to minimize the appearance of minor scars or other mild-to-moderate abnormalities. Dermabrasion removes the epidermis and penetrates into the dermis.
Because dermabrasion involves the removal of live tissue, it is painful and requires the use of an anesthetic, ranging from topical anesthetics to full sedation, depending on pain sensitivity of the individual and degree of dermabrasion needed. Redness and crusting are typical during the recovery period and may last roughly two to three weeks. Antibiotic, anti-inflammatory, and analgesic ointments for the affected area are often recommended after treatment (Alkhawam 2009). Some dermatologists prescribe topical tretinoin (eg, Retin-A) for a few weeks before dermabrasion, as this may shorten healing time and reduce post-procedure skin abnormalities (Mandy 1986). Sun exposure should be minimized for a month or more before and after dermabrasion. Although uncommon, lasting redness, scarring, or other skin abnormalities may occur (Alkhawam 2009).
Microdermabrasion is similar to dermabrasion but slightly less invasive, removing only the upper layers of the epidermis. Microdermabrasion can minimize appearance of very superficial skin abnormalities or be used to improve general skin appearance (Alkhawam 2009). This gentle technique produces modest, temporary results that may require as many as 16 treatments to be seen (Mayo Clinic 2014). Given that only the upper layers of the epidermis are affected, microdermabrasion is considered a relatively safe technique with minimal redness after treatment; however, in rare cases, prolonged redness, itching, small vessel breakage, bruising, and pinpoint bleeding can occur (Alkhawam 2009; El-Domyati 2016; ASPS 2016c).
Individuals currently undergoing treatment with isotretinoin (Accutane) or who have an active herpes outbreak should consult a healthcare professional before undergoing dermabrasion or microdermabrasion procedures (Alkhawam 2009).
Botox (the brand name for botulinum toxin type A) injection is one of the most popular cosmetic procedures in the Unites States. Numerous studies have demonstrated Botox injections can be a safe and effective treatment for facial wrinkles, including frown lines, crow’s feet, and forehead lines (Hexsel 2011; Small 2014).
Botox is a neurotoxin that inhibits the release of acetylcholine, a neurotransmitter needed for muscle contraction. By injecting very small amounts of Botox at selected sites, a temporary relaxation of facial muscles and reduced appearance of wrinkles can be achieved (Hexsel 2011; Small 2014). The results may last several months, and repeated treatments are needed for maintenance (Mayo Clinic 2014).
Minor bruising and pain at the injection site, as well as allergic reactions, can occur after Botox injections (Hexsel 2011; Small 2014). Other complications include facial asymmetry and lowering or drooping of the eyelid or eyebrow due to migration of the neurotoxin. Although these complications are uncommon and temporary, they are often very distressing when they occur (Small 2014).
Tretinoin (also known as all-trans retinoic acid or, eg, Retin-A) is a pharmaceutical retinoid (vitamin A derivative) approved by the Food and Drug Administration (FDA) for topical use to treat photodamage, acne, and other skin conditions including psoriasis and basal cell carcinoma (Ascenso 2014; Ting 2010; Kligman 1989; CIHR 2016). Tretinoin stimulates new collagen formation and decreases collagen loss, inhibits skin metalloproteinases, increases fibroblast proliferation, and suppresses inflammation (Baldwin 2013; Ascenso 2014; Mukherjee 2006).
Although tretinoin appears to be helpful in treating photoaging of the skin, mild-to-moderate side effects such as skin redness, irritation, burning, and scaling are common (Culp 2015; Mukherjee 2006; Geng 2009). Tretinoin increases sun sensitivity, so topical sunscreens and sun-protective clothing are recommended during treatment to prevent sunburn (Mayo Clinic 2014).
Laser Skin Resurfacing
Laser skin resurfacing can help improve the appearance of wrinkles, blemishes, and scars. Modern laser methods are precise and are considered to be suitable for facial skin (ASPS 2016b; ASDS 2016b). Laser resurfacing is used to treat a range of skin flaws associated with aging and photoaging, including liver spots, vascular lesions such as telangiectasia and rosacea, and fine lines and wrinkles (Lipozencic 2010a; Lipozencic 2010b; ASPS 2016b). A common laser resurfacing procedure is fractional skin resurfacing in which partial, precise, targeted laser application leaves small areas of the normal skin surface intact (Carniol 2015; Lipozencic 2010b; Halbina 2014; Lipozencic 2010a).
After laser therapy, individuals generally experience mild burning, swelling, flaking and peeling, and changes in skin color (bronzing) that can persist for months. These symptoms heal more quickly and the risk of infection and permanent scarring and skin color change is lower with fractional laser therapy compared with other laser resurfacing techniques; however, fractional laser therapy typically requires more treatment sessions (Halbina 2014; Mayo Clinic 2014).
Injectable Hyaluronic Acid
A number of injectable hyaluronic acid preparations are FDA approved to treat characteristic signs of facial aging such as loss of skin volume and elasticity, and appearance of wrinkles and folds. Originally developed in Europe, hyaluronic acid dermal fillers replaced problematic injectable collagen products and have become one of the more popular treatments in the field of cosmetic dermatology. Hyaluronic acid is a naturally occurring substance in many tissues in the body. This compound strongly attracts water molecules, restoring fullness and volume to the skin (Gold 2007; Manna 1999; ASOPRS 2015; FDA 2016; Suman 2011; Edwards 2007).
Among the approved brands of hyaluronic acid injectables are Restylane, Juvederm, Hylaform, Puragen and Captique. Some hyaluronic acid injectable products are derived from animal tissues, while many are created by bacterial synthesis. Effects of hyaluronic acid injection procedures are quickly seen and can last up to six months. The procedure is relatively safe, but can produce redness, bruising, and swelling in the area of treatment. Injections may need to be repeated every few months (Pak 2015; ASOPRS 2015; Mayo Clinic 2014).