With devices “resurfacing” the facial canvas and botulinum toxin A “relaxing” the mus­cles of facial expression, dermal fillers address the issue of loss of volume and complete the triad of procedural nonsurgical facial restoration. During the last five years, a myriad of dermal fillers have been approved by the FDA and the way fillers are […]

Botulinum toxins are essential in global facial rejuvenation for relaxation of muscles of facial expression. The most widely studied botulinum toxin is Botulinum toxin A, which is primarily employed in the upper one-third portion of the face to address glabellar, fore­head, and periocular rhytids. The lower one-third portion of the face is also gaining momen­tum […]

The risks of ablative resurfacing and the limitations of nonablative resurfacing and pho­torejuvenation led to the development of fractional resurfacing, which is now the preferred Before After Before After 1 treatment Figure 13.2 Pre – and post-photopnematic therapy with topical delivery system. mode of resurfacing. Fractional resurfacing can be divided into true nonablative fractional resurfacing […]

Another modification of visible light sources is the advent of photopneumatic therapy. Photopneumatic therapy takes a radical approach by manipulating optics of the skin instead of device characteristics by applying simultaneous vacuum suction to narrower band broad­band light sources using blue and green photons. Suction stretches the skin, allowing the blue and green photons to […]

Enhancement of visible laser and light-based photorejuvenation can be accomplished with photodynamic therapy (PDT). Photodynamic therapy was originally introduced with overnight incubation of 5 amino-levulanic acid, followed by activation with a 420 nm blue light for the treatment of actinic keratosis. This approach did not gain momentum due to significant discomfort and recovery time. Photodynamic […]

The undesired prolonged recovery and risks of ablative laser resurfacing led to the devel­opment of nonablative laser resurfacing with a myriad of lasers in the infra-red region. While safety was generally accomplished with these modes, the clinical results were, at best, modest. The premise of nonablative devices is “inside-out” resurfacing, where the epidermis remains intact […]

Skin rejuvenation can be accomplished by ablative, nonabrasive, and fractional modes of injury. In the 1990s, ablative laser resurfacing was introduced with the advent of pulsed 10,600 nm carbon dioxide and pulsed 2940 nm erbium-YAG lasers. While ablative Table 13.1 Summary of Devices in Lasers and Light-Based Therapy resurfacing produced excellent clinical outcomes, it lost […]

Table 13.1 summarizes the mechanisms of lasers and light-based systems. The central dogma to these therapies is predicated on the theory of selective photothermolysis (SP), where in theory any target can be selectively destroyed if an optimal thermal relaxation time of the target is matched with the optimal chromophore. Biologically, the active chromophores are melanin, […]

Vic A. Narurkar Bay Area Laser Institute, San Francisco, CA, and Department of Dermatology, University of California Davis School of Medicine, Sacremento, CA, USA 13.1 Introduction 281 13.2 Lasers and Light-Based Systems 282 13.3 Ablative Laser Resurfacing 282 13.4 Nonablative Skin Resurfacing 283 13.5 Photodynamic Therapy 283 13.6 Photopneumatic Therapy 284 13.7 Nonablative and Ablative […]