Facial skin rejuvenation

Reviewed By:
Rana Rofagha Sajjadian, M.D., AAD
Mary Ellen Luchetti, M.D., AAD

Facial skin rejuvenation is the use of techniques designed to restore damaged skin to a youthful, healthier-looking appearance. It may involve medications, procedures, surgery or a combination of these treatments, and is used to repair damage caused by factors such as illness, aging and exposure to the sun.
The skin is the largest organ in the body. Over time, the skin fibers that keep the skin taut – collagen and elastin – weaken as a combination of gravity and internal and external factors pull the skin downward. In addition, years of exposure to the sun can create superficial blemishes that become more pronounced with time, and disorders such as acne can cause scarring that is cosmetically unappealing.

Dermatologists and dermatologic surgeons use facial skin rejuvenation to combat this deterioration and improve the skin’s general appearance. Different techniques may be performed depending on the condition to be treated. A person’s skin type is a critical factor in determining which procedure can best restore facial skin health.

Facial skin rejuvenation can help reduce wrinkles and sun spots, tighten loose skin, improve skin texture and color, remove blotches or damaged blood vessels, and lessen the appearance of minor scars. Over the years, advances have helped make such procedures less invasive and safer.

Types and differences of facial rejuvenation

There are several main categories of facial skin rejuvenation, including: Topical products. These are drugs or cosmetics that are applied to the skin. They usually are used to treat fine lines, superficial wrinkles and other milder signs of aging. Some topicals can also be used to prevent skin damage or to reduce or delay the need for other procedures. Topical medications include tretinoin (a substance within the vitamin A family), alpha-hydroxy acids (derived from fruit and dairy products) and topical antioxidants (including vitamins C and E). Fillers. Soft tissue fillers are used to elevate facial furrows and hollows, reduce wrinkles and give the skin a smoother appearance. They are especially effective when used around the lips and mouth and for correcting depressions and scars. Substances used for this purpose include bovine collagen (fibrous protein substance derived from cows), fat removed from another part of the patient’s body, hyaluronic acid derivatives, hydroxyapatite, poly-L-lactic acid (PLLA), and silicone and polymer implants. Botulinum toxin. This agent – a purified version of the bacteria that cause botulism food poisoning – can be safely injected in tiny amounts into individual muscles to create a nerve block that relaxes that muscle’s movement. Botulinum toxin is used to treat lines and wrinkles associated with facial expression. The Food and Drug Administration (FDA) approved use of this product for glabellar wrinkles, or wrinkles between the eyebrows. However, many dermatologists and plastic surgeons also routinely treat other areas, such as forehead lines or crow’s feet around the eyes, safely. Botulinum toxin also may be used to relax muscle bands that may be visible in the neck. Treatment results typically last for three to four months. Chemical peels. Chemical solutions such as alpha-hydroxy acids, trichloroacetic acid and carbolic acid may be applied to remove outer layers of aged, discolored or irregular skin. Depending on the specific type and concentration of the acid used, the skin exfoliates or peels over a period of days, leaving behind new skin that is smoother, has fewer wrinkles and is more even in color. Chemical peels are often used to treat wrinkles around the eyes and mouth, skin discoloration, age spots, mild acne scars and dull skin. They may range from mild peels (for fine lines and wrinkles) to medium-depth peels (for moderate skin damage, such as age spots, freckles and precancerous growths such as actinic keratoses). Chemical peels cannot remove deeper scars. Dermabrasion. Resurfacing procedure in which skin is mechanically “sanded” with an abrasive instrument, such as a rapidly rotating brush. This removes outer skin layers and smoothes the skin overall. It is used to treat significant scarring, pigmentation and sun damage. Although healing time may take several weeks, results are often impressive and long-lasting. Microdermabrasion. A technique similar to dermabrasion that uses either micro-particles or a diamond-tipped wand to remove part of the top skin layer (epidermis). This helps stimulate proteins involved in cell differentiation and growth. Key adventages of microdermabrasion are that it is noninvasive, does not require anesthesia and creates little or no discomfort. In addition, it does not require significant recovery time. It is usually performed in several treatment sessions, two or three weeks apart. Lasers. Used to remove layers of skin with laser light energy. Lasers work by creating an intense beam of light that travels in one direction. They may be either ablative (remove the top layer of skin) or nonablative (treat layers beneath the surface layer). Lasers are used to vaporize or improve wrinkles, scars, skin discoloration, broken blood vessels and precancerous skin growth. Lasers also may be used to treat lines and blemishes on the neck and to improve folds and creases by tightening loose skin. Finally, lasers often enhance other treatments, such as chemical peels, liposuction of the face and neck, and blepharoplasty (eyelid surgery). Intense pulse light (IPL). Makes use of broad spectrum light that filters out harmful wavelengths. It is used to treat vascular (blood vessels) lesions and problems involving texture, pigmentation and pore size. IPL is often combined with techniques such as microdermabrasion or botulinum toxin. Light-emitting devices (LED). Makes use of light, delivered through light emitting diodes (LEDs), to activate skin cell receptors stimulating them to produce new collagen and elastin. It is used to treat fine lines, hyperpigmented lesions (brown spots and freckles) and other skin problems associated with sun damage. LED is often combined with other facial rejuvenation treatments such as botulinum toxin, dermal fillers and nonablative laser, IPL and photodynamic therapies. Radiofrequency technology. Using radiofrequency waves, these non-invasive techniques result in skin contraction and tightening that can lead to lifting of the face, brow and cheeks without surgery or a prolonged recovery time. Photodynamic therapy. Involves the application of a topical medication called 5-aminolevulinic acid (ALA) to the skin. ALA is left on the skin for a specified period of time. The area is then treated with colored light (blue, yellow or red) using LED, IPL or a pulsated dye laser. Photodynamic therapy also can effectively treat early precancerous changes of the skin. Surgical excision. Removal of tissue using a scalpel or other sharp instrument. Excision may be used to remove moles, scars and benign (noncancerous) skin growths that enlarge with aging. Surgical excision may also be used to treat droopy eyelids by removing excess fat pads and skin (blepharoplasty), reduce severe lines in the forehead, raise the eyebrows (browlift) and tighten and trim excess skin on the cheeks, chin, neck and around the mouth (rhytidectomy, or facelift). Liposuction. Surgical removal of local fat deposits by applying suction through a small tube inserted into the body. Liposuction can be used to remove excess fat and improve the contour of the face and neck areas. Local anesthetic is often used in liposuction procedures. Neck and jowl treatments. Many different techniques may be used alone or in combination to treat problems such as sagging jowls or double chins. Techniques include chemical peels, botulinum toxin therapy, laser resurfacing, liposuction, radiofrequency procedures and neck lifting. The choice of technique used to treat a patient may vary depending on several factors. A patient’s skin type and treatment goals are important factors in determining which technique is best. In some cases, a combination of techniques may produce improved results. Before, during and after facial rejuvenation Patients who are considering facial skin rejuvenation will consult with a physician to discuss various aspects of the procedure. It is important to search for a qualified dermatologist who has experience performing facial skin rejuvenation. Dermatologists are skilled in the use of a wide variety of surgical and nonsurgical methods of treating skin conditions. As a result, they will be able to recommend a procedure based on: Type of skin condition being treated Location of the skin being treated Degree of damage Patient’s skin type Patient’s treatment goals Time required for recovery Patient’s age Patient’s medical history Prior to the procedure, patients should follow any preparatory advice recommended by their physician. This may include dietary restrictions and changes in medication regimen. The choice of technique will dictate how the procedure unfolds. Some procedures – such as botulinum toxin injections and others that may take place in a physician’s office – can be completed in as little as 30 minutes without the use of anesthetics. However, more invasive surgical procedures (e.g., eyelid surgery) may require use of anesthetics and a brief hospital stay. Recovery time for facial skin rejuvenation varies significantly, depending on the technique used to treat patients. Many techniques – such as soft tissue filler and botulinum toxin injections, microdermabrasion and some laser and intense pulse light (IPL) treatments – require no recovery time. More invasive procedures may require between three and 10 days of recovery time. In most cases, patients will feel no significant pain as a result of the procedure. Minor discomfort may occur, however, in addition to mild redness and swelling. In many cases, repeat procedures will be necessary at some point to maintain the restorative effect achieved during the initial procedure. Potential risks with facial skin rejuvenation Facial skin rejuvenation is generally safe, and new surgical techniques and technological advances have made surgical procedures less risky. However, there are risks associated with any type of treatment, especially surgery. Side effects may include: Mild redness Inflammation Minor discomfort Sun sensitivity months or years after treatment More significant side effects also may occur, especially when more invasive procedures are used. These may include: Scarring Persistent redness Permanent pigment changes Processes such as chemical peels and dermabrasion sometimes cause reddening and peeling of the face that is similar to a sunburn. This typically lasts from a few days to several weeks, depending on the strength of the solution used and the depth of the skin peel in chemical peels, or the amount of skin surface removed in dermabrasion. Medications may be prescribed to reduce discomfort or prevent infection, and patients will be advised to remain out of the sun until the new skin is ready for such exposure.