Treating Aging Skin Is Both Art and Science

COSMETIC & LASER SURGERY

Maintaining Youthful Skin

Your skin is your barrier to protect you from this world. It is also the organ that is most tied to our appearance. In the quest to maintain youth, most people focus on the skin and skin health to preserve that youthful look.

There are many variables that contribute to the aging of the skin but first you must have an idea of the anatomy of the skin to appreciate the many facets of skin aging and correction.

DR. FRANK VENZARA,above right, and Dr. Robert Bashore, left, with Physician Assistant Dan Daniels, center, in one of their two fully equipped surgical suites. The doctors are Board Certified Plastic and Reconstructive Surgeons, and Daniels is a member of the American Academy of Physician Assistants.

The skin is an organ. Just like other organs of the body, such as the heart, lungs, liver, etc. the skin has its own unique cells and structure. To simplify the discussion the skin can be divided into 3 main layers, the epidermis, the dermis, and the subcutaneous tissues.

Each one of these layers factor into the aging process and special techniques are used to combat the effects of aging at each of these levels. When putting together a plan to correct the effects of aging on the skin we take all these layers into consideration and put together a plan that is either comprehensive or targeted on one of these layers.

n First there is the epidermis. This is the top layer of skin and contains the pigment cells of the skin (melanin). The epidermis is what we see when we look at each other and is also our major defense against the sun.

The effects of the sun on the skin and its role in aging are called photo-aging. Melanin is our major defense against blocking out the UV rays, which in turn causes photo-aging. Even with the protection of melanin, there are significant changes with the epidermis over time. The UV rays damage the basal level of cells and alter their genetic composition, causing unevenness of the skin’s tone.

Brown and red spots start to become visible over time, and they typically don’t get better without intervention. Staying out of the sun and using sunscreens can prevent some of these changes, but many of us were unaware of the harmful effects of the sun until 15-20 years ago. Unfortunately much of the damage is already done. The epidermis is also altered my many other factors not just the sun. Some common offenders are hormonal fluctuations, environmental exposures, smoking, and diet.

• So what can we do to help? Fighting fire with fire applies here, and we treat photo-aging with photo-rejuvenation.

Advanced platforms utilizing IPL (intense pulsed light) and lasers as well as multiple other light based procedures can typically reduce the amount of brown and red spots and restore and improve skin tone. Selective photo-thermolysis is the process of transferring light into heat and destroying a lesion or vessel.

This is the concept that drives most laser platforms. The Lume 1 manufactured by Lumenis® has multiple wavelengths of pulsed light that can be used to reduce the most stubborn brown and red spots. Chemicals can also be used to fight the effects of photo-aging by stimulating epidermal cell turnover and bleaching out the clumps of old pigment.

Obagi© is a skin care system that combines the prescription benefits of retinoic acid (Retin-A) and hydroquinone with blenders and toners to maximize their effectiveness. Dermabrasion can also be used.

The dermabrader mechanically destroys the epidermal cells and stimulates new skin cell growth. The disadvantage to the dermabrader when compared to chemicals, IPL, and laser treatments is that the dermabrader treatments typically involve a significant amount of downtime if they go deep enough to alter the lesion’s characteristics.

Microdermabrasion is a way to get around the downtime issue of dermabrasion but typically it takes many treatments to possibly make a small difference.

• The second layer of skin is the dermis. The dermis is the white layer of skin that we sometimes see after we scrape or injure our skin.
• The dermis is very vascular and one of its major functions is to supply blood to the epidermis. The dermis also gives the skin its turgor or firmness. As we age, the skin at the dermal layer gets thinner and more relaxed. This leads to wrinkles and sagging skin. Unfortunately there are typically no creams or ointments that can penetrate to this deep dermal level without significant downtime.
• To get around this issue we incorporate resurfacing lasers and surgery to manipulate the deep dermal layers of skin. CO2 resurfacing laser is the gold standard of laser resurfacing and it works by contracting the dermis through heating and in turn stimulates new collagen growth. Active FX is a treatment that involves CO2 resurfacing and is related to minimized downtime and pain.
• The extremes of skin laxity from the effects of gravity and weathering still require surgical corrections. Surgical options like face lifts, neck lifts, forehead lifts, blepharoplasty, etc. all involve removing excessively lax skin and repositioning the skin into a more youthful placement.
• Surgery is still the most effective and dramatic way to correct sagging skin but it also typically involves more costs and more downtime than other options. Surgery has been around a long time and it still is the single best way to correct skin laxity.
• Combining surgery with some of the above mentioned procedures can truly transform your skin and restore a more youthful look. There is a reason that surgeries have withstood the test of time and that reason is because they work.
• Lastly there are the subcutaneous tissues. By definition the word subcutaneous means under the skin and technically this tissue is not skin organ tissue. When we refer to subcutaneous tissue in this article we are typically referring to the layer of fat and collagen that acts as a bed for our skin to lie on. Again, aging takes its toll on these tissues and typically changes the distribution of fat. Losing fat from our face and hands is what often happens, and it can make these areas look thin and gaunt.
• Replacing the lost volume is the goal in combating this, and dermal fillers are a quick and effective counter to this phenomenon. Products like Restylane and Juvederm, which are brand names for hylauranic acid based dermal fillers, are the first line of defense.
• Products like Sculptra offer a more permanent correction but are stimulatory in nature and require more patient commitment to get a noticeable result. Sometimes, we actually do fat grafting which involves harvesting fat from an area that has a significant amount and relocating to an area of need.
• Unfortunately, fat grafting usually causes more downtime compared to other dermal fillers, and does not guarantee that you will have more persistence of correction than the other methods of re-volumizing.

Chemical, Laser, Or Surgical

Using all of the options mentioned and applying them appropriately to an individual’s needs is the real art involved in cosmetic medicine. Taking care of our skin is important to our general health and well being but it is also vital in maintaining our aesthetic appearance.

As a patient, the utmost importance will always be placed on protecting our skin from the sun and its cancer causing rays. However, when it’s time to work on and correct the effects of aging on the skin it will come down to one of only three choices: chemical, laser, or surgical. Protection first, correction second and when you’re ready for correction we will be there.

Dr. Frank Venzara

ABOUT THE AUTHOR

Dr. Frank Venzara was born in Chicago and has resided for the majority of his life in South and Central Florida. He is a graduate of both University of Miami’s Undergraduate Program and Medical School. He trained as a surgical resident at Jackson Memorial Hospital in Miami and as a plastic surgery fellow at the University of Missouri’s Truman Medical Center in Kansas City, Missouri. He has practiced in the Central Brevard Area for 25 years as a Board Certified Plastic and Reconstructive Surgeon. When not attending to his surgery schedule, Frank enjoys surfing and fishing. Dr. Venzara can be reached at 321-452-3882, or log on to www.brevardplasticsurgery.com.