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Cutaneous aging. Chemical peels, Collagen injection, and dermabrasion
Despite recent advances in science and medicine, we have been unable to significantly retard the process of cutaneous aging. Chemical peels, collagen injection, and dermabrasion are clinical techniques that can help camouflage the aging process.
In addition to combating the signs of aging, these agents can be used to help ameliorate scars and to destroy premalignant lesions and even some malignancies. Dermabrasion and chemical peels are methods of producing a controlled injury. Only if the injury is in the proper tissue plane can the desired result be achieved. If too superficial, the result will be disappointing. If too deep, the results can be catastrophic.
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Chemexfoliation
Chemexfoliation, or chemical peeling, creates a controlled injury in an attempt to correct a particular problem. Dermatologists such as Mackee used phenol as early as 1903 to treat acne scarring and introduced it into the literature in 1952. |
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Peeling agents
Trichloroacetic acid solution was one of the first and most versatile agents developed for chemical peeling. It is available in crystals and must be mixed with purified water to achieve the desired concentration.
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Glycolic acid Peeling
Glycolic acid is one of the alpha-hydroxy acids. They are naturally occurring organic acids derived from various fruits. Glycolic acid comes from sugar cane, lactic acid from sour milk, citric acid from citrus fruits, tartaric acid from grapes, and malic acid from apples. They can be synthesized from various chemicals in the laboratory.Glycolic acid is now in many over-the-counter cosmetics. It is used in low concentrations ranging between approximately 3% and 10% on a daily basis. Side effects are relatively uncommon with low concentrations, although irritation can be seen.
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Dermabrasion
Dermabrasion was first introduced in 1953 by Dr. Abner Kurtin, a New York dermatologist. It is a technique that combines a hand engine with either diamond-studded fraises or wire brushes. It is used for the correction of photodamage or scarring, or both. Dermabrasion is extremely dependent on technique. Gouges and deep scarring can easily be created while doing the procedure. It is a technique that should be learned slowly, carefully, and at the side of someone quite experienced. The advantage of this technique is that one has direct control over the depth of injury. Very light, delicate dermabrasion can eradicate the most superficial problems. By going deeper into the papillary and reticular dermis, deep scars can often be improved. Dermabrasion can be an attempt to sand down a scar or defect or to sculpt the surrounding tissue down to a level where the defect becomes less noticeable. The art of dermabrasion is knowing how deep to go. If one goes too deeply, scarring will be created. If one does not go deeply enough, the results will be suboptimal.
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Aging Face
Soft tissue augmentation using injectable materials is a useful adjunct in rejuvenation of the aging face7. It also plays an important role in the clinical improvement of scars resulting from trauma or disease.
Although injectable silicone was withdrawn from the market, it had been used for years to correct fine lines and scars. As a supposedly inert foreign material, it formed a nidus for the formation of new collagen around it, similar to a grain of sand in an oyster. As the use of silicone for breast implants was challenged and eventually banned, the microdroplet technique of silicone injection into the skin was also abandoned.
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Adverse Reactions
Fortunately, adverse reactions with injectable Zyderm, Zyplast, or Fibrel are rare. In approximately 3% of patients who receive, a Zyderm test implant, an allergic reaction develops at the site with erythema, induration, and pruritus. Seventy percent of these occur within the first 3 days, 80% within the first week, and the rest within one month. Studies with Fibrel have shown that approximately 2% have a positive skin test. Of the patients with negative skin tests who were treated, 8% had treatment site reactions. Approximately 3% of patients with a nonreactive skin test to Zyderm collagen will have an adverse treatment site reaction. Most commonly, a treatment site reaction will be similar to an allergic reaction at the test site. This would include swelling, erythema, and pruritus.
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