Photo-Aging and Sun Damage: Minimally-Invasive Skin Procedures
Intro
According to the Skin Cancer Foundation, “photoaging is a direct result of cumulative sun damage you’ve been exposed to throughout your life.” With the cumulative sun damage, photoaging can eventually lead to the appearance of fine lines, wrinkles, and pigmentation. Beyond the development of fine lines, wrinkles, and pigmentation, research also says that chronic exposure to sunlight can lead to the development of skin cancers. With all of this, looking at ways to protect the skin from sun damage is useful to prevent the appearance of fine lines, wrinkles, and pigmentation. In addition to protecting the skin from sun damage, people may also look towards skincare actives and skin procedures to address their photoaging symptoms.
2 weeks ago, we learned about how sun exposure can cause photo-aging and photo-damage. In addition to this, we also learned about sunscreens, the different types of sunscreens, and how antioxidants may be useful at protecting the skin. Click here to read my blog post on sun exposure, sunscreen, and antioxidants. Last week, we learned about the evidence betting skincare actives claimed to address photo-aging and sun-damaged skin. Click here to read last week’s blog post on skincare actives.
In this week’s post, we are going to speak about the evidence behind minimally-invasive skin procedures claimed to address photo-aging and sun-damaged skin.
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
minimally-invasive PROCEDURES
What does “minimally-invasive” mean & What are some examples?
“Minimally-invasive” cosmetic procedures are generally known as procedures that do not require surgery. Minimally-invasive cosmetic procedures usually do not have a downtime as long as surgery, and the results of surgery are longer-lasting than minimally-invasive cosmetic procedures. Common minimally-invasive cosmetic procedures are neuromodulatory injections (Botox, Xeomin, etc.), dermal fillers, microdermabrasion, non-surgical facial rejuvenation, and more.
Minimally-invasive procedures have also become more mainstream in society, and have been used as a way to slow down/prevent signs of aging. Due to the low-to-no downtime of some minimally-invasive cosmetic procedures, a 2020 study showed that minimally-invasive cosmetic procedures have been becoming popular amongst the Millennial generation for preventative treatments.
Read on through to learn about:
facial Peels
Light therapy
Collagen induction
Bio-regenerative therapies
Facial PEELS
GLYCOLIC ACID (GA)
Glycolic acid (GA) is a common skincare active and clinical peel used in-office used to resurface the skin, with lower strengths being available over the counter and stronger strengths provided by licensed providers. GA is a superficial peel, which means that it mainly acts on the upper layers of the skin, called the epidermis.
Now, how does GA work? Well, GA is known to break down the “glue” that keeps dead skin cells together to help with skin texture. Additionally, a 2019 study completed on animal skin showed that GA reduced the effects of UV-B on collagen degradation to prevent the development of fine lines and wrinkles.
Now, how effective is GA peel therapy? GA peel therapy has been shown to aid with some signs of photoaging, with a study showing that GA peels commingled with topical vitamin C was helpful at reducing severity of wrinkles. Another study showed that GA peel therapy helped with fine lines and unevening skin darkening when 10% GA was applied daily. Additionally, partially neutralized versions of GA have even been shown to be effective at stimulating collagen production without causing irritation and inflammation on the skin.
TRICHLOROACETIC ACID (TCA)
TCA is another peel that is commonly used for photo damage that is only available as an in-office treatment with a licensed provider. A provider will select between TCA, GA, and other acids depending on many factors, such as symptom presentation and severity of photo damage. TCA is a medium-depth peel, meaning that it can go deeper into the skin and reach the dermis. And, since it can go deeper into the skin, it is more-important to consider a patient’s Fitzpatrick skin type, and other factors, as this peel has the possibility of causing post-inflammatory hyperpigmentation and scarring.
Now, how effective is TCA? Literature shows that photo-damaged skin treated with TCA 40% combined with topical retinoid improved skin roughness due to chronic sun exposure, but did not have any effect on wrinkles. Additionally, GA 70% has been shown to be as effective as trichloroacetic acid (TCA) 15% for photo damaged skin, which suggests that those who aren’t good candidates for TCA could be recommended GA instead by their provider. Another study looking at GA and TCA showed that combined GA and TCA led to improved skin hydration levels and improved skin elasticity, but that TCA alone was more effective at reducing wrinkles.
LIGHT tHERAPY
INTENSE PULSED LIGHT (IPL)
Intense pulsed light (IPL) is a minimally-invasive procedure that is commonly used for photorejuvenation of the skin, and for many other skin goals. In regards to how it works, an in vitro study shows that IPL stimulates collagen-producing cells, called fibroblasts, in the skin and increased the production of collagen expression in the skin. And, a 2011 study showed that IPL caused a significant increase in collagen in the skin and an improvement in skin elasticity.
Now, how effective is IPL? A small study completed in 2004 showed that IPL was effective at reducing the severity of photoaging after 3 treatments and that the procedure was well-tolerated in subjects with minimal side effects. And, a 2006 study showed that 3 IPL treatments done at 1-month intervals on those with Fitzpatrick skin types I-III led to improved skin texture and improved uneven skin tone, but did not have an effect on wrinkles. And, another study completed on asian patients showed that 4 IPL treatments done at 3-4 week intervals was “safe and effective” for photoaged skin.
FRACTIONAL LASERS
Lasers are concentrated beams of light that can carry high amounts of energy, and ablative fractional lasers are a type of light therapy that some providers may recommend specifically for skin tightening. Some examples of ablative fractional lasers are: CO2 fractional laser and ablative Er:YAG fractional laser.
How do these ablative fractional lasers work? Literature indicates that these lasers use water to vaporize treated zones to promote collagen production in the skin. Because of the high concentration of energy, there is a possibility of scarring, discoloration, and skin infection, but do know that these fractional lasers are considered “significantly safer” than non-fractionated lasers.
How effective are ablative fractional lasers? A 2008 study showed that 3 treatments CO2 laser led to “subjective improvements in wrinkles, skin texture and mottled pigmentation” and that CO2 laser led to increased dermal thickness
COLLAGEN INDUCTION
MICRONEEDLING
Microneedling is a minimally-invasive cosmetic procedure that uses very fine needles to address “skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery.”
How does microneedling work? Research shows that microneedling is a controlled method to cause skin trauma and activate the body’s own wound-healing process. The wound-healing process is a 3-step process where the immune system is triggered to cause inflammation, leading to the activation of collagen-producing cells, and ultimately leading to collagen production and skin tightening. Additionally, microneedling has been used as a means for transdermal drug delivery, with some providers using hyaluronic acid, BotulinumtoxinA, filler, and others into the skin.
How effective is microneedling? A small 2015 study showed that 6 microneedling treatments done every 2 weeks lead to significant improvement in photoaged skin with skin showing increased leaves of collagen. And, a small 2017 study showed that 2 microneedling sessions every 30 days combined with daily sunscreen use led to improvement in melasma, reduction in melanin pigmentation, and increased collagen in skin.
RADIOFREQUENCY
Radiofrequency (RF) uses electric-based heat to address signs of photoaging, and literature indicates that radiofrequency has been shown to be “beneficial for the treatment of facial wrinkles, brow lifting, periorbital wrinkles, nasolabial folds, jowls, marionette lines, jawline contouring, and neck laxity.” However, since it does use heat technology, those with implanted medical devices are not good candidates. Additionally, literature indicates that radiofrequency is “less effective in older patients, either due to decreased capacity for dermal healing, decreased tissue hydration, or increased severity of preoperative deformity.” How does RF work? Science says that RF breaks down existing collagen and stimulates the production of new, shorter collagen leading to “lasting tissue tightening.” Literature also shows that RF “has demonstrated clinical improvement of skin tightening, texture, and wrinkles.”
BIO-REGENERATIVE THERAPIES
PLATELET-RICH PLASMA (PRP)
Platelet-rich plasma (PRP) is a nutrient dense serum made from the patient’s own blood that has been shown by literature to “contribute to the acceleration of healing, tissue growth, and generation of hyaluronic acid.” This minimally-invasive procedure includes PRP being injected into the skin, and is commonly used for skin rejuvenation to address clinical signs of photoaging.
How does PRP work? Science says that the proteins and the growth factors in PRP “stimulate stem cells and improve cellular proliferation, differentiation, and regeneration,” which ultimately lead activation of collagen producing cells to make collagen in the skin “and other elements of the extracellular matrix” for skin rejuvenation.
How effective is PRP? There are various methods as to which PRP can be delivered into the skin. The first method is topical application with microneedling and the second method is through injection directly into the skin. Research indicates that 3 treatments of topical application of PRP with microneedling done every 2 weeks led to a subjective improvement in general appearance, skin firmness-sagging, and wrinkle state. Additionally, science suggests that the PRP acts synergistically with microneedling in the activation of collagen-producing cells. Scientific research also shows that PRP injections led to cellular improvements in photoaged skin and that PRP injections improved skin texture. And, in our clinic, we do a combination of microneedling technology with PRP.
Polydioxanone (PDO) THREADS
Polydioxanone (PDO) threads are absorbable surgical sutures that have been used in surgery for many years, with science indicating that these sutures being completed absorbed by the body in 4-6 months. This science shows that absorption process ultimately leads to the activation of collagen-producing cells, and leading to the formation of collagen in targeted areas. And because of this, PDO threads have been touted as a method for a “non-surgical facelift.”
There are different types of PDO threads, such as smooth/monofilament threads and barbed threads. Both types of threads will activate collagen-producing cells via the absorption process. According to literature, smooth/monofilament threads are meant produce a firming effect and regenerate tissue, but it does not produce a lifting effect. Barbed threads, on the other hand, “clasp” the skin to produce a lifting effect.
For more information on PDO threads, I highly recommend The Things We Do.
SUMMARY & TAKEAWAYS
This blog wraps up a 3-part series on sun damaged skin and photoaging! In this blog, you learned about minimally-invasive cosmetic procedures to address some signs of photoaging. I have been saying this since part 1, and will continue on saying so - Remember that prevention is the best method, and that sunscreen is the best way to prevent sun damage and photo-aging. For those with mild signs of photoaging, speak to your provider about topical skincare options. And, for those looking for more support or faster effects, speak to your doctor about the minimally-invasive procedures in this blog post.
As a quick recap, you learned about the following minimally-invasive cosmetic procedures in this blog:
Facial Peels: Glycolic acid and TCA
Light therapy: Intense-pulsed light and fractional lasers
Collagen induction: Microneedling and radiofrequency
Bio-regenerative therapies: Platelet-rich plasma and PDO threads
Remember, we do platelet-rich plasma (PRP) with microneedling in-office. And, we recommend that those interested in PRP with microneedling for facial rejuvenation to schedule a consultation to see if PRP is worth your while. And, the cost of the consultation can be applied to your PRP treatment cost.
In next week’s post, I am going to address sunscreen myths that I have seen surface on social media.
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