Dear Dr. Seckel, How is it that the sun can cause aging by damaging the collagen and elastin, while IPL and laser rejuvenate the skin by the same method? Darcy, Spokane, WA
Dear Darcy,
Thank you for your very insightful question. Facial skin aging is caused by a number of factors of which the sun is a most important one. Ultraviolet radiation from the sun as you point out causes facial aging by direct damage to the collagen and elastin fibers in the dermis or deep layer of the skin. Healthy collagen keeps the skin plump and supple, and the elastin gives the skin elasticity, the ability to snap back when it is pulled away from the face. As the skin ages, after years of exposure to the sun the elastin fibers are broken up and collect in the deep layers of the dermis a condition called solar elastosis a classic sign of facial aging in the skin. Other factors contribute to facial aging including loss of facial fat which plumps the skin when we are younger, loss of facial bone density, elevated cortisol the stress hormone, free radicals released by toxins and bad diet, and intrinsic factors – our inherited genetic propensity for facial aging.
Facial aging caused by the sun results after years of damage to the collagen and elastin, and aged facial skin has a damaged, lax, inelastic dermis which is deficient in healthy collagen and elastin.
The new “high tech” facial rejuvenation, anti-aging treatments attempt to restore or rejuvenate the facial skin and reverse facial aging changes by producing new healthy collagen and elastin and removing the old damaged collagen and elastin from the aged facial skin. This is a very sophisticated method which can best be described as “controlled scar formation”. Results can be beautiful.
The laser, IPL, radiofrequency wave or any other irritant such as a chemical peel is used to irritate the skin and damage the collagen and elastin in the dermis. When you irritate the dermis of the facial skin you initiate a process called inflammation. Inflammation is a healing or reparative process of the body. Where the collagen and elastin of the dermis is irritated or injured, white blood cells come into the area and remove the damaged collagen and elastin and some of the white blood cells convert to a cell called the fibroblast, a cell which can produce new collagen and elastin to replace the damaged collagen and elastin.
The key difference between skin sun damage to collagen and elastin and the skin damage caused by a laser or IPL is that the damage caused by the sun is chronic, that is it continues year after year and although the dermis tries to heal and produce new collagen and elastin the damage from the sun continues year after year and overwhelms the body’s natural inflammatory healing process. The damaged collagen and elastin atrophies or shrinks and dies and any new collagen or elastin which is formed is immediately damaged by further sun exposure.
Laser or IPL treatment called Photo facial skin rejuvenation is a very quick, very powerful event that damages a great deal of the aged collagen and elastin all at once and causes the aged skin to heal and regenerate a great deal of new collagen and elastin in a very short time. New collagen and elastin produced after a laser or IPL treatment during the first six months is probably more than would be produced in five or ten years in response to the sun, and of course ten years worth of sun damage is not daily hitting the new collagen and elastin so the dermis over a period of time after a number of treatments is plumped and the facial aging changes are lessened and non-surgical facial rejuvenation has occured. However, if sun block and good preventative skin care is not instituted after the laser or IPL treatment, the sun will damage the new collagen and elastin and facial aging will return.
The ability of laser and IPL to rejuvenate the face is dependent on many different factors. Visible wrinkle removal and skin tightening with one treatment requires ablative laser resurfacing with a CO2 or Erbium laser. This is called laser resurfacing and is a procedure which causes the face to be red and raw and requires 8-10 days of healing, followed by 6-8 weeks of facial redness requiring make up. This procedure produces dramatic immediate results.
The non-surgical facial rejuvenation procedures done with the IPL,. photo facial and non ablative lasers are very different. These are often called no down time facial rejuvenation procedures, meaning that you do not have the redness and healing time associated with the laser resurfacing procedure mentioned above. The no down time facial rejuvenation procedures done with the IPL and non ablative lasers take many treatments, five to seven sessions, over a period of six to seven months to see a result that often is only 20-30% as good as the result of the ablative laser resurfacing. The problem is that the no down time procedures only produce a small amount of inflammation and new collagen and elastin formation at each treatment, so they work much more slowly.
I often use a newer procedure called a microlaserpeel using the new erbium laser. In this procedure a very mild ablative laser peel is performed but only very superficially. The skin is red for only four to five days instead of 6 weeks, but more new collagen and elastin formation is produced and results are better than with the non ablative IPL, photo facial and laser treatments.
If you want to read a detailed discussion of exactly how the laser and IPL photo facial skin rejuvenation treatments produce inflammation and new collagen and elastin production in the drmis, read chapter 8 in my book Save Your Face - The Truth About Facial Aging, Its Prevention and Cure available on this website.
This is a very long answer to your excellent short question, but I hope it helps. For further information, visit my Boston Plastic Surgery Practice, contact me or read Save Your Face.
Thank you,
Boston, Massachusetts
Peabody, Massachusetts