SKIN REJUVENATION WITH LASERS

Our skin undergoes changes with the aging process and loses its healthy, youthful and aesthetic appearance. Aging is not a factor on its own, but external factors such as the sun, accidents and injuries, skin diseases such as acne and smallpox can also impair the appearance of the skin.

Medical procedures to treat (correct) the conditions that occur due to both aging and skin diseases can be grouped under the title of skin rejuvenation and skin rejuvenation. Chemical peels, botulinum toxin applications, PRP (platelet-rich plasma), mesotetherapies, and face suspension methods with threads are used for medical skin rejuvenation.

For skin rejuvenation, surgical applications such as face and neck lift are performed in advanced ages or those with severe (stage 4-5) sagging.

Laser methods, on the other hand, have started to be preferred more in recent years due to their effectiveness in skin rejuvenation and rejuvenation, clinical success and safe application conditions.

For this purpose, CO2 (carbon dioxide) lasers were used for the first time in the 1980s and are still the gold standard of skin rejuvenation today.

Over time, other laser systems have started to be developed together with the CO2 laser and they are used effectively today.

Laser systems used for skin rejuvenation are divided into 2 as ablative lasers and non-ablative lasers according to their ability to damage the skin integrity (ablation).

1. Non-ablative lasers (the ones that do not damage or peel the skin); Alexandrite Laser is PDL, IPL and Nd:YAG laser.

2. Ablative lasers (those that cause skin damage and peeling) are Erbium and CO2 lasers.

1-Ablative lasers:

Ablative skin resurfacing lasers are lasers that provide controlled tissue damage by removing the entire epidermis (upper layer of the skin) and a part of the dermis (lower layer of the skin) at the desired depth with laser-heat damage. An increase in heat occurs around the tissues that these lasers eliminate, and this heat is transmitted to the surrounding tissues, ensuring the regeneration and restructuring of collagen. Thus, with the renewal of the skin and the increase of the supporting tissues in the deep tissues, a younger, fuller and lively appearance is obtained.

With these features, ablative lasers are used especially on aging skin with sun damage.

These lasers;

Spots and color changes on the skin surface,

wrinkles,

Vascular structure increases,

sun-induced skin tumors,

Skin rejuvenation in areas where other skin rejuvenation methods such as around the eyes and mouth are not very successful,

It is used in the treatment of bad scars after acne, trauma and surgery.

On the other hand, ablative lasers can be used as surgical blades in some skin diseases. For example, they can be used for this purpose in rosacea (rose disease), rhinophyma (growth in the nose), xanthelasma (yellow spot on the eyelids), warts and skin tumors.

Is the skin color of the people who will have ablative laser important?

For those with very dark skin, ablative lasers are not preferred.

Where can ablative lasers be applied?

The face, neck, décolleté and upper hand are among the most common application areas.

Can anyone have ablative laser?

After ablative lasers, the regeneration process of the skin begins in skin appendages such as hair and fat cells. Patients should not have problems with skin appendages. For example, scleroderma is not preferred in patients who have undergone radiotherapy for these reasons. It is necessary to pass 1 year after the use of drugs such as isotretin (roaccutane, zoretanine, aknetrent) used in the treatment of acne.

Extreme caution should be exercised in patients with structural keloid (hard and raised healing of damaged tissue from the skin).

Is there pain during the procedure?

The application is performed under local anesthesia, regional anesthesia or general anesthesia in suitable patients.

What should be considered before and after the procedure?

Preventive antiviral, antimicrobial and antifungal treatments can be started before the application. Retinoids, especially trethionines (vitamin-derived drugs) can be used on the skin due to its effect on the healing process after laser. After the procedure, it is necessary to be very well protected from the sun with high protection factor creams for a few months.

Since edema will develop at the application site after laser, there will be fluid discharge from the tissues. Therefore, proper care and dressing of the application site is extremely important.

After the application, redness-erythema lasting for a few months may remain. It is important to be protected from all kinds of light sources so that this redness does not turn into a stain.

Fractional definition has been used in ablative laser applications since 2004. This definition means that the laser creates ablation (that is, tissue damage) of certain parts of the skin, while the areas between them remain intact (like a sieve). The aim here is to reduce the damage in the entire tissue in ablative lasers, shortening the long recovery time and reducing the side effects.

2-Non-ablative lasers:

Traditional (ablative) or fractional lasers are still the gold standard in skin rejuvenation and facelift applications, but new skin rejuvenation systems are being developed because of the long recovery times after these methods and the limitation of the patient’s social life. During the use of new laser systems, patient compliance is higher (more comfortable) and the recovery time after the application is almost non-existent. These new systems are defined as “Non-ablative skin rejuvenation”. During the application, the epidermis, which is the superficial layer of the skin, is protected, and the skin is restructured (collagen production) by providing high heat (with photothermal effect) in the dermis, which is the deep tissues of the skin, without minimal (very little) or no damage to the epidermis. It aims to trigger the production of new collagen, elastin and intermediate support products with the photothermal effect and to increase the volume of the dermis. Thus, the regeneration of the skin is provided.

What are other skin rejuvenation methods?

Chemical peels for skin rejuvenation and skin renewal, dermabrasion, dermaroller (micro-needling), botulium toxin (botox), fillers (hyaluronic acid and others), PRP (platelet-rich plasma), face lift-rejuvenation with threads, carbon peeling, etc. method is available.

What are the differences between CO2 laser and Nd-Yag lasers?

The main factor determining the superiority of the carbon dioxide (CO2) laser is the wavelength. Other lasers have shorter wavelengths and are limited in their effectiveness to remain on the surface of the skin and require repetitive sessions for a good result. The CO2 laser has a wavelength of 10.650 nm and its results are more effective as it reaches the middle layer of the skin – the dermis. In CO 2 lasers, the depth affected by the application on the skin is not determined based on eye judgment or experience, as in chemical peeling or dermabrasion, the desired depth is precisely known with the laser. The fact that the fractional mode has been used in CO2 lasers for the last 5 years has carried this laser to higher levels. It has become the gold standard that can be used today in skin stretching, rejuvenation and rejuvenation.

The main factor determining the superiority of the Nd:YAG laser is again the wavelength. Nd YAG laser has a wavelength of 1060 nm. With this wavelength, it reaches the deeper layers of the skin in a way that protects the epidermis (it is defined as nonablative because it does not cause damage and peeling in the epidermis). It provides restructuring in the dermis, that is, rejuvenation of the skin. It is an extremely safe method for skin rejuvenation, renewal and skin stretching, which can be applied to any skin type and desired area of ​​the body, including the face. Its superiority to CO2 lasers is that it does not damage the upper layers of the skin, so it is not noticed from the outside, and its disadvantage is that it needs repetitive sessions.

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