Shining a new light on ageing

Of course, it's perfectly normal for your skin to age, and for that youthful glow to fade. However, excessive exposure to sunlight hastens the process. It accelerates and exacerbates natural skin changes with age, causing wrinkles, sagging, leathery skin, dark spots and broken blood vessels.

While it isn't possible to look 20 when you are 50, there is another form of light that can help you look better, not older, as the years go by. It is laser, an acronym for "light amplification by stimulated emission of radiation".

Its popularity is growing globally, as the technology's advances and treatment technique refinements make it look pretty good - and safe - for what is known as non-surgical facial rejuvenation, says Sandton aesthetic medicine specialist Dr Alastair Clark.

You may be more familiar with lasers from science fiction movies like Star Wars, in which the light was a weapon of choice to destroy various enemies. Lasers are a little more mundane than that.

They play a diverse role in everyday life and modern medicine. They are in products and technologies - ranging from DVD players to dental drills, metal-cutting machines and measuring systems. Doctors use lasers to improve vision, cauterise wounds, remove tattoos, improve scars, transplant hair and remove hair permanently, and increasingly to beautify the skin.

Laser is really just pure light, a form of radiation not to be confused with nuclear radiation or the sun's damaging UV radiation. A laser machine emits light in a coherent way, as it is of one precise wavelength, say the experts.

"All the waves are synchronous," says Sandton dermatologist Dr David Presbury.

As a result, treatment can be "very powerful", Presbury says. The light is designed to target specific tissue in the skin, at which point the energy converts to heat, and a specific, predictable reaction occurs, he says. An example is a vascular laser that would react with red - red cells in vessels.

Laser light of different wavelengths effectively fights signs of ageing by resurfacing the skin (removing the top layer completely) and injuring skin tissue - the fibroblasts in the cells in the tissue matrix - producing new elastin and collagen, causing skin to regenerate as it heals.

In effect, says Clark, director of the Sandton Aesthetics Institute, doctors use lasers to cause "varying degrees of controlled injury to the skin, depending on the problem and desired outcome".

The injury is deliberately designed and measured to be relatively minor, he says, enough so as not to scar the skin permanently, but enough to induce new collagen formation that can tighten and rejuvenate the skin.

He believes in this way, laser therapy can be an alternative to a facelift, depending on the extent of wrinkling and sagging of the skin. It also works well as an adjunct to a facelift, Clark says.

That's because a facelift really only changes the skin "like a tailor changes clothes to fit", as one writer put it. It can remove excess skin, but skin quality remains much the same. That's because youthful looking skin is more than just wrinkle-free. It has the condition, tone and texture that creates the glow of youth. It may require more than even the most skilful cosmetic surgeon's scalpel.

Laser treatment may be a case of use sooner rather than later.

"Use it at the first signs of ageing, and you may never need a facelift in the future," says Clark.

Presbury agrees, and says: "The Americans tell us that everything works best 'in the preemptive mode'. Therefore people who perceive an early problem are suitable, whatever the age."

In the 1980s and 1990s, the gold standard for skin "resurfacing" was the ablative (wounding or destroying) laser, say the experts. There are two ablative systems: CO², and erbium Yag lasers. Both react with water in the skin cells, but emit different wavelengths of light. They work by vaporising the surface of the skin - removing the whole epidermis and some of the upper dermis.

"This was great for wrinkles," says Presbury, "but it left the skin difficult to manage for two to three weeks, with significant redness, nearly always with obvious reduction in the pigment (hypopigmentation), with a clear and unsightly division between treated and untreated areas."

Fractional CO² laser systems, both ablative and non-ablative, made by companies such as Palomar and Fraxel, have been developed to reduce the thermal damage and side effects of ablative lasers, and remove layers of sundamaged skin in a more controlled, less damaging way. These are now in more common use than earlier ablative lasers.

Palomar in the US, a Massachusetts-based company, is at the forefront of research on lasers for skin rejuvenation. Clark says other companies pay royalties to Palomar for the technology they use in their machines, though the company is unlikely to make its latest technology available under licence. And the company's R&D budget is "funded by infringement of copyright payments", he says.

Fractional lasers use a fractionated beam that delivers thousands of tiny columns of heat deep into the skin. They coagulate rather than vaporise old skin cells, stimulating new collagen formation and leaving the surrounding tissue unaffected and intact, says Clark.

This translates into minimal downtime, faster healing and fewer side effects (a few hours of mild skin redness and little swelling), and new collagen formation that continues for about six months. However, results with non-ablative lasers are usually not as extensive or long-lasting.

Patients may require four to five treatments with non-ablative lasers at intervals of about four to six weeks, says Clark. Presbury says that by using settings for removing pigment, fewer treatments may be necessary, as the reduction in pigment can be seen between the sessions.

A big advantage of non-ablative fractional lasers is that they can be used on all skin colours and types, says Clark.

Presbury agrees, but says that while fractional lasers are safe for Asian and black skins, their use requires "more care, at least in the short term, as you can cause increased darkening - post-inflammatory hyperpigmentation".

New machines with dual settings are "entirely designed to treat pigmented areas such as melasma", Presbury says.

Fractional ablative lasers cause more swelling and redness and thus longer downtime than nonablative lasers, but require fewer treatments, and can achieve longer-lasting results.

Clark says he was not a fan of ablative lasers for conditions that could be effectively treated with non-ablative lasers. However, after attending the World Laser Symposium in Marbella, Spain, last year, he now favours a combination of the two for deeper, ageing skin conditions that can't be managed by non-ablative lasers alone.

"This keeps to a minimum the negative side effects of ablative lasers, while maximising their deeper skin resurfacing and rejuvenation effects," he says.

Another major benefit of nonablative lasers is that they can be used on necks and hands, says Clark - two of the earliest telltale signs of ageing and have been notoriously difficult to treat.

That's in part because necks and hand have some of the thinnest skin on the body, and are usually exposed to the sun's damaging rays without the proper protection.

In addition, as the neck area begins to sag, gravity exerts its force and muscles weaken, compromising the whole support system.

Then there is the effect of fat loss that occurs with age. Fat loss has only recently been identified as a key factor in the ageing face, neck and hands, says Clark. It causes a loss of the fullness and firm contours typical of a youthful face. Coupled with muscle weakness, fat loss causes the sagging and banding under the chin, often referred to as turkey neck, that cannot be restored by cosmetic surgery or even laser alone. It makes hands look skeletal.

Non-ablative fractional lasers can tighten and improve the condition of the skin on ageing hands and necks, says Clark. However, optimal results often require treating the fat loss as well with artificial fillers such as Restylane Vital, a gel from Q-Med, the makers of a range of dermal fillers for different parts of the body.

Restylane is the first cosmetic dermal filler made of non-animalbased hyaluronic acid, a substance that exists naturally in the human body. It is found in greatest concentrations in skin, where it gives volume and fullness.

The hyaluronic acid in Restylane is a clear gel known as Nasha - non-animal stabilised hyaluronic acid. It is biodegradable and fully biocompatible with human hyaluronic acid. It works by hydrating the skin, improving its elasticity and tone, says Clark

Because Restylane is a nonanimal-based substance, it is approved as safe for patients who are allergic to collagen, says Clark. Results are apparent almost immediately and typically last longer than collagen.

Doctors use lasers to cause varying degrees of controlled injury to the skin, depending on the problem and desired outcome

Source: Business Day