In my clinic I see lots of clients who just want to get rid of wrinkles in the prerioral areas, décolleté, neck and hands. Most of my clients at the age over 50. Their concerns are: rough skin surface, deep creases, fine wrinkles, plaque-like thickening, yellowish skin color and skin discoloration, especially in the areas of neck, chest, hands and around the mouth.
All of them represent baby boomers generation: people who have spent lots of time under the sun. Now they feel well, eat healthy, they are in a good body shape. Their faces look as good as they want, doing surgical and not surgical treatments, but… neck, decollate, premoral areas and hands are huge markers of the aging. The reason for this concern is a prolonged sun exposure with the developed cosmetical condition, named solar elastosis. Solar elastosis is one of the symptoms of photoaging, which induces clinical and histological changes in the skin, since prolonged sun exposure these changes.
Clinical changing of photoaging skin condition is characterized by changing the texture, color and moisturizing level. Changing the texture includes rough surface, deep creases, fine wrinkles, plaque-like thickening, etc. The color changes characterized by yellowish shadow, irregular pigmentation and teleangiectasia. Skin dryness is a marker of photoaged skin dehydration.
These clinical changes are reflected by histological changes in the epidermis and dermis tissues. Epidermal layer shows alterations such as epidermal hyperplasia or atrophy, thickening of stratum corneum, atypical keratinocytes, paraceratosis and thickening of basement membrane disappearance of dermal papillae and increased numbers and irregular distribution of melanocytes and melanosomes (Gilchrist 1996).
Dermal histological changes include accumulation of elastotic material (collagen and elastin degradation product) in the upper and middle dermis with alternating areas of fibrous (also known as solar elastosis) with increased numbers of tangled and thickened elastic fibres and granular and homogenous elastic material (Matsuta et al., 1987).
The molecular changes in the skin are well described in the scientific literature and most of the concentrating on the influence of the UV light. Suberythemogenic doses of UV and low doses of IR / heat lead to an influx of neutrophils. Neutrophils are packed with proteolytic enzymes (such as neutrophil elastase) that participate in extracellular matrix (ECM) damage processes, mainly collagen and elastic fibers degradation. Neutrophil elastase is strongly associated with solar elastosis and together with martix metalloproteinases (MMP) are considered as major contributors to photoaging process (Rijken and Bruijnzeel, 2009). In addition, UV radiation generates reactive oxygenspeices, where these oxygen species lead to oxidative damage of the skin (Miyachi,1995). Oxidative stress leads to mitochondrial and nuclear DNA damage (Gilchrest and Bohr, 1997). Rising in the oxidative damage, mitochondrial DNA mutations and p53 mutations (Jonasol at al,1996) are postulated factors of photoaging. The presence of deformed collagen fibres, decrease in amount of collagen, increase in amount of ground substance, dilate blood vessels are consequences of the dermal layer alterations as the result of massive UV exposure.
There are only a few ways to treat the solar elastosis in the modern aesthetic medicine.The treatments that are the most “resultative” are:
No doubt that all of these treatments give very mild effect. Since solar elastosis is the skin damage in both levels: dermis and epidermis, the typical treatments cannot target them both. Superficial chemical peels work only on the level of epidermis. Meed level peels, as Retinol, TCA maximum influence on the papillae dermis. Phenol peel, like non-ablative lasers, is able to stimulate changes on the level of reticular dermis. But, it’s a well-known fact that photoaged skin heals on the very bad way, first of all because of dehydration and luck of capillaries blood flow. Selective photothermolysis, like IPL technology, is able to change the skin color interacting with melanocytes, but is able to do nothing with the massive elastic conglomerates in the dermis skin layer. As a conclusion it is a high demand of a technology, or the combination of technologies that will work in the same time on epidermis, papillae and reticular dermis layers.
In my practice, I found one perfect solution, working with Viora’s fractional RF system. Due to its wide spectrum of parameters and unique features, SVC™ technology of V-touch can promote different biological responses in three skin layers (epidermis, papillary and reticular dermis).
For changing the skin texture and color, better to say discoloration, skin resurfacing ablative effect is required. Similar to laser action, a response is achieved by using high energy settings with short pulse durations. Thermal zone injuries in the epidermis skin layer work to burn out the areas of epidermal hyperplasia - hyperkeratosis. For such aesthetic conditions, as hyperpigmentation, large pores, skin discolouration, hyperkeratosis ablative thermal zone injuries are evaluated as the treatment of the choice.
For skin rejuvenation, in the SVC™ technology longer pulse duration is used, similarly to non-ablative laser action. With longer pulse is possible to deliver a sufficient thermal dose of energy that is necessary for coagulation and dermal selective necrosis. Theses pulses targets elastotic material within elastin and collagen degeneration areas.
For a skin tightening effect and lifting only volumetric heating is necessary, which can be achieved by using a low energy setting and the longest pulse duration available.
Thus, solar elastosis treatment protocols demand the ablation and coagulation in one pulse. This is avalible while using medium pulse durations. Ablation helps to handle with the appearance on the sun elastosis on the epidermal layer, whereas as deep skin coagulation reaches the pappilar and reticular dermis, layers of elastin and collagen sun degradation.
The result of such smart combination will be reduction of hyperpigmentation, even skin tone, skin tightening and skin lifting, also as skin moisturizing.