Isabel Muñoz Martínez
Nurse Specialist in Aesthetic Nurse
Carmen Flores Navarro
Dr. Carlos Hernández Montoya
Specialist in Psoriasis and Skin Cancer
Dra. Ana Rita Rodríguez de Valentiner
Specialist in Atopic dermatitis and Alopecia
AESTHETIC DERMATOLOGY AND LASERS
Hair loss is generally known as alopecia. There are several types of alopecia and before any treatment it is important to have an adequate evaluation by a dermatologist to specify the diagnosis and propose the relevant treatment.
Regarding the coadjutant treatment in consultation of dermatology for alopecia mesotherapy of different types such as plasma rich in platelet factors, hair products or dutasteride. This depends on the type of mesotherapy.
This is an inflammatory disease of the sebaceous glands that frequently affects adolescents between 14 and 16 years old. The main treatment of active acne is dermatological medical treatment; that is, oral medications with isotretinoin, antibiotics and / or contraceptives according to age, sex and type of acne. This treatment will be accompanied by measures of hygiene and proper care of the skin and topical medications with specific creams, which is adjusted depending on the particular conditions of the patient and the degree of severity of acne. Dermatological treatment is essential to prevent or reduce the risk of scarring.
In some cases, local coadjutant treatment may be required, either to control the active lesions or to treat the scars, which will be discussed in the next section.
Comedonic: microdermabrasion, facial cleansing, superficial chemical peeling
Mild inflammatory acne: peeling - IPL- LED
On active acne disappearing it can leave marks that cause a significant aesthetic impact on the patient. Acne scars are defined as irregularities on the surface of the skin, usually subsidence that remains after the disappearance of active acne lesions and are classified according to the width and depth of the same. In addition to scars, there may be changes in coloration such as redness, brown spots or residual hypopigmentation.
Acne must be adequately treated by the dermatologist to prevent or reduce the number of marks or scars, hence the importance of dermatological consultation.
After acne can be a combination of marks that are classified as stains, scars circular distensible (rolling scars), rectangular scars (box scars), scars punctate less than 2 mm (scars) ice pick, scars very deep, and raised scars (hypertrophic or keloids). Each type of scar needs to be approached with different techniques.
Among the techniques to treat acne scars we have surgical and fractionated CO2 laser, ND yag laser, hyaluronic acid fillers, microsurgery with removal of very complex scars to transform it into a more aesthetic scar, chemical peel, IPL, microdermabrasion, Skin Roller, infiltrations with medications such as corticosteroids.
Before starting a treatment for acne marks or scars it is important to have a consultation that explains the real expectations of improvement of the scars and where the treatment can be personalized according to the type of scars the patient bears.
It is important to know that, in many cases, a combination of techniques produces more satisfactory results.
Melasma manifests as irregular geographic brown spots appearing on forehead, cheeks, upper lip skin more frequently in young or middle-aged women. Its treatment is based on a dermatological evaluation that assesses associated pathologies and personalize the treatment, especially photo protection and lightening creams according to the condition of the skin and the time of year. Melasma is very dynamic and tends to get worse in summer and improve in winter. As a coadjutant to medical treatment, different techniques can be used. Your choice depends on several factors to be evaluated by the dermatologist, however in general they can be used in combination. The techniques to be used are:
- Fractional CO2 Laser
- Nd:yag Laser
- Chemical Peeling
- Skin roller with Amchafibrin
Scars from surgical and non-surgical wounds.
Infiltration with corticosteroids, surgical and fractionated CO2 laser, ND yag laser, hyaluronic acid fillers, chemical peel, IPL, microdermabrasion, Skin Roller
Photoaging is a process of acceleration of aging caused by the sun that is manifested by spots on the skin, opaque skin, actinic keratosis, early onset and increased facial wrinkles. It is classified according to the Golgau scale in 4 grades according to the severity of the damage.
Techniques for its treatment:
TFD, CO2 laser, IPL, microdermabrasion, chemical peeling, fillings with Radiesse or hyaluronic acid.
There are different lesions that manifest as spots on the skin. Among the most common dark spots that consult patients may be solar lentiginous marks, flat seborrheic keratosis, freckles, melanocytic nevi, post inflammatory hyperpigmentation and Melasma that has already been discussed.
Techniques for its treatment:
CO2 laser, IPL, microdermabrasion, superficial or medium chemical peel.
Wrinkles are linear depressions more or less deep in the skin that occur over the years. Its appearance can be markedly accelerated by exposure to sunlight (photo-aging) and smoking.
There are two types of wrinkles:
Dynamic wrinkles are those due to muscle contraction such as crow's feet, frown lines or transverse wrinkles of the forehead and that only appear or accentuate when the facial movement is made.
Static wrinkles are those that are present although we have all the facial muscles relaxed.
Techniques for its treatment:
CO2 laser, Ultherapy, Radiesse®, hyaluronic acid, IPL, Botulinum toxin (Botox®), Radiofrequency, microdermabrasion.
Skin flaccidity occurs when the density of the dermis decreases due to the progressive reduction of its components, such as elastic and collagen fibres. This produces sagging of the skin and tendency to wrinkles.
When the predominant issue is mild to moderate flaccidity, the most appropriate techniques include CO2 Laser, Calcium Hydroxyapatite injections (Radiesse), treatment with sodium deoxy cholate for localized fat and Ultherapy (High intensity focused ultrasound (HIFU)). Laser CO2 acts on the most superficial areas of the skin, Ultherapy acts at the level of the SMAS (aponeurotic muscle system) and deep fibrous septa on the skin to induce the production of collagen and restore the tension lost in the skin. Radiesse) acts according to the site of infiltration, whether in the deep dermis or at the supra-periosteal level. To achieve the best results, an adequate and individualized assessment of the patient's status and, in general, combined treatments is important.
One of the most useful ways to achieve facial rejuvenation is with the use of filler materials such as Hyaluronic Acid and Calcium Hydroxyapatite. These products alone or combined with each other and with Botulinum Toxin are very effective tools for an effective and very natural facial rejuvenation.
The hyaluronic acid fillers according to the degree of crosslinking and calcium hydroxyapatite are used in different areas of the face:
Upper Third: volumising the very thin temporary fossa, filled with wrinkles of the forehead and the intercalary groove. Especially important in this third is the use of botulinum toxin to regulate the contraction of the muscles of expression such as frowning, forehead wrinkles and crow's feet.
Middle third: very effective to return volume to cheekbones, mid area of the face, groove of the tear, treatment of bags, correction of crow's feet, densify and induce production of collagen in the skin of the cheeks by means of vectorization, rinomodelacion .
Lower Third: Correction of nasal-lip furrows, grooves or marionette lines, contouring of the mandibular contour, upper lip wrinkles (bar code), profiling and / or lip plumping. In this region of the face, botulinum toxin can help to shape the face by correcting the excessive contraction of the masseter in the case of bruxism and relaxation of the platysma to outline the jaw line.
In the NECK, the combination of botulinum toxin and fillers is effective in inducing collagen and decreasing the flaccidity of the skin with the use of calcium hydroxyapatite and relaxation of the platysma bands with botulinum toxin. This produces rejuvenation of the neck and decrease of the double chin.
In the ESCOTE both hyaluronic acid and calcium hydroxyapatite can improve the vertical wrinkles that occur.
It is a technique of semi-permanent makeup on the eyebrows, which is applied with an instrument called tebori, and a special needle, depositing pigment in the epidermis. The technique consists of three parts; Eyebrow design, pigment deposit and mask placement for pigment fixation. The micro blading of eyebrows differs from micropigmentation in the depth to which the pigment is directed, I feel it is more superficial, thus generating a sense of naturalness, aimed at patients who want to reinforce or define their eyebrows, or with total alopecia of the same. Looking for a natural eyebrow and suitable for your face. In the same way we also treat patients with cancer who, due to their treatment, will lose the eyebrows, reinforcing before the loss to increase their positive body image during the chemotherapy process or performing them during the process of the same.
This is a technique of semi-permanent makeup of the eye, which is applied with a micropigmentation machine and a special needle, depositing pigment in the epidermis specifically between the eyelashes. This is intended to give the appearance of a larger eye, defined and without the need to use make up all the time in a traditional way. All while maintaining the naturalness of the face, using a personalized and comprehensive technique depending on each client.
Technique by which the professional extraction of blackheads or pimples and clogged pores(called open and closed pores by dermatologists) is produced. The extraction of clogged pores should be done by a professional to avoid the rupture of the follicle that could produce inflammation and leave marks. It is advisable to have a prior valuation by a dermatologist to indicate the most suitable treatment and to prepare the skin for at least 3 weeks before the first cleansing and who recommends the importance of doing this. The procedure lasts about 45 minutes and requires initial polishing, extraction and subsequent decongestion of the skin.
Diamond tip microdermabrasion is a non-invasive cosmetic procedure, in which the physical exfoliation of the skin occurs. The objective is to achieve a soft, luminous skin, control of clogged and dilated pores, attenuate wrinkles and superficial scars.
For this, a diamond-tipped device with different diameters and thickness adjusted to the area of the face to be treated is used, which produces the painless elimination or "polishing" of the most superficial layers of cells of the epidermis.
The attenuation of wrinkles and scars is achieved by stimulating cell regeneration and collagen production in response to the elimination of the superficial layers of the epidermis.
The treatment is done by sessions, and it is recommended to schedule about 6 to 10 sessions separated 10 to 15 days. Each session lasts about 30-40 min. This procedure does not require recovery time so at the end of the session normal activities can be resumed.
Discomfort is minimal and short lived if they do occur and include redness and sensitivity of the skin. It is not recommended if you have any irritation or infection of the area to be treated or during pregnancy.
This is an alternative treatment to others with low risk of adverse effects and several applications.
It involves the use of very thin needles of between 1 and 2 mm in length that slide along the surface of the skin, inducing stimulation of its regeneration. Subsequently, the application of active principles such as vitamins, trace elements or treatments which will be able to penetrate much more to achieve their effects can be performed.
Its main applications are:
- The disappearance of fine lines
- Increase of elasticity, firmness and luminosity of the skin
- Reduction of scars, keloids and burns
- Reduction of acne marks
- To correct dilated pores
- Stretch marks treatment
From this you get a generalized rejuvenation of the skin.
Chemical peeling is a dermatological treatment in which controlled and predictable exfoliation of superficial skin cells takes place through the application of an acid chemical and the supervision of the subsequent regeneration of the skin.
Depending on the penetration level, the peel is classified as superficial, medium or deep and will be applied depending on the problem to be treated and the type of skin.
The chemical peel is used to treat spots, fine wrinkles, large pores, certain types of acne, scars and to improve the texture of the skin.
It is recommended to consult with the dermatologist prior to the peeling in which a correct diagnosis of the condition to be treated is made, real expectations, convenience of the peeling and indicate an adequate treatment during the days before the realization to prepare the skin for the process.
On the day of the procedure, the skin of the face is cleansed and then the programmed peel is applied. You may feel a burning sensation that subsides soon and then it is removed and a post peeling moisturizer is placed to relieve the skin. It is done in sessions of 20 - 30 min of duration an average of 3 to 5 sessions that can be repeated every 3 or 4 weeks.
According to the depth of the chemical peel, a peeling of the treated skin lasts between 3 to 7 days and is more or less evident. For people who cannot afford this effect, another type of procedure can be recommended, such as IPL or microdermabrasion or Skin roller.
LASERS AND OTHER EQUIPMENTS
Youth at your fingertips
Facelift WITHOUT surgery
Only one session of 30 to 90 minutes
Immediate return to normal work or social activities
Visible results in the short term
More than 1,000,000 treatments, more than 50 clinical studies and more than 100 patents guarantee its safety and efficacy.
Approved by the Food and Drug Administration (FDA) of the United States and CE (European Community) certified
HOW DOES IT WORK
Through high intensity micro focus ultrasounds, which apply intense heat (60º-70ºC) in the subcutaneous layers of the skin, but leaving the superficial layers intact; and by means of an exclusive ultrasound control visualization system called DeepSEE®, which allows locating the exact area and depth of the skin to be treated. This revolutionary technology allows rejuvenating the face, neck and neckline. The heat induces collagen production progressively over the next two to three months, tightening and elevating the skin on the face and neck and softening the neckline. An authentic lifting effect without the need to go to the operating room.
The fractionated CO2 laser is an ablative light system considered today as the best tool for the treatment of:
- Marks and Scars
- Facial rejuvenation
- Rejuvenation of the neckline
- Rejuvenation of the hands
The fractionated CO2
The fractionated CO2 laser emits hundreds of tiny beams of light that penetrate the skin to the surface of the dermis and produce microscopic wounds surrounded by healthy tissue allowing rapid healing and high production of collagen.
The results of fractionated CO2 Laser are usually very satisfactory and greatly improve the patient's self-esteem and quality of life. Specifically, it is useful for the rejuvenation of the eyelids and the skin of the upper lip, sagging of the face and neck, spots and wrinkles of the neckline and the back of the hands and acne scars.
Thanks to its action on wrinkles, blemishes and scars, the patient achieves very natural results and a rejuvenating effect on the skin. Furthermore, given the progressive production of collagen and remodelling of the dermis, an increasing result is produced in the following months with an improvement in the quality of the skin.
Process ; Before the procedure, a medical evaluation of the clients ‘personal history and the condition of the skin is necessary in order to prescribe the topical treatment prior to the procedure is essential.
The laser session is performed under the use of topical anaesthesia by using a cream 40 minutes before the procedure. In certain cases a local anaesthesia may be required.
Immediately after the treatment it is normal to feel the skin tight, red and itchy as if it had been exposed to the sun. Then tiny scabs are formed that disappear in about 5 days and give a brown appearance to the skin. That is why it is recommended to spend those first days at home. After this, the skin acquires a pink tone and makeup can now be used, at which time you can return to work and social life. The dermatologist will make specific recommendations for hydration, photo protection(sun cream!) and treatment throughout this process.
How many sessions are necessary?
The number of sessions will depend on the severity of wrinkles, spots or scars, oftentimes being a single session. Normally the results are progressive being evident from the start but progressively improving with the week and reaching a maximum around 3 or 4 months after the procedure, at which time a new session may be required.
The intense pulsed light or IPL is a very effective non-aggressive treatment for a global facial rejuvenation of the face, neck, décolleté and hands. It acts on spots, very fine wrinkles, veins, redness, enlarged pores and opaque and dull skin. The light acts on the deeper layers of the skin to improve and unify texture and colour and provide a lot of light.
The treatment is done with clean skin, make-up removal. A cold gel is placed beforehand to protect the skin and facilitate the transmission of light. The procedure takes approximately 30 minutes depending on the surface to be treated. No anaesthesia is required.
It is important to not to be tanned for the treatment and to avoid the sun after the session to maintain the results.
After treatment and depending on the presence of more or less of the spots, there may be small brown patches or only a diffuse pink coloration and a sensation of heat that subsides in the first hours with moisturiser. You can put on makeup later and get into normal life.
The results are very good from the first session although normally an average of 3 sessions is recommended, separated by a month between each. The first thing to improve are the spots and redness and as the sessions progress, a general improvement in the tone and quality of the skin is noticed. The results can remain between 6 to 12 months depending on the previous condition and the post-treatment maintenance.
The Nd-Yag laser is a type of laser that can effectively correct vascular lesions such as ruby birthmarks ,(visible spider-shaped vein) such as those present on cheeks or on the sides of the nose or on the neckline, broken blood vessels , or the reddening of recent stretch marks, among others. The Nd-yag laser acts by concentrating the energy in the red colour of the blood vessels of the skin coagulating and producing its disappearance without damaging the surrounding skin, which is very safe.
At the time of the session, the skin is cleaned and the laser is used. No anaesthesia is required. After the procedure a heat and redness is perceived that is transient. Sometimes there may be a small purple mark.
The number of sessions depends on the type, nature and extent of the lesions that you wish to treat. The sessions should be done with a separation of approximately 4 weeks between them.
It is recommended that the skin is not tanned for treatment and that the skin is protected from the sun with a high factor sunscreen.
The Nd yag laser is a non-aggressive treatment that takes about 15 to 30 minutes and then you can put on makeup normally and return to work and social life immediately.
The results are very good and harmonious, with decreasing or progressive disappearance of bags etc. as the sessions progress, on average three. You must bear in mind that thread veins may take several weeks to be absorbed.
Some of the lesions treated dependant of their original nature may reappear in the future and it is necessary to repeat the procedure after a few months or years to maintain the results.
Radiofrequency is another aesthetic technique that takes advantage of the electromagnetic wave energy with a frequency spectrum of between 30 and 300 nm that, when applied to the skin, produces a progressive heating of the dermis, this heating has several effects such as:
- Induce rearrangement of the collagen fibres and the fundamental substance of the dermis.
- When heating the tissue, it produces vasodilation, significantly improving blood circulation, favouring the supply of nutrients and oxygen to the cells and rejuvenating the deep tissues of the skin,
- As the sessions are repeated, the production of collagen and a fundamental substance increases, such as hyaluronic acid. In this way it acts on facial sagging.
- When heating in depth, excessive fatty tissue can decrease as in the double chin.
The main indication of facial radiofrequency is mild to moderate flaccidity and fine wrinkles of the facial skin. It requires between 6 to 10 sessions that can be done every 7 to 14 days. There is an immediate result of tension by shrinkage of the collagen fibres and a more long-term result by neocolegenogenesis, that is, production of collagen, which is more progressive and for which the repetition of the sessions is required. To specify these results in the different areas of the face we have:
Front: raise the eyebrows and tighten the skin of the forehead
Eye contour: densifies and tightens the skin of the eyelids, decreasing fine wrinkles, dark circles and enlarging the look.
Cheekbones: tension of the skin, minimizes pores.
Oval facial and mandibular profile: redefines the oval by decreasing sagging and jowls.
Neck: re-densifies the skin.
Prior to the session, the skin is cleansed to remove any makeup or sunscreen. The procedure is painless; at the most it feels an itch or heat, for which anaesthesia is not required. Radiofrequency is applied directly by means of an apparatus that is placed on the skin and it is displaced until it covers the area to be treated, passing 2 to 4 times for each area until reaching the therapeutic temperature. A full face session requires about 30 - 40 min. The skin will take a pink colour that disappears progressively in the next 1 to 2 hours and that does not prevent makeup so you can return immediately to your usual activities.
The advantages of facial radiofrequency are safety, accessible cost, can be combined with other techniques, painless, immediate incorporation to daily activities, useful in complex areas such as eye contour or chin, is not invasive.
The contraindications of facial radiofrequency are scarce and include eczemas or infections in the area to be treated, metal implants such as fixed dental prostheses in the area to be treated, pacemaker, pregnancy or lactation.
In the aesthetics unit of Euroclinicas we have a new Deka Radiofrequency system that is bipolar with high efficiency in the dermis, respecting the epidermis, very useful for flaccidity and fine wrinkles.