3: BEAUTY & COSMETIC TREATMENT PART-II

3:1 ACNE AND MILIA

ACNE:

Everybody likes to impress others through one’s impression. So, one tries to improve one’s image & look. Most of us try to do so everyday. If we have ugly scar or pits of acne on the skin, it irritates conscious & subconscious part of mind & person feels restless, depressed & socially inhibited.

Acne is a problem of youth all over the world. Everybody has to face acne sometime or the other in his lifetime. Development of acne is natural but due to ignorance and tendency of solving the problem by short cut, dealing with the acne is often wrong on the part of an individual. So, most of the time, the person, his friend & parent try to overcome this problem by wrong pways. It results into permanent scars & black spots on the face. Most of us do not have knowledge of dealing with acne. We do not learn about dealing with such problem in our curriculum studies. In young age, we do not have strong urge to know about such problem. Everybody feels that he should not have this problem of acne & if ever he develops such problem, it should get cured immediately. Most of youth have beautiful & glowing skin. They take it for granted. So, they are not aware that every beauty has certain limited period of preservation. So, most of youth less often follow the precautions to prevent the acne problem & the complication. One needs to prolong this period by following proper precautions. They become serious in taking treatment or fsollowing precautions only when problem is advanced or reached in incurable state.

There are thousands of small holes on the skin which are openings of pilosebaceous unit. In this unit, there are sebaceous gland & hair follicle. On the chin, 500 units/ small holes per square centimeter are present. Sebaceous gland produces oil like secretion called sebum and hair follicle produces hair. Most of these hairs do not come out on the surface of the skin except in beard area of males. So, in naked eye vision, skin appears hairless. Acne is a disease of pilosebaceous unit i.e. hair follicle & sebaceous gland. Acne is polymorphic skin lesion. Acne is not just a disease but it is continuously multifactorial process in pilosebaceous units of the skin.
Acne is the most common cosmetically altering condition. It is the most common disorder of the skin. Acne is the most common cosmetically altering condition.Millions of people suffer from various forms of acne which create scars, thickening of the skin, depressions and pigmentation on the face in most of them. It affects body, mind, emotions & social life of the individual also. So, patient often does not take interest in work or studies.
Acne affects people from all ethnic groups, all ages, and both sexes. 75% people belong to 16-25 years of age. About 25 years of age, mainly women are affected by problem of acne due to hormonal effects. At the age of 25, the severity of problem reduces gradually. Adults feel more surprised when they suffer from acne. So, profound psychological effect is seen in adult patients having problem of acne. In contrast, youth accept this problem because most of them know that it is related to age & so they are less disturbed. Acne develops on face, back, chest and neck.

Factors provoking acne: -

There is not single or isolated cause for acne. These are multiple possible factors which provoke the process of formation of acne. People with problem of acne have overactivity of sebaceous gland due to external factors like pollutants in environment, sun exposure, hot-humid tropical area, oily atmosphere, certain cosmetics etc. and internal factors like hormonal imbalance, fatigue, emotional stress, genetic factors etc.

Acne increases during stressful period e.g. pre-examination and examination period, premenstrual phase. Cosmetogenic chemical aggravates them. Oily and fried food, junk food may provoke it.

People having recurrent &/or excess acne have skin having imbalanced activities due to over activity of sebaceous glands in the skin, oil is produced which creates tiny break outs in the form of pimples or black heads. Oil production from sebaceous glands attracts dust and bacteria. It breaks out pimples. Thus, acne is merely inflammation of sebaceous glands.

Anatomy of pilosebaceous unit:

The depressed pouch like structure from where hair arises is called hair follicle. The area which is prone for acne development has more hyperfunctioning sebaceous glands and are of bigger sized. Sebaceous gland is 1mm below skin surface. Acro infundibulum is the most superficial part of the follicle. 200 µm (micrometer) below the acro infundibulum there is infra infundibulum. Sebaceous gland in the skin opens in hair follicle & it produces sebum whose secretion is controlled by hormones. Sebaceous glands of the skin and hair follicles have same common opening. Both of them have cell lining which is shaded out after every four weeks. These shaded cells migrate towards opening of these glands for their excretion. During puberty, due to increase in androgens like testosterone, in males & leutinizing hormone in females during premenstrual phase, sebum production increases.

Process of acne formation:

Before           After treatment

In puberty, hormonal level increases which increases production of sebum (oil): Presence of bacteria alter these oils in sebum & these oils solidify to obstruct drainage pathway of these sebaceous gland which provoke acne formation. Dead cells shaded in the glands migrate towards the opening of the glands. These may adhere each other and may block the opening of hair follicle or sebaceous glands. Such blockage promotes growth of the bacteria. Oil (sebum) in sebaceous gland get oxidized in the duct and become hard and causes blockage of these glands. Bacteria and oil forms the plug which obstruct the duct Due to close space in this blocked duct, due to increased proliferation and accumulation of sloughed follicular keratinocytes, mixed with sebum into infra infundibulum comedogenesis starts here. Propionibacterium acts on triglycerides and releases cytokinines. If hair follicle is blocked due to any other reason, inflammation develops easily. Excellent environment is produced for growth of the bacteria and development of inflammation. So, redness, swelling and pain develop at that spot of skin. It bursts open. Such lesion produces pigmentation and scar. Due to 0inflammation and trauma caused by itching, pain develops. An individual try to pick at acne. Such picking traumatizes and tears the skin. The injured tissue heals with scar. Severe inflammation leaves behind the scars and pigmented spots which are cosmetically not acceptable. Epidermal melanin gets deposited in open comedones (black heads). Ceramide gets deposited in sebum in this area of follicle.

If inflammation in the hair follicle increases, this blocked follicle ruptures in the dermis. So, bacteria & debris are released in the dermis. Such internal bursting is often provoked by patient’s habit of picking over the acne. Such bursting inside the skin often leads to black pigmentation in the skin.

Sometime due to blockage of duct, the common pilocebaceous unit creates slight or more elevation & nothing else. It may subside later on. If pathological process progresses further in this raised spot, yellow secretion accumulates. It is called as pustule. This pustular lesion is small, inflamed, tender, red at the base & white or yellow in the centre. When Comedo remains beneath the skin & remains closed it is called acne white head. When this raised inactive part of the acne grows further to form a nodule. Such acne nodule is somewhat larger spherical painful lesion located in deeper dermis.

When fluid or pus accumulates in this nodule having closed cavity it is called as acne cyst. Acne cyst is more deeper inflamed, painful & pustular. If it is not treated, it often causes scarring.

First stage of acne- Comedogenesis

Hair follicle loosens hyperkeratitic material within this follicle which may block this hair follicle. If such blockage develops, it produces more dense compact hyperkeratosis which provokes formation of acne. Clamped keratinocytes in hair follicle block the deeper part of the duct or hair follicle. This blockage provides good nutrition to bacteria like propion bacterium. Sebum & keratinocytes act as excellent nutrition for these bacteria. It further leads to formation of papule & pustule. It also produces non-inflammatory follicular reaction. This first stage of acne formation is known as comedogenesis.

Before

After

Various appearances of acne:

Black heads, white heads (omedones), the pimples (larger papules), pustule, small cyst. Pimples, pustules and cyst burst open and form scars which are more likely to be permanent.
Recurrent acute acne vulgaris are more common from 10-30 years of age. Then, it decreases. Those who develop papule, pustule and nodulocystic lesions develop scarring and dark spots on the face.

Most of the patients achieve 40-50% improvement with normal medical treatment. Small papule and pustule responds best, comedone and cyst respond poorly. There is no single medication that works for all patients & for all stages. Medicines have their limitations. He needs to continue preventive treatment even if acne disappear because acne disease has a tendency to recur in spite of full treatment.

Prevention of Acne:

Acne has a tendency of recurrence. So, after proper treatment even if acne disappeared completely, they tend to recur. Best treatment of acne is to prevent them & do early intervention during initial period.

Always follow preventive care throughout the life as follows:

1. Avoid self handling of acne problem and self medication. These factors provoke more acne and recurrence.

2. Keep face clean. Clean the skin daily with simple warm water 4 times in a day. Wash face frequently to remove excess of oil and bacteria. Wet the skin to emulsify and remove grease if any material is on the skin. then, risnse the skin with hot water.

3. Use bactericidal skin soap to prevent infection. Avoid to use harsh and high pH soap. If the skin is oily, use deodorant and soap with antiseptic agent. After returning home, always wash off the cosmetic thoroughly with mild soap. One may take mild steam bath.

4. Do light massage on the skin. Avoid massage on the spot where there is discomfort or pain.

5. Use light make up. Avoid heavy make up and oily cosmetic procedures. For oily skin, use good powder foundation which provides coverage. Talk powder helps to absorb surface oils.

6. For normal skin and dry skin, use moisturizer twice in a day. In case of oily skin, use oil free moisturizer once in a day.

7. Take more green leafy vegetables & fruits. Avoid fast food, fried food, over processed food e.g. chocolate, sweets etc.

Treatment of acne:

Before               After

As acne is in various forms & various stages, one needs to use proper medicine for proper type of acne & in proper stage of acne disease.

Most of the patients do not continue to take treatment because they do not have awareness that acne disease has a tendency of recurrence after certain interval. So, patient mismanages treatment or fails to continue the preventive treatment for sufficient long term.

So, take regular preventive treatment in spite of disappearance of acne. One needs to make changes in treatment. Each stage of relief from disease has tendency of recurrence in spite of full treatment & full cure of disease at particular stage. So, reappearance of the disease does not mean that the past treatment has failed or doctor could not make proper diagnosis. When knowingly & unknowingly patient thinks so, he feels frustrated & may feel depressed. So, he may not eager to revisit doctor or he may change the doctor. As a non medical person, & as a patient, he does not know exact action, efficiencies, limitations & side effects of these products. As a victim of self medication he is not eager to know how long these products should be used, how frequently & how to identify side effects of his medication. He is not aware of which preparation suits to his skin type. So, if medicine preparation which is meant for oily skin, is used for dry skin the disease aggravates. He often neglects side effects of disease because he thinks that these are effects of disease & not of medicine. Thus he may continue to use that unsuitable medicine & aggravate side effects. So, roughness & dark spots on the skin increases.

Acne prevention by peel:

Before               After

Dermatologist may do salicylic acid peel. In make up foundation containing salicylic acid as additive helps in prevention & amelioration of the acne. To prevent acne, in morning, wash face with 2% salicylic acid cleanser. Then, apply topical antibiotic solution or azelaic acid then, sun screen SPF 45 with moisturizing cream is used. In very oily skin, use its lotion or gel. In the evenings again wash with 2% salicylic acid cleanser. Apply a topical retinoid. One may add oral antibiotic, oral retinoid & oral contraceptive & salicylic acid peel in recalcitrant cases.

When acne develop:

Before                                      After

a. Never touch acne unnecessarily as it creates temptation to squeeze and scratch. Avoid itching & pressing over acne. It further increases temptation to squeeze & scratch. Also avoid squeezing or scratching of acne or any lesion on the face. Our fingers are often contaminated. So, touching the acne with finger increases possibility of infection.

b. Those, who have frequent infection of acne, use bactericidal soap to prevent infection. E.g. Neko soap, detol soap. Use soft soap having pH near neutral. Do not use hard and high pH soap.

c. Avoid cosmetic sunscreen which overstimulate oil glands.

d. Cosmetics: Use water based oil free cosmetic sparingly. Always wash off cosmetic thoroughly with mild soap after returning home. Do not use oily and greasy cosmetic products. e. Role of diet: Avoid certain food like fried food, chillies, chocolates, excess oil etc.

Do not cover the lesion with a fringe. Skin behaviour of the individual also varies from person to person. So, treatment regime is individualized. Benzoyl peroxide is effective medicine. Scars and discoloration spots of acne can be treated with hydroquinones, LASER resurfacing, chemical peels, dermabrasion, microdermabrasion, surgical excision etc.

Treatment of acne is highly individualistic to achieve satisfactory results. One needs to assess skin hormonal activity, use of cosmetics & other products, sun exposure, diet, stress, life style, habits, etc. Response to treatment differ from person to person. Therefore one needs to make changes in the treatment from time to time. So, there is nothing like fixed treatment formula which will be 100% effective to every case of acne.

Acne cosmetica:

Cosmetics may cause acne in certain individual. So, choose non greasy & non-occlusive cosmetic products. Avoid cheap or non qualitative cosmetics.

Acne detergican:

Frequent wash of face with soap, some shampoos & facial cleaner may provoke formation of acne. Bacteriostatic agents & some biological ingredient are irritating to follicle. Soap removes oil from the surface of the skin but does not remove sebum in the hair follicle. Ask patient not to wash face with soap more than two times in a day. One may intermittently wash the face with simple water in mean time.

Rosacea:

Before             After

Between 25-60 years of age, this acne form condition may develop. It produces facial redness, flushing, papules & pustules. New blood vessel formation is also seen. Use of AHA & retinoids aggravate this problem. Use antibiotic & BHA. Advise Laser for telangiectasis. Sebum secretion is reduced by decreasing function of sebaceous gland, tretinoin, adapalene, tazarotene, retinol, oral retinoids (isotretinoin). Thus, act on first step of the formation of acne.

Before                                      After

Treatment:

There is no medication that works effectively. Very few drugs work against present acne. Most of drugs work on prevention of future problem of acne. The later group of drugs work on prevention of future problem of acne. The later group of drugs take about eight weeks to give results. Salicylic acid, benzoil peroxide & steroid treat already visible acne. Steroid is used very consciously because it may lead to steroid acne.
Use cleansing products that loosen the existing harden oxidized oil and adhered dead bacteria along with debris. Apply cleansing agent which has astringent property which loses existing hardened oil / debris/ bacteria mixture. Due to high chances of recurrence of acne lesions, laser treatment for acne is not used as primary treatment. Those who do not want to take oral treatment, or those who want fast results, laser treatment is useful.

Before                         After

Unplug blockage in the follicle:

It is done through action on keratinisation / exfoliation in follicle. The cause of acne is blockage of follicle by exfoliated keratinocytes. To unplug this blockage in follicle, oral retinoids like tretinoin, isotretinoin are used. This drug reduces positive & negative charges on the keratinocytes. So, cohesiveness among them reduces. Due to this unplugging, antibiotic can enter in follicle to treat the inflammation to eradicate existing comedones & to prevent the formation of new ones.

1. Keep skin of the face wet:
Dryness in atmosphere & in the skin induces acne activities. Specially in dry weather dryness of the skin should be prevented. To keep the skin wet, use emollient. Non comedogenic product like Emollient facial cleanser treatment can be used in all types of treatment of acne. One may use benzoyle peroxide. Wash with 10% concentration. It is abrasive cleansing lotion.

2. Eliminate or reduce infection:
Infection by propionic bacteria produces inflammatory extracellular products. Free fatty acids are also produced by bacterial division of surface lipids. Benzoyl peroxide kills bacteria. Erythromycin / Clindamycin treat infection & also reduce production of inflammatory free fatty acid. If not treated with adequate doses & in required frequency, 60% patients develop resistant bacteria.
Benzoyl peroxide may accelerate aging of the skin. benzoyle peroxide and tritinoin should not be used simultaneously because former denature the later & so reduces the effectiveness. In acute acne, laser light source near 400 nm is used to kill bacteria. It is used as adjuvant treatment.

3. To remove material that clogs the pores & duct of pilosebaceous unit:

Comedolytics are used. Salicylic acid (BHA) & a-hydroxy acid (AHA) like glycolic acid, lactic acid loosen the plug of keratinocytes in the follicle. BHA is more effective. Retinols & azelaic acid can also do this work.

4. To reduce inflammatory response:

Anti-inflammatory products like salicylic acid locally & ibuprofen / aceclofenac locally can be used in combination with antibiotics. Topical steroids should be used with caution as it may worsen acne & may lead to skin atrophy. Steroid injection reduce inflammatory response.

5. To reduce level of the sebum:
Oral & topical retinoid can be used to reduce activities of sebaceous glands. In females, oral contraceptive help to stabilize & to reduce secretion of sebum.

6. Take care of the skin as mentioned in chapter of skin care.

7.Use of Make up & powder
Youths should avoid foundation. They may use day cream or compact powder. Removal of make up at right time is more important than application of make up. It helps to maintain the skin.

8. Sunscreen can cause allergy, sensitivity.
Apply sunscreen atleast 3 times in a day. If sunscreen having 15 SPF is applied twice at a time, that double layer does not make SPF 30 but it makes better protection by 15 SPF. More the SPF more is its viscosity & thickness.

Before                                      After

Physical sunscreens:

Zinc oxide, titanium dioxide

Chemical sunscreen:

They work by chemical action.

Use of Sunscree & Skin protection from sun:

In Indian patients, sun screen having 10-15 spf gives 93% protection. Indian skin is more pigmented. So, it tends to absorb more sunlight but protects better. Avoid exposure to sunlight between 10 a.m. to 3 p.m.

Use clothing, umbrella, brim hat, clothing should be sufficient. Cotton is less effective in protection as compared to synthetic. One may use double layer of cotton cloth. Colour has less role in prevention of penetration of the sunlight.

Sunscreen can cause allergy, sensitivity.

Apply sunscreen atleast 3 times in a day. If sunscreen having 15 SPF is applied twice at a time, that double layer does not make SPF 30 but it makes better protection by 15 SPF. More the SPF more is its viscosity & thickness.
Physical sunscreens: Zinc oxide, titanium dioxide

Chemical sunscreen: They work by chemical action.

Treatment of Acne scarring:

Before                    After

Treatment of scars depends on their size, depth, shape and duration and depigmented spots. If scar has elevation, it is flattened or leveled. Shallow scars are blended with surrounding tissue with Laser. Whiteness of the scar is reduced by replacing scar tissue with more vascular skin. Deep brand scars or ‘ice pick’ scars and pits need elevation by Laser. Punch excision and grafting: In case of major scar of acne, deep scar & ice pick like scars, the scar tissue is cut out and the wound is closed with suture or it is grafted with the skin. Skin is taken from behind the ear for grafting.

Undermining and subscision:

The depressed part of skin is released from its underlying scar tissue and allowed to rise up. This may be repeated for better elevation and more formation of collagen. Sometimes often release of skin as mentioned in above paragraph, soft tissue filler is injected or fat is injected. Such fat is taken from another part of the body. Thus, to treat scar of acne multiple modalities are used as per the need of patient and then LASER resurfacing is done. All these procedures do not require any admission in hospital. If scar and pigmentation develops on the spot take the dermatologist’s opinion. If scars and pigmentation do not respond, consult laser centre.

Microdermabrasion is done or acetone scrub is done. In acne, deep scar subscision and microdermabrasion may be done simultaneously. The photo sensitizer drug or prodrug (Amino levulonic acid ALA) is applied 1-3 hours prior to irradiation. During this period patient should stay away from natural light.

Retinoid work like magic but it has side effect and should be avoided in child bearing age. Tritinoin, adapalane are also used. Apply tritinoine, tarazotone, azeilaic acid, glycolic acid, Kojic acid, contractubex gel.
In deep dermal scarring, do subcision. Punch grafting may also be done. Atrophy of fat below the lesion causes depressed scar. Wire scalpel may be used to treat it.

CO2 Laser treatment in acne:

CO2 Laser                Nd:YAG Laser

CO2 laser can treat complications arising out of acne vulgaris. If small sub epidermal abscess, follicular abscess and cyst develops, it is punctured with CW CO2 laser. Then, margins are resurfaced. In case of multiple infected acnes, CW CO2 can be used.

Pitted ice pick scars are narrow tracks deeper down. These are treated with CW mode of CO2 Laser.
For flat scar, stretched scars, depressed scars, atrophic scars, hypertrophic scars, thin scars, tunnels and bridges of skin, CO2 laser can be used to smoothen the skin and to reduce marks of these scars. This laser treatment improves textural irregularities and superficial scars of acne.

With laser peel, skin becomes polished and skin rejuvenation makes it more bright and attractive.
Deep acne scar, bridges of the skin, skin tags or tunnels are excised first then resurfacing is done in same sitting or next sitting.

For acne scarring, results of non ablative resurfacing or mild to moderate ablative resurfacing in combination with subcison and punch biopsy may be done. Patient who have received isotritinoine within 6 months are not be treated with LASER, till this period is over.

Flat and stretched scar can be resurfaced easily but in case of scar with border, one needs to feathered or bevel the border.

Mild textural irregularities, macular lesion and mild superficial scarring improves with single or two passes with low fluence and least contact time (100 to 300 millisec).

For fine wrinkles / rhytides, one pass is enough. For tough recalcitrant, post acne scar 3-4 passes will be needed.
Due to acne lesions, local area of skin loses elasticity and so skin becomes loose. It can be treated by CO2 resurfacing CO2 laser contracts fibroblasts and increases neo-collagen deposition.

In addition, CO2 laser also creates better collagen shrinkage and has very less risk of infection.

Fluence and dwell time is decided according to depth of resurfacing.

CO2 laser resurfacing is superior to dermabrasion because it is without any bleeding, one can judge the depth of resurfacing and margins of even small depressed scar can be beveled. The shoulder of the shallow scar is cut or abraded by keeping handle of laser at right angle to the margin of shallow scar. Raised margin is reduced upto the base of the scar.

When CO2 laser is used post inflammatory hyperpigmentation get cleared with tretinoine application. In bigger lesion, CO2 is used to debulk the lesion and the QSW 532 and 1064 is used. Flat lesion needs 3-8 J/sq. cm. CO2 laser is used to debulk the lesion then long pulsed 1064 nm and Q-switched 1064 and frequency, double Nd-YAG 532 laser is used.

Laser peel and facial laser rejuvenation and facial resurfacing can do wonder for skin of your face

Laser treatment in acne:

Laser treatment for acne is most advanced and effective treatment for acne. For treatment of acne complication, such as scars, depression, thickening of skin, pigmentation, darkening of the skin etc. where other treatment does not work, laser treatment works.

Low fluence of IPL and Nd: YAG laser can treat acne.
Acne patients have larger sebaceous glands. Antiandrogens or retinoids & non ablative laser like Nd: YAG & IPL can reduce size of sebaceous gland & so secretion of sebaceous gland is reduced.

CO2 laser resurfacing treatment & Nd: YAG, laser IPL non-surgical treatment for acne is superior to microdermabrasion because it works effectively and improves collagen remodeling in underlying deeper part of the skin.

Use of Nd: YAG laser helps in improving tone and texture of the skin without causing any damage to the surface of the skin. It can be used sometime after use of CO2 laser. It can also be used along with CO2 laser to improve the results further.

IPL

Wide pulse light system & low fluences laser can also be used for treatment of acne e.g. IPL, pulsed dye laser and KTP. These lasers are also used for facial rejuvenation. 644 nm IPL is used for pigment removal of acne.

Sunlight: -

Energy is absorbed & released by photon. Sunlight contains UVA, UVB & UVC. In it 95% are UVB. UVC does not reach to ground level due to ozone layer. When UVC comes in contact with oxygen, it forms ozone. UVA penetrate epidermis & produces changes at dermal level and may cause sun burn. UVB & UVC produces changes at epidermal level & may produce pigmentation.
UVA is present more in morning & evening sun light.

Which mistakes a person commits in treatment of acne?

Self medication, wrong medication, right medication at wrong place, right medication in late phase, using medication prescribed previously or prescribed for others etc. are different mistakes. Most of us do not try to read scientific literature about it. Person commits such mistakes easily & takes these mistakes easily. Then try to deny & camouflage own mistakes rather than correct these mistakes. Acne is recurrent disease. But persons consider that once acne is relieved, it will not develop again.

What are effects of acne on the person?

Everybody likes to look young, flawless & smart for whole life. When person realizes that he has failed to maintain flawless skin of the face, he develops stress & feels fear of losing beauty. So, he feels stress due to stress, depression & frustration, person commits more mistakes & often fails to correct his own simple mistakes. It affects his career, social life & family life.

In which age group acne problem is seen?

Usually, in young age, acne problem is seen. But the problem of uneven skin due to acne is a problem of not only young age but also of adult age and old age.

When do we develop problem of acne?

There are thousands of holes on our skin which are openings of a tube in which sebaceous gland & hair follicle opens. Oil like sebum secreting from sebaceous glands are present in the skin. These glands open in tubes like sac of hair follicle. So, the secretion of sebum & dead cells of these glands & hair follicle come out on the surface of the skin regularly. If the way towards opening of hair follicle on the skin surface is blocked, this material accumulates in the deep part of the skin & so that local area swells which we call as pimple or papule. This obstruction develops due to chemical changes caused by bacteria. Thereby making secretions solid & hard. Those who use oily cosmetics or excess cosmetics or do not remove make up after returning to home, do not wash face regularly in evening are likely to develop acne.

Imbalanced hormones in the body, oily, fried processed food, chocolate, stress, also aggravates this problem. Habit of picking & pressing pimple, self medication, lack of proper treatment over a sufficient period further aggravates the disease.

Aging, gravity, environmental pollution, excess heat or cold weather, unnatural ways of life, stress, irregularity, lack of enough sleep and rest, affect the fresh appearance of the skin and youthfulness of the face. So, smooth, polished, shining, skin becomes rough, dull, non shining. Use of certain fast foods, low quality cosmetic wrong method of make up, to certain chemicals in make up aggravates this problem. Due to all these factors, we develop pigmentation, scars, depressions, dark spots, on the face which make our face less attractive. Most of us have some sort of such problem on our face, so our mind feels pinching. Skin of our face is often badly affected by ultraviolet rays not only in sunlight but also in day light in the room. Computer’s monitor rays contain ultraviolet rays while effect our face.

Make up:

Make up is not just colouring the face. Many young girls think so and act accordingly. All youth must approach with patience to improve one’s look. The youth has smart & glowing skin. He/she needs to further improve one’s beauty. One should try to maintain beauty in such a way that other do not feel that you have done something. So, simple approaches are better.

3.2 Microdermabrasion, Diamond Dermabrasion & Dermabrasion (Skin polishing):

For resurfacing of skin of the face, three methods are used

• 1. Dermabrasion and Microdermabrasion.
• 2. Chemical peels
• 3. LASER

• Dermabrasion:

Scraping away the top layers of the skin is called dermabrasion. Dermabrasion is mechanical in its mechanism and action. It can be done with rough wire brush or diamond impregnated burr. Scrapping is done upto the safest point of deeper layer of scar. The skin is skimmed off until its deeper point of scar becomes more even with skin surrounding it. Procedure requires 30 to 60 minutes. No down time is required. It can be done under local anaesthesia. Even wrinkle can be scrapped. Smooth acne scar can be treated in this way. A small rough spinning wheel is applied to the area e.g. deep wrinkles around the mouth, acne scars and pits. New skin develops over it by 7 -10 days. This new skin is more supple, soft and youthful. New skin has less wrinkles and discoloration. Before undergoing procedure, patient should inform doctor about history of any cold sore, herpes, use of tobacco in any form, bleeding tendencies. Do not use make up, sunscreen or any product prior to procedure. After Dermabrasion, apply petroleum jelly. Do not do any strenuous activities and exercises to prevent hyper pigmentation or discoloration. Avoid exposure to sunlight. Dermabrasion may cause change in skin pigmentation. Skin may be lighter, tighter and blotchy in appearance. Exposure to sun may darken the skin. White head may develop. Initial skin pores appear enlarged and later shrink. Infection and scarring may develop. Follow the instructions properly to reduce all these risks.

Simultaneously, different procedures are used e.g. chemical peel is used to treat fine wrinkles. Dermabrasion and dermoplanning is used for deep or imperfections caused by acne scars & injuries. Considering skin type, colour and medical history. People with dark skin may become permanently discoloured or blotchy after dermabrasion. Freckles disappear. Results are affected by age, health status and body tendencies of the individuals.
Depending on the area involved, dermabrasion takes few minutes to hour. This procedure may be repeated in certain cases. It may be done in stages if scarring is deeper or area of the skin involved is large.

Derma Planning:

Microdermabrasion and derma planning helps to refinish skin’s upper surface. It is a method of controlled surgical scrapping. It softens the sharp edges of surface irregularities. So, it is often used to reduce scarred effect of previous injury to reduce fine facial wrinkles specially around the corners of mouth. It can be performed even on small area. These procedures can be done along with facial rejuvenation.

In dermaplanning, dermatone is used. Dermatome has oscillating blade that moves back and forth to remove layers of the skin till the lowest point which makes that point even with the surrounding skin. After the procedure area may be kept dry. Some may apply ointment. Redness and swelling develops locally. Locally one may feel pain or tingling or burning. Later on scab or crust may develop over the treated area. One may feel itching due to healing process. Visit your doctor if redness and itching continues. Shaving may be delayed.

After healing, new skin appears swollen, sensitive and bright pink for several weeks. Do not get exposed to sun and chlorinated water for four weeks. Thus, skin needs protection until pigmentation has completely returned i.e. for 6 to 12 months. You may wear non-allergic make up.

After surgery, patients may gain weight because they take rest and are sedentary. They tend to release their emotional energy through comforting. Due to lack of adjustment in diet they easily reach out the food. So, weight increases. So, after healing period, restart exercise. During the period of rest, food tends to regulate behavior.

Tasty and junky food tend to create bad behaviour. Healthy and balanced diet helps to elevate energy.
Due to restrictions in diet certain patients feel stress. He needs to adjust with new life style. He needs to train him. He adjusts himself with recognition of hunger and fullness. He needs to adopt new strategies for substituting eating to relieve stress. Patient should follow weight reduction strategies to avoid revision of procedures.

Revised procedures is less successful. In this procedures, upper layer of the skin (epidermis) is grounded or sanded down to allow new, fresher skin to regrow.

Microdermabrasion and diamond dermabrasion:

Microdermabrasion is non invasive and non surgical procedure. It removes outer dead layers of the skin safely and under proper control. There is no down time after the procedure and so it is called ‘lunch time peel’. In microdermabrasion, patient should remove her make up. No anaesthesia is needed. In this, medical grade micro crystals are propelled at high speed against the surface of the skin. At the same time, used crystals and debris are collected in waste container and are disposed off. In diamond dermabrasion, no such microcrystals are used but diamond tips are used for polishing.

This massaging action stimulates blood flow, enhances oxygenation of the skin, increase regrowth of collagen and cell renewal. Flushing and cleansing effect resulting in vibrant healthy complexion. It takes 30 to 45 minutes. Later on one can safely apply make up. Microdermabrasion/ diamond dermabrasion improves skin tone and make the glow of skin more healthy. Skin becomes more soft and smooth. In altered pigmentation colour of skin becomes more even. It reduces unsightly pores and large acne scar. It reduces the frequency of acne break outs. In this procedure, microcrystals of aluminium hydroxide are bombarded on the skin and are sucked. In these crystals cause microinjuries and exfoliate epidermal cells. After microdermabrasion, Vit. C and retinoid may be applied for absorption in the skin. Atrophic scars can be treated with it. Stretch marks may also be treated with microderma. It may be carefully used for hypertrophic scar.

Who should choose microdermabrasion & diamond dermabrasion?

Those who do not want longer recovery time, and want to join work immediately may choose Microdermabrasion. Those who have skin which is sensitive to chemical and those who are not responding to medication given for acne may prefer this procedure. Results are seen immediately. Skin becomes more soft and light pink. Those who need vigorous microdermabrasion, pinkness of the skin persists for longer period. Patient should avoid sun exposure for the first 24 hours.

What is microdermabrasion?

It is an European technology designed to rejuvenate and refresh the skin. There is no down time afterwards one can immediately go to work.

How does microdermabrasion work?

This method removes the upper layer of non viable skin cells mechanically. This seems to stimulate lower layers of healthy skin to reproduce. Particles of aluminium oxide crystals, sodium bicarb cells or silicon delivered particles are forcibly directed to the skin and are suctioned back into the machine.

What are the effects of microdermabrasion?

Microdermabrasion softens fine wrinkles, reduces superficial skin discoloration, small skin surface and provide healthy glow on the skin. When microdermabrasion is combined with superficial chemical peel, better results are obtained. Microdermabrasion does not remove deep wrinkles, deep pigmented skin changes and acne scars. For these conditions, laser and deep, chemical peels are required. Consult your cosmetic surgeon because each person has a different skin with different needs and desires.

What is expected during treatment?

During the procedure, one may feel a slight pulling sensation. It is non painful procedure which takes 20-30 minutes.

Wrinkle preventing procedures:

Laser peels, microdermabrasion, chemical peels and botox.

Follow maintenance plan after rejuvenation procedure:

After rejuvenation procedure, one needs to follow beauty and youthful maintenance plan because aging environment and stress affects everybody. So, doctor may advise use of sun screen and avoidance of sun light exposure. He advises additional points which vary from person to person. Many people are very young from inside. Cosmetic surgeon tries to match external appearance with that of inside youthful spirit.

Smoothening contours for youthful appearance with face rejuvenation:

Absence of any facial shadow makes a person look young. In young person, skin is firm and elastic, cheeks are high, no hollows under the eyes and no wrinkles on the face. Chemical peeling and microdermabrasion can be combined. Chemical peeling can be of mixed type. Do microdermabrasion and other photorejuvenation laser treatment for better results.

3.3 Radiofrequency and laser cosmetic procedures:

Radiofrequency is electromagnetic energy. RF is colour blind. RF cannot work upto dermis. Collagen shrinks & fibroblast stimulation increases. In bipolar RF, depth of penetration is limited. Less energy is given. More treatments are needed. In unipolar RF, depth of penetration is the most. So, more energy is delievered. Less sittings are required. Energy is given till patient can tolerate & does not feel pain.

Collagen is our body’s basic building block. It is also a major component of the skin, tendons and connecting tissue. Remodeling of collagen in the skin can be done with the help of radio frequency cautery and CO2 laser. These tools also help to form new collagen. This helps to plump up the skin and remove wrinkles. It reduces looseness of the skin. These procedures are quicker and minor. Effect of treatment usually last for 9 year. Those who have healthy life style gets more benefit after this treatment. There is no down time with radio frequency and non ablative laser. FDA approved this technology in 2002. during procedure patient feels an immediate coldness followed by a brief period of hot sensation, followed by slight cool tingle. Use of thermal lift along with filler technology for deep facial lines wrinkles give better results.

Thermage /Radio thermoplasty / non ablative & ablative Laser face rejuvenation:

To regain more youthful look, to improve appearance without any incision and without any down time thermage (Radiothermoplasty) or non ablative Laser face lift surgery can be done. These are llunch hour procedures. To tighten skin and to make it firm internal collagen in the skin is treated by thermage technique &/or Laser treatment. These are safe, non-invasive procedure which reduces signs of aging. Heat is deeply and uniformly given in the tissue underneath the surface of the skin. This sustained heat produces contraction of this tissue and lax skin gets tightened. Top layers of the skin are protected by cooling spray. The repetition is required. The number of treatment depend on the patient’s age, skin type, health status and habits. This procedure requires few minutes to an hour depending on the size of area to be treated. Results appear within two to six months.

Ablative lasers are used for rejuvenation when problem is severe. In acne pits & scars, wound scars & other depressed pits, this is very good & effective technique.

3.4 Surgery of the scar, birth marks & moles

Some scars on face make face less attractive. Some scars affect facial expressions. Development of the scar and its effects are highly individualistic. Patient’s attitude towards the scar is variable. After scar formation, one should allow to pass a period of one year after injury. By this time, healing process matures. As wound heals puckering of surrounding skin layers takes place. The muscles and tendons of underlying layers are affected by contraction of scar layers. In hypertrophic scar, collagen production remains in the boundaries of scar area. So, the area becomes thick and develops unsightly scar. So, it restricts movements of underlying muscles and tendons. When keloid develops due to overproduction of collagen, it extends beyond the boundaries of the scar area. To improve the scar appearance effectively, one may require more than one procedure and more than one technique. In era of cosmetic surgery, it is unnecessary for any one to live with scar. Scar tissue is excised and incisions are closed with fine stitches which results into less prominent scar. After facial scar excision, keep head elevated during lying down position. To reduce swelling, one may use cold compression. Avoid all physical activities and facial expressions which places undue stress on the axis of the incision. Ask your surgeon about activities which should be avoided. After surgery, patient may feel some pain or discomfort. Due to natural process of healing, swelling, bruising and redness may develop locally. Keep patience till wound heals. Internal healing maturity process may continue for few months and so appearance improves gradually. In flap technique of removal of the scar, its entire tissue is excised. Then, skin flap from adjacent healthy skin is lifted is moved over the area of this new wound. In skin graft technique, section of the tissue of the skin from one area is taken and it is transferred to wound area from where the scar is excised. Z-plasty technique: In this technique, scar from one area is moved to the other area i.e. nature fold or crease of the skin to reduce its visibility. Thus, it does not remove all scar signs but it makes scar less visible. Scar is surgically revised. The small thin line of new scar is lasered.

Removal of Birth marks:
Birth marks are present at birth or develops shortly afterwards. There are various types of birth marks which vary in the shape, size and colour. Some birth marks fade over time but others become permanent. Birth marks are classified into two categories:

1. Portwine birthmark
2. Coffee and Cream birth marks

Birth marks are removed for cosmetic reason or to reduce possibility of health risk development. Method of removal depends upon the type of birth mark and severity of its condition. Usually laser treatment gives better results than non laser surgical method. It is done under general or local anaesthesia. Depending on size, the time of surgery, varies from 15 minutes to few hours. After removal minor bleeding, bruising and infection may develop occasionally. Down time is little. The area may deeper in colour or may lighten. As per type of lesion, laser surgery or surgical excision on technique is used. When non ablative or non surgical laser technology is used multiple sittings of treatment are required.

Surgery of Mole:

Moles are considered as beauty marks by many of us. Moles are dark spots present on the skin anywhere on the body. These are bothersome in some individuals. Some people feel self-conscious about its appearance. Some people feel itching on it. Some moles are pre-cancerous and so their removal reduces the risk of cancer. Unwanted moles can be removed and skin can be made clearer. Moles can be removed by various methods like excision, shaving and LASER treatment. It is done under local anesthesia. It requires 15-60 minutes for removal. In surgical excision, full depth of mole is removed and wound is sutured. In Laser mole removal, there is no need of cutting and suturing. If hairs have grown in the mole, it needs surgical removal. No down time is required one can go home after certain time. Pain is minimum. Wound heals in 7-14 days.

Treatment of dark spots/ pigmented lesions:

Lentigen is more common in women and scheborrhoic keratosis is more common in males. In skin type III, IV pigmentatory changes are more common due to photo aging.

Before                    After

Hori’s nevus or nevus of Ota are seen dark skinned Asians. It s bilateral bluish hyperpigmentation on bilateral malar area less commonly it is present in area of temples, roots of the nose, alae nasi, eye lids and fore head.

Pigmentation in ABNOM occurs adultahard is symmetric and bilateral. It is more resistant to treatment than nevus of Ota.

Dark skinned patients have less wrinkling. They likely to have more problem of hyper pigmentation and erythema after LASER resurfacing. So, its use may be limited to acne scarring.

3.5 Chemical peel

It is procedure to improve texture of the skin. Chemical peel removes controlled thickness of damage skin in order to stimulate normal healing and skin rejuvenation.

Chemical peel is to treat facial blemishes, wrinkles and uneven skin pigmentation with the help of chemical. It also improves skin conditions and makes the skin younger and smoother. Thus, without any incision, appearance is enhanced and self esteem is boosted. This procedure can also be done in conjugation of face lift. Thus, this procedure does not prevent or slow down the aging process but it restores youthful appearance of the face. In chemical peel, an acid solution is applied over the face to take off an outer layer of the skin. There are three strengths of solution. Light, medium and strong.

In mild peeling, chemical solution is applied once on the skin. For mild or superficial peel does not require any anaesthesia. The skin of face is thoroughly cleaned before the procedure. Then, chemical peel is applied.
It causes mild tingling sensations or stinging sensations. Patient can immediately go to his place of job. It provides healthier and radiant look. The depth of peeling depends on the amount of time for which this solution remains on the skin and number of coating of acid applied. It corrects fine wrinkles, mild sun damage and mild pigments.
Medium peel works more deeply. It causes sun burn appearance. It is used to treat moderate wrinkles, moderate sun damage, pigment changes, and precancerous lesions. Trichloroacetic acid or phenol is used.

Deep or strong peel is used if patient has deeper wrinkles, acne scars, rosacea. Deep or strong peel is not used in patients with dark and oily complexion. It is a risk for heart patients. It is done under general anaesthesia or local anaesthesia and takes 1-2 hours. It is done once. After application, skin will peel off for about two weeks. Patient should be away from routine activities for about a week. Face becomes very red and raw for two weeks. This procedure risks infection, scarring, colour and pigment change.

Later on thin layer of petroleum jelly is applied to encourage healing. Sunscreen and make-up may be applied later on. This solution exfoliates outer layer of damaged skin. This is least expensive method as compared to other resurfacing method. It has its own limitations. Peel may be superficial or deep. In deeper peels, seven days are required to shed outer layer. The new skin is more soft and supple. It appears more youthful. It has less wrinkles and discoloration. It has healthier glow. During consultation, tell proper history of your sickness at present and in past. Also, inform about any prior procedures done, medicines taken, any drug allergy. So, also let him know about what motivated you to seek this procedure. Avoid use of alcohol and any tobacco product. Let doctor know about what you expect after the procedure.

There are various types of peels for various types of problems. TCA peel, glycolic acid peel, salicylic acid peel, lactic acid peel, madelic acid peel are commonly used. Peel to treat acne & dull skin, pigmentation on the skin, mellasama, scars etc.

3.6 Hyper Pigmented or dark spots on the body – I (Mellasma)

Mellasma:

Before                    After

Most common acquired pigmentation. More common in females. It is multifactorial in origin like genetic, endocrine, UV light.

Mellasma is also known as mask of pregnancy or chloasma. Mellasma starts in child bearing age. Melasma are irregularly shaped but often distinctly defined blotches of light to dark brown pigmentation. Mellasama usually develop on cheek, nose, upper fore head & sometimes in neck. It may develop on the nipples & around the external genitalia.

Its presentation is classified into 3 groups:

1. Centrofacial pattern: It is present in 65% cases. In it cheeks, forehead, upper lip, nose and chin are involved.
2. Malar pattern: It is present in 20% cases. It affects mainly cheek & nose
3. Mandibular pattern: It is present in 15% cases. It involves chin & it is less common.

In Mellasma, melanin and number of melanocytes increase in number of basal cell layer. Melanin granules are also present dermoid.

Ultraviolet ray in sun light and estrogen are biggest culprit. So, it often occurs during pregnancy & use of oral contraceptive. Reproductive age & dark skin persons are more likely to develop. Other factors are nutritional deficiencies, progesterone, antiepilepsy drugs (like hydantoin, dilantin).

Non standard cosmetics may induce mellasma in some cases.

1 /3 rd cases are idiopathic. Mellasma reduces in winter.

Types of Mellasma:

1) Epidermal 70% and seen as intensified when examined under woods lamp
2) Dermal in 15%. It does not intensify under wood lamp
3) Mixed type 10-15%

Differential diagnosis:

Addison’s disease. Rechls mellasma, Naevus of ota, drug induced pigmentation, malar rash (SLE), hydroquinone induced achromoses.

Diagnosed in wood lamp light. If its colour enhances, it is epidermal. If it does not enhances then it is dermal. In mixed type, one of both features is present. This examination helps to assess prognosis in the treatment of mellasma.

Initial treatment of mellasma:

One may start with one product and go on adding other products. Start with hydroquinone 2% then increase upto 4-5%. Some may start directly combination of hydroquinone and tritinoic acid and steroid. Use it in night and in day use sunscreen. Kojic acid and tretinoin may cause irritation.

Once patient develops mellasma, there are high chances of experiencing recurrence. Mellasma of epidermal presentation respond to treatment but that of dermal presentation does not respond to treatment.

A. Avoid sunlight, Use UVA screen for care & home windows. Use protective clothings & hat. UVA can penetrate glass. So, use proper glasses.

B. Use good high SPF sunscreen having broad spectrum coverage. No sunscreens offers full protection. So, best is to avoid sunlight.

C. Use medicine regularly.

Recurrence after treatment is common. 45% patients respond , 50% show partial response. Intermittent touch up session is required after every 6-8 months fluence 3-5J/sq. cm. for debulking bigger lesion upto >10 J/sq.cm energy is used.

Solar lentigos:

Before                    After

3.7 Pigmented lesions II.

Certain drugs, Vitamin B12 deficiency, hormonal imbalance, Diabetes mellitus, acanthosis nigricans can also cause it. Nutritional deficiencies, use of certain cosmetic and medicated creams, thyroid problem, menopause, and pregnancy may provoke mellasma. Solar radiation, hormonal changes, oral contraceptives, hormonal replacement therapy, multiepileptic treatment may cause mellasma. Facial mellanosis may be present simultaneously.

Although mellasma is non life threatening condition, but it causes social, psychological and recreational harassment.

Pigmentation

Most of the females have worry about three problem. These are pigmentation, wrinkles & aging.
Pigmentation caused by acne and sunlight are causing significant stress & embarrassment. Although most of the products advertisers of over the counter product promise that their products will lighten the dark spots, it is not always so because there are so many causes of hyperpigmentation. External & internal factors are variable from individual to individual. Melasma, solar lentigo, post inflammatory hyperpigmentation & dark circles under the eye are pigmentation conditions. Melanocyte produces melanin containing melanosomes. These are incorporated into keratinocytes of epidermis. In dark person, these melanosomes are larger & contain more amount of melanin. Degradation of melanosome is slow in dark skin person as compared to that in light skinned individual.

Ultraviolet light & changes in skin colour:

Ultraviolet rays is a major source which damages the skin. When skin is exposed to sunlight or ultraviolet light in sunlight / day light, skin’s defense starts working against further ultraviolet damage by the process of tanning or melanogenesis. So, melanin production increases & skin becomes more dark. This increased amount of melanocyte is transferred to keratinocytes by melanocytes.

Superficial lesions:

Lentigens, ephilides, seborrhoic keratosis, nevi spilus and junctional nevi.

Blaschkos lines:
These are lines on which nevi are present and develop.

Melanocyte nevi are treated only when they cause cosmetic problem. These nevi can be congenital, acquired, compound, intradermal. Thermal relaxation time of melanocyte is 250 to 1000 nanosec. In deep pigmentation, pigment granules in cell wall should burst and so cell membrane ruptures. Melasma and café-au-lait tend to recur in spite of Q-SW laser.

Disorder of epidermal melanocytes:

1) Freckles (Ephelides):

Number of melanocytes remains normal but melanin is increased in basal layer. Develop brown macules on exposed area of skin, increase in number during the summer. Alpha hydroxyl acid and tretinoin can reduce freckles. QS Nd YAG and radiofrequency can also be used.

Solar lentigos are seen generally after 50 years of age & so are called senile lentigos. 90% persons above age of 65 years have some solar lentigos. Face & back of the hands are mainly affected sites. These do not occur in sun protected area. Sunlight is the culprit. Clinically, it is difficult to distinguish freckles, (ephelides), solar lentigos & lentigos simplex. These can cause risk factor for melasma & basal cell carcinoma. These have elevated levels of melanocytes.

2) Lentigo:

Number of melanocyte and melanin increases in basal layer keratinocytes and melanocytes. These are dark brown macules. Develop on exposed area (sun lentigo) or non exposed area and on palm, plantor surface and mucus membrane. Lentigo simplex is common form of lentigo which has no predilection for sun exposed skin. Lesions are light brown to black. For lentigens, Q.S. Nd YAG 532 and 1064 is used with energy 3-6 J/ sq.cm at 5-10 Hz. Fq-Q SW YAG laser (3-4 mm spot skin). With 1-4 J/sq. cm.

3) Café-au-lait macules:

There is increased content of melanin and increased number of melanocytes. Appear as light brown macules or flat lesions 1-20 cm in size.

4) Senile lentigens

5) Epidermal nevus:
Linearly arranged papillomatous keratosis papules. There is hyperkeratosis and epidermal hyperplasia in basal layer.

6) Seborrhoeic keratosis:
There is hyperkeratosis, acanthosis and papillo matosis. Smooth macules to verrucuous pigmented papules or plaque seen. Seborrhoeic keratosis is due to excess keratocytes and melanocytes. These are common epidermal proliferations.

D. Disorder of Dermal melanocytes:

(2) Mangolian spot: Ill defined patch in sacro coccygeal area at birth which usually disappears after 4 years. Melanin granules are present in wavy dendrite cells present in dermis.

(3) Nevus of Ota:

Bluish gray macules on periorbital facial skin and in ipsilateral sclera of the eye (dark dissaturation). Some patients respond better with energy between 6-20 J/sq. cm with QSW Nd:YAG 1064 and QSW 532. Pigmentation in ABNOM occurs adultahard is symmetric and bilateral. It is more resistant to treatment than nevus of Ota.

Dark skinned patients have less wrinkling. They likely to have more problem of hyper pigmentation and erythema after LASER resurfacing. So, its use may be limited to acne scarring.

(5) Nevus of ito:

It is similar to nevus of ota but situated in supraclavicular, scapular or detoid area. Some respond better as mentioned in nevus of ota.

(6) Blue nevus: It is solitary lesion having dome shaped and blue black papules. Epidermis is not involved.

(7) Dermal-epidermal pigmented lesion:

Mellasma, post inflammation and post traumatic pigmentation compound nevi, Becker's nevi. These are seen in adult. It is flat. They have hairs on it.

Becker's nevi: These are large, hyperpigmented spots on the trunks of size, 2-40 cm lesion has coarse hairs and variable keratosis. Epidermal pigmentation is more.

Becker’s nevi:

These are large, hyperpigmented spots on the trunks of size, 2-40 cm lesion has coarse hairs and variable keratosis. Epidermal pigmentation is more

Lentigen is more common in women and scheborrhoic keratosis is more common in males. In skin type III, IV pigmentatory changes are more common due to photo aging. QSW 1064 and 532 in combination is used.

Nevus spilus:

Within a tan brown patch, histologically, it is like neromelanocytic nevi. It is histologic polymer of lentigo simplex. It may become malignant. It responds to FO Nd YAG. QSW .

Treatment of pigmented lesions:

Pigmented lesions like solar lentigens nevi of Oti and Ito, café-au-lait-macules (CALMS) and tattoos can be effectively treated. Malasma, nevocellular, nevi, lentigo, partial are treated by Laser. Invasive melanoma cannot be treated with laser.

Tattoo:

Patients with darker skin and these hyperpigmentation and tanned skin have higher risk in tattoo removal. It is easier to remove tattoo of a person having fair skin. Q-switched Nd: Yag and Q- switch Ruby are better effective. As tattoo becomes old, it fades away to body’s process of elimination. So, it is easier to remove older marks of tattoos. Some tattoos cannot be removed completely. Ghosts like colour may remain at site of a treatment. Multicolour professional tattoos are difficult to remove. Those who do not use skin protection new lesions may develop later on.

Polikiloderma of Civattee:

Affects the side of the neck and lower lateral cheek. Atrophy pigmentation and reticulate telangiectasis are present. Q-switch Nd YAG selectively damages melanosomes in the cell wall.

Treatment for Poikiloderma:-

TRT of melanosomes is less than nano sec. Longer wave length penetrate more deeply and can target cells in greater depth of dermis. It requires more energy because absorption co-efficient decreases with increase in wave length. Shorter wave length requires less energy to damage pigmented cells. More the pigment more will be damage and sub threshold energy stimulates pigment production. Q-switch leads to thermal and mechanical damage. So, whitening is end point. It indicates that entire melanocyte is killed. Low fluence of frequency doubled Nd YAG is absorbed by haemoglobin also. It leads to purpura formation and epidermal necrosis.

CO2 laser is used to debulk the lesion then long pulsed 1064 nm and Q-switched 1064 and frequency, double Nd-YAG 532 laser is used. Nevocellular nevis responds partially to QSW laser and recurrence is common. Congenital nevo cellular nevi: Results are partial

Post inflammatory hyperpigmentation:

Post inflammatory hyperpigmentation is also known as post inflammatory pigment alteration (PIPA). It appears more in persons having dark skin, acne, eczema, allergic reaction ( fixed drug eruption), any injury such as burns, surgical wound, trauma, peels & laser resurfacing can cause it in dark skin person.

Melanin increases within basal keratinocytes. In dermis free and phagocytosed melanin is present.

Cutaneous insult increases melanin synthesis in area of injury or inflammation. So, dark pigmented spots of irregular shape develop.

Avoid sun and use sunscreen. Keep patience as these tend to improve with time. Non irritating topical produces like hydroquinone, kojic acid & retinoid are helpful but slow in action.

Dark eye circle:

It is the most common complaint in both men and women. Its exact cause is not known. Skin in this area is thin. So, any inflammation or vasodilatation may manifest as darkening of the area.
Nd: YAG laser & Ruby can be used with some results. Use Vit K (phytonadione) combined with retinol (0.15%) is helpful. Use sunscreen & take more or enough sleep.

Xynthelesma:

It is present near the eye. It is seen as depigmented lesion. In 50% patients, no abnormality is seen in blood lipid level. Triglycerol level is raised such patient is asked to have cardiologist opinion. CO2 laser can be used with excime laser.

In seborrhoeic melanosis, retinoid with antifungal ointment gives good results.
Hydrocortisone is mild local steroid.
Autotoxic Vit. B12 is also be given.

3.8 Vitiligo/leukoderma:

Unstable vitiligo- increases in size, shows appearance of new lesion and has ill-defined margins. There are various types of vitiligo. Focal vitiligo has good prognosis. Vitiligo vulgaris has several patches. It has fair prognosis.

Segmental vitiligo has no satisfactory prognosis. Acrofacial and universal vitiligo has poor prognosis. Indicators of poor prognosis are lesion on prominent and bony part, lesion on palm and sole, nipple and areola. The vitiligo or whitish patches on the skin is considered as a social stigma. So, this condition causes lot of stress in patients. Vitiligo is an autoimmune condition having genetic predisposition. PUVA is therapy of enhancing skin repigmentation. Orally psovalen tablet is given two hours later the patch is exposed to ultraviolet (PUVA) rays for a fixed duration. When UVA is not available patch is exposed to sun rays (PUVA SUL). In treatment with UVB can also be done. Excime laser may also be used. Such medical treatment is done to stabilize growing patch. When patch stops growing it can be treated by surgery.

Various surgical methods are available for good cosmetic results:

1. Multiple punch technique: From donor site, multiple thin grafts are taken with special punches. These grafts of size 2-25 mm are grafted. When these grafts heals PUVA therapy is given. Repigmentation occurs in 6 months.

2. Ultra thin skin grafting: A ultra thin (very thin) skin graft has a layer of upper part of skin i.e. epidermis. It is grafted on the dermabraded or LASER abraded part of stable vitiligo within 8-10 days. Melanocytes are taken up by the abraded skin and it starts pigmenting. Rest of graft falls off by 8-10 days. Duration of 2-3 months is required to merge and match with surrounding skin colour.

3. Suction blister grafting: On the donor site prolonged negative pressure is applied with suction. It results into raised large bleb which contain epidermis. This thin graft is placed on dermabraded recipient surface. It provides cosmetically acceptable results.

4. Melanocyte transplantation: Melanocytes are artificially cultured and the suspension is applied to it. The area is covered with collagen dressing.

5. Tattoing: Artificial pigment is injected into depigmented areas. Matching pigment shade is selected. With the help of manually or electrically driven needles pigment granules are implanted into leucoderma patch. After 1-2 year bluish hue ad develop at this site which may be unacceptable by beneficially. So, this procedure is reserved in cases where patch is in an inoperable site.

3.9 OUR APPROACH TO BEAUTY:

Everybody should educate one to understand care of one’s health & beauty: Health is beautiful but every healthy person may not be beautiful. So, also every beautiful person may not be healthy. Due to various reasons beauty has shorter life. One needs to take care to prolong its life. Due to fear of losing beauty & strong internal urge to improve or maintain beauty person becomes emotional. Emotional thinking makes the person more confused & such person may tend to take wrong decisions or tend to delay right decision or tend to postpone implementation of right decisions. Advantages of this mentality is taken by advertisers. They spend a lot of money on advertises of cosmetics. We spend more on advertised commercial cosmetics and less on self education on basics of beauty and its maintenance. Hence enlighten & train yourself to maintain beauty in your own case.

Cosmetic treatment:

Mission is of cosmetic treatment to undo the damage which patients do in their 20’s and 30’s due to compelling wish to enjoy thrill of life.

At the age of 40, one must think of undoing some of the damage individual has done in 2nd and 3rd decade of life. In women, skin aging starts showing the effect of aging at 35 years of age and in men it starts at 44 years. If one starts to take care earlier, person gets better results.

Beware of using cosmetics without consulting your doctor!

In few years, concept of cosmetic treatment has become more popular and more matured. General population has become more aware of it.

The product containing enough concentration of ingredients which work into the skin to produce visible changes in texture and quality is called as active product. It works beneath the skin. Retinoic acid, great retinols, AHA, C serum are important ingredients. When you use such formulations, you should identify the changes it causes. You should like its feel, smell and comfort so, that you can use it for longer period.

Self image:

Everybody has self image. Man himself plays a dominant role in creating his own good or bad self image. Our attitude, thinking, emotions, behaviour & activities play a great role in developing or deteriorating self image. This is greatly supported by our external physical beauty & social reactions.

Self image is a perception of how we believe in our look and how we look to others. Good self image give better self confidence, better development of skill and makes comfort in relationship. Dissatisfaction about self image makes the person more self conscious, inhibited and leads to less development of his / her skill . Because of fear of what others will say, he tends to avoid adoption of good habits & tends to adopt common & socially accepted bad habits. This specially happen in the company of good (?) friends.

So, subconsciously, unknowingly & silently they suffer from a feeling of inferiority, self non satisfaction, self-malhandling etc. Such suffering naturally affects career, studies & self- development. So, irrespective of age and profession everybody should think of improving one's own external appearance.

Young people always think that . their skin will look young forever. They take beauty for granted. So, in an attempt to enjoy life or to live life happily, they neglect to adopt good habits. Thus, many youths unknowingly damage their skin during their 20’s and 30’s.

3.10 COSMETIC SURGERIES & YOU

Need of cosmetic surgery is growing

In this world of competition and dynamism, due to cultural impact, still many people think that spending money on cosmetic surgery is a bit silly and so in spite of having money and having mentally decided, they postpone their decision significantly. Thus, many patients delay in decision making. Cosmetic surgery was never so much safe and standardized as it is now. So, paying to look beautiful is more acceptable, to cater one’s need to improve professional life, social life & personal life. Therefore we find that more and more people are undergoing the cosmetic surgery.

Cosmetic procedures are for all those who want to look young irrespective of the age.
Nowadays most of us have some facial flaws and signs of premature aging, which undermines self-confidence. Surgical procedures like double fold creations for Asians and various chemical peels are used to improve skin.

Cosmetic surgery changes the look of the person and helps to change feel of individual about oneself.

What is cosmetic surgery?:

It is subspeciality of enhancement of appearance through surgical and medical techniques. So, it maintains normal appearance, restores normal appearance and enhances the look. This surgery is directed to all areas of head, neck and body. Among the youth patient, rhinoplasty, dermabrasion, CO2 resurfacing of the skin of the face and anywhere on the body, face rejuvenation, breast augmentation, liposuction are common procedures. Among older patients, facelift, breast lift, blepharoplasty, CO2 laser resurfacing of irregular or rough surface of the skin (on the face or anywhere on the body) fillers and botox are more common procedures.

One needs to find out what is the problem and why one looks less attractive. Then, one should find out the causes of these problems in that particular person e.g. wrinkles can be due to aging but these are aggravated by sun light exposure, sagging of the skin, repetitive facial expressions. Fine wrinkles are treated with mild procedures like Laser skin tightening, non-surgical face lift procedure mild peels to more intense microdermabrasion. Botox helps to reduce furrowing on the fore head. For deep fold and sagging skin laser resurfacing, soft tissue fillers or face lift can be done. Less intensive procedures like microdermabrasion has no down time and is suitable for mild problem. To soften deep crevices and discolorations, carbon dioxide laser resurfacing is done. It gives dramatic results.

Everybody should educate himself on ingredients of cosmetics and their action. He should train himself on how to take care of body. This avoids overwhelmed long term losses of beauty. You take your skin matter in your hands while purchasing skin care over the counter products. Most of you do not consult skin specialists or cosmetologists about suitability of these products for your specific skin. cosmetics have certain wrong effects on the skin after persistent use of specific period. Be careful in using a product which contain waxes, drying agents and harsh chemicals. Consult your doctor or cosmetologist or dermatologist before using any cosmetic products & need of any cosmetic procedures. They can suggest effective & target specific cosmetic procedure.

Cosmetic cocktailing:

Sometimes two or more cosmetic procedures are done simultaneously e.g. brow lift with blepharoplaty with botox, rhinoplasty & chinplasty.

Lunch time procedures:
Procedures like ‘Thread lift’, filler injection, non-ablative face rejuvenation, microdermabrasion, iontophoresis, are called as lunch time procedures. These are done at lunchtime. These are shorter procedures. So, patients resume his / her routine activities immediately and there is no down time or recovery time.

Cosmetic surgery technique:
With recent advantages, many new patients on friendly techniques have developed. So, current trend is to use smallest possible incision, shortest down times, early recovery.

So, concept of virtually scarless started by putting incisions in hidden part. For cheek augmentation, for chin augmentation, buttocks augmentation incision are placed in non visible part.

Most of the cosmetic surgeries are the ‘finest’ products available for the best value. Benefits are not only in the form of improvement in physical appearance but also in terms of improvement in mental and social factors. Recovery is made convenient and comfortable. So, many women or even men want to undergo cosmetic, surgery before marriage to become a trophy bride or trophy bridegroom.

More sophisticated machines are now available for sophisticated rejuvenation of the face & body. So, with quicker healing and less problems after the cosmetic surgery, its popularity is increasing.

Why you should undergo cosmetic surgery?

Think but do not think in a wrong way before taking decision of cosmetic surgery:

Many people still feel that spending money on the cosmetic surgery is bit silly and so in spite of their own need, they tend to avoid to undergo such surgery & continue to expose one self to feeling of inferiority at subconscious level. There is nothing odd in undergoing cosmetic surgery. In modern days of competition and persistent progress, it is always safe and beneficial to pay for looking good. Improving one’s own beauty is need of personality fulfillment of such need helps to feel more confident and so you do work in better way. Cosmetic surgery improves appearance. So, confidence and self esteem also increases. Cosmetic surgery leads to changes in the concerned parts of body but also creates changes that are than skin deep. Others also like to interact with you. About two crore people all over the world receive some sort of cosmetic surgical enhancement every year. So, you are not alone when it comes to finding ideal way to pricely procedures. Factor like expertise, efforts, time decide charges. Cosmetic surgery is not covered by health insurance policies.

There is nothing like guess work or surprise in cosmetic surgery. Every patient is different. Every patient’s needs and results are different. Only try to know in short what exactly surgeon will do.

Middle aged people, due to fear for losing career, middle aged people are anxious to halt aging process of their body. Cosmetic surgery makes them feel better. Trends of cosmetic surgery is healthy sign of progress in pursuit of self-esteem. The procedure are procured by patient not for a quest of glamour but for self-respect. So, many people wear clothes of young people style without shyness and these clothes fit optimally.

Nowadays, the techniques of cosmetic surgeries have become less invasive, often there is early recovery. Although relatives and friends say, “You do not need cosmetic surgery” the individual does not want to look old and so many undergo cosmetic surgical procedure in spite of opposing opinions of relatives or friends.

About fifty per cent people having cosmetic problems undergo cosmetics surgery because they want to look younger and smarter. Thirty three per cent patients want to improve the appearance in their career (to look less tired), ten per cent want to improve their appearance for better appearance for better opportunities of dating, remarriage and to avoid problem of divorce. Cosmetic surgical and non-surgical procedures are becoming more common and more acceptable. All procedures are not for everyone. Cosmetic surgeon is better judge to decide which procedures will help in a particular patient. He learns to plan for the better approach to improve one’s look.

Never shop or bargain:

In modern market of competition, we have learnt that those who provide qualitative service and do qualitative job charge accordingly. Standard people do not compromise for quality. When you shop, you bargain and try to pay less and you feel you have won. It indirectly affects the quality you get.

Choosing cosmetic surgery:

Self motivation is the best motivation. So, do not undergo cosmetic surgery because others say so. Be self motivated for such procedures. Well informed patient is most likely to end up as a satisfied patient.

Cosmetic surgery is not a commodity like a bag or tie when one size fits all. So, let cosmetic surgeon know what you want. Then he will decide whether you really need cosmetic procedure and which procedure is the best for you. Always try to understand the benefit and the risk of every procedure. Keep realistic expectation about the potential results of surgery.

Consultation:

During consultation, let doctor know how you feel about your appearance, how you believe others see you and how you would prefer to look and feel. Speak candidly about the changes you will like to feel. At the end of consultation try to assess whether you and your surgeon have understood each other completely. Try to understand how much surgeon’s skill works, how much is extent of your cosmetic flaw and how much are nature’s limitations. Try to take compromising decision rather than one sided decision.

Do not schedule surgeon when you are very busy or if you have emotional burden because recovery is prolonged. If you are consulting surgeon and if you not able to get answer you want to hear, probably problem is not correctable and it may be non physical.

Who should not undergo cosmetic surgery?
If you try to achieve your goal of overcoming crisis in your life through an unrelated change in your external appearance, do not choose cosmetic surgery. First overcome the crisis e.g. loss of job, divorce, death of a spouse. If you have unrealistic expectations having nose or face like any celebrity, restoring original perfection following severe accident or severe illness or expecting appearance of youth of many decades past or you feel that you may easily want to acquire celebrity life style after cosmetic surgery do not undergo cosmetic surgery.

If you are not able to give proper answer of why you feel need of this cosmetic surgery, cosmetic surgeon may not select you for surgery. If you feel that after removing minor defect in your appearance, life will be perfect, do not choose cosmetic surgery. Elimination of minor defect has no relation with making life perfect. So, many people live their life successfully in spite of gross defect in appearance. e.g. Late Dada Kondke, Late Charlie Chaplin. If you are taking psychological or psychiatric treatment do not undergo cosmetic procedures because it is not your urgent need and this procedure will not solve your problem of mental health, social /professional career and frustration. First psychiatric treatment is compulsory.

In cosmetic surgery, the patient who is expecting 100 per cent result is not good candidate.

Ideal patient for cosmetic surgery:

An ideal patient for cosmetic surgery is one who realizes that surgery will not necessarily change his life or make him successful in career or improve existing disturbed relationship. He accepts that he wants to change shape of part of body. It helps to see himself in more positive way and probably improve self esteem. It is not the body which helps you to participate in improvement of your progress but it is your skill, expences, intelligence, education and knowledge which helps to take care of your own progress. Cosmetic improvement provides adjoining support and not main support. The person who realizes this fact experiences multifaceted joy after cosmetic surgery. Those who do not understand this fact and think that only surgery will provide them joy should not undergo cosmetic surgery.

In the world, more than two million people undergo cosmetic surgery. Liposuction, breast augmentation, eye lid surgery and face lift are commonest. Out of them, women are 90%. In men, liposuction, eyelid surgery, face lift, cheek implant, chin implants, rhinoplasty and correction of gynaecomastia are commonly done. In teenager rhinoplasty is commonest procedure. 45% patient undergoes multiple procedures of cosmetic surgeries.

Caution:

Do not choose to undergo cosmetic surgery to influence a change in someone other than your self. You might end up disappointmented.

Fashion:

Primary goal of fashion is to keep things fresh.

How to adjust with change in appearance: -

If cosmetic surgery, will make dramatic change in your appearance post operative adjustment takes longer time. Try to accept your redefined body image on your own, as it helps to make you well versed with your self. After surgery, it is better to have some one who understands you and gives emotional support and physical help. Even most independent person may need emotional support. After surgery one may likely to feel depressed and unpleasant. It is temporary phenomenon provoked by swelling, bruises, discomfort, anxiety & doubt whether I will really get results in improvement of appearance. To aggravate such depression & unpleasantness.

One may feel stress, exhaustion, metabolic change or frustration of waiting for the results to appear. One may feels depression temporarily due to anxiety about results. It usually recorrects within a week. So, take brisk walk, involve in light social activity, be busy with your hobbies and have small out goings.

We can have control on ourselves and our thinking, speaking and accepting. But we cannot have control on others and on their thinking, speaking and accepting. Generally, more than 60% people in the community have dominant negativity in personality. So, they have habit of giving negative advice and negative comment for others even if others do not ask. They just want to dominate others through their negative approach and want to prove how they are right and how others are wrong. They insist that their opinion must be not only respected but accepted by others. If others do not accept, then, they make it prestige issue. They do not think whether they are really commenting in proper manner and whether it will create positive effects. Beware from such persons who may be your family member, relative or friend.

Some people have a habit of passing negative comment. Such people may be your friend or relative so be prepared to hear their shocking comments. You may say, “I have done this for myself and let me be content with what I have.”

Who should undergo cosmetic surgery procedures?
Most of us have some cosmetic problem. So, everybody of us need some cosmetic therapy or some cosmetic procedure. Consult cosmetic surgeon to assess one’s problem. Let him know your expectations about your own look. Then cosmetic surgeon will guide you.

Are cosmetic surgeries safe & without danger?
Cosmetic surgery is like other planned surgeries. Each surgery has its share of risks but with modern technique these risks are done with great safety.

How many cosmetic procedures can be done in the same individual at a time?
All cosmetic surgeries discretion and on patient’s demand, more than one cosmetic surgical procedures can be done at a time. It saves patient’s down time. It is economical. But the risk may increase in some of the patients having other physical problem.

Why one should undergo cosmetic surgery?
Cosmetic surgery helps to make changes that are more than skin deep. It enhances confidence and personal self esteem.

Website and patient’s attitude:
Our website provides relevant content which is time tested and trusted. It helps for effective decision making.

3.11 NON-SURGICAL LASER PEEL/RESURFACING OF FACE (RENOVATION OR REJUVENATION OR RENEWAL OF FACE)

We are troubled by unwanted dark spots, hyperpigmented spots, moles, naevi, roughness of the skin, acne pits, acne scars, other types of scars.

Almost everybody of us has certain cosmetic problem of the face.

We can offer following solution of international standard: -

These problems can be corrected by surgical (ablative) laser or medical laser (non-ablative) laser machines.

Our centre has both of these facilities. Usually medical lasers (non-surgical or non-ablative laser) machines are used for rejuvenation or renovation or renewal of the skin on the face or any other parts of the body. But when drastic change is required, surgical or ablative lasers like CO2 laser is used to correct acne scars, acne pits, thickened healed acne spots, scar of wounds.

• We have world's the most advanced Q-switch Nd:YAG Laser machine from United States of America (USA) called Medlite C6 which is the most suited to Indian skin.
• Lasers of this machine helps to improve colour, texture & glow of the skin, hyperpigmented spots, dark spots & wrinkles on the skin disappear. Skin becomes more tight. Aging appearance of the skin reduces dramatically.
• We have ISOGIE Europe machine to improve appearance of face. It strengthens muscles of the face & other parts of the body. It reduces wrinkles. Thus, it helps in non-surgical lift of the face, breast tummy/stomach (abdomen), buttock etc. This machine is approved by FDA of United States of America.
• We have additional world's renowned machines like Long Pulse Nd:YAG laser and intense pulse light machine (Deka's synchronous platform) for additional rejuvenation of face.
• Due to additional, availability of surgical laser machine CO2 laser, we improve all minor and major flaws on the skin simultaneously e.g. skin tag, warts, depressed spots, acne scars & pits etc.
• We have in addition, acugel ultra sonic wave treatment machine, iontophoresis & skin polishing machine (microderma or diamond derma) which helps in better results in persons who have resistant & extensive problem.

3.12 SURGICAL LASER PEELS / LASER RESURFACING:

Break through in treatment of scars, pits & depreseed spots

Some persons have unevenness, scars, depressions, raised spots & static wrinkles on the skin of the face. These can be treated with surgical or non-surgical laser peels or laser resurfacing. In mild problem, laser procedure is used.

Why one should choose CO2 laser resurfacing?

To minimize fine lines, scars, on face and body and areas of uneven pigmentation,surgical LASER resurfacing or ‘LASER peels’ is done. CO2 lasers or Erbium YAG lasers are used for this procedure. CO2 laser resurfacing has better results. This procedure can also be used correcting acne scars, improving aging skin and sun damaged skin. Thus, it erases fine lines and wrinkles of the face. Fine lines are more often seen on upper lip, cheeks and fore head. Crow feet around the eyes are improved. The skin of eye lid is tightened and becomes smoother. Frown marks, smoker’s lines, pucker marks, scars improve satisfactorily. It removes brown spots and splotchy uneven skin colour. This procedure can be performed on whole face or in specific region. It is the latest break through. This procedure is also done in conjugation with other cosmetic procedures. It produces least bleeding, least bruising and least discomfort as compared to other procedures of face surgeries. It is very precise method.

What is done in CO2 laser resurfacing?

In surgical laser resurfacing, superficial layers of damaged skin are stripped away. After healing smoother, tighter and younger look of skin develops.

Superficial or medium resurfacing is limited to the epidermis and papillary dermis. Deeper resurfacing additionally reticularis dermis is removed. Later procedure is more aggressive and need more healing time. To achieve results do deeper resurfacing, one needs to do superficial resurfacing several times. Using a wand like LASER hand piece, wrinkles are vaporized and replaced by fresh skin cells. There is more control in the depth of penetration. So, there is more and more precision and safety. Thus, this revolutionary technology removes one layer of skin at a time revealing the fresh skin underneath. So, it is referred as super pulse or ultra pulse CO2 laser. Thus, there are lower risk of scarring.

Procedure:
Depending on area and problem, LASER resurfacing requires five minutes to 1 ½ hour. In case of deeper problems, LASER resurfacing is performed in two or three sittings. Protective creams are advised after the procedure.

Sometimes bandage is applied over the area for about five days to protect the healing skin. After procedure apply ice pack to control swelling. Do not pick the crusts off as it may result in scarring. Scars disappear in about 10 days. Redness may persist for several weeks. Protect from sun exposure till colour of skin has returned to normal. Use sun block with SPF and hat. Skin remains pink or red for few weeks. After two weeks, make up can be applied safely. Rarely make up may cause irritation. In such case, use of make up is postponed for few weeks. After healing fresh appearance of the skin increases.

Side effects:

Every procedure however minor, carries some risk, uncertainty and unpredictable results in spite of expert and experienced hand. Patients of black skin, olive skin and brown skin are at increased risk of pigmentation changes after the procedure. Patient should protect from sun exposure for few weeks. Some patients may develop scarring and lightening of the skin. It can activate infection. Those who have taken accutone in past 12 to 18 months may develop abnormal scarring also. Those who have local infection should avoid this procedure till infection is not controlled.

Limitations:

Although this is the best procedure for those who need dramatic change dut to existent scars, acne scars/depressed pits/other wounds.

There are limitations in achieving results. Although this procedure improves the appearance of the face, it cannot prevent you from aging. Dynamic lines which develop due to natural expressions like smiling, talking, squinting, chewing, blinking, usually recur. These can be treated with botox therapy. Some patients need maintenance treatment such as chemical peels and medicated facial creams.

3.13 AGING:

Aging is continuous dynamic process, which affects our body, mind and social active status. Aging phenomenon starts as soon as we are conceived as a single celled fertilized ovum in the mother’s womb. There is definite age at which balding occurs. We directly or indirectly accelerate the process of our aging in us because we are often careless in maintaining improved health status. Since young age, we are under the influence of misconcept that “I am energetic young person. So, aging will not affect me."

In some persons, aging can be slow or rapid. In others, initially it is slow and become rapid in later part of the life. Everybody tries to keep his/her appearance or presentation in such a way that he/she will be looking younger, dynamic and smart. We try to hide flaws on our face by using remedies at home, beauty parlours & cosmetic centres. We spend lot of our money on cosmetics, ornament, clothes to look young & beautiful. We also spend lot of our time in front of mirror & in beauty parlours. But many of us think that we do not have enough time for aerobics, yogasanas, pranayam, self relaxation technique, improvement of stress management & self development. So, we tend to avoid these activities or we tend to find reason to explain about "Why I cannot do these activities?" We tend to mislead ourselves. We do not spend enough money to treat our diseases but we waste our money by spending on non nutritious processed food, tasty food, junk food & socially accepted wrong habits.

Bad life style:

Due to strong will of progress in career, we adopt many bad factors of modern life in our own life. As others are also doing so, we feel nothing wrong in adopting bad life style. In this compulse world of competetion, we are hypnotised to earn more money and live life 'kingsize'. Naturally, we succumb to bad lifestyle of modern life. Bad life style tends to create aging changes at early age. Bad life style means excess tea, use of tobacco in any form, too much alcohol, over or wrongly processed food consumption irregular schedule of meals, irregular & incomplete, sleep and rest, eating modern food outside the home frequently, persistently mismanaged stress. Smoking and use of tobacco in any form is more damaging than the sun & environment. Smoking & tobacco reduces internal blood supply to all internal organs and affects body’s ability to heal on its own. Aging is due to intrinsic factors like genetics, wrong habits, negative attitude, over expression or undue expression of emotions. It is also due to extrinsic factors like photodamage, force of gravity, environmental factors (like pollution), stress. It can also be due to personal factors like bad habits in routine life, sedentary life style, physically extra stressful life, irregularity of life style, lack of enough sleep, imbalanced nutrition, emotional disturbances, mechanical life style. Damage to skin increases with increasing age, sun exposure, wrong habits (e.g. smoking, alcohol, junk food, excess tea) & undue hormonal changes.

Excess tea and use of any tobacco product like smoking have synergestic effects on aging process.

All of us are afraid of disease, aging and death. But still we keep us not ready to face these problems. Subconsciously we often approach to these three factors without prior preparation. Because of good health & stamina in young age we take for granted our health & stamina, consciously, we say “We are ready to face aging and we do not have any fear of these three factors. “Thus, we play gimmick with ourself. We consciously cheat our subconscious part of mind, thoughts and emotions. We often make us slave of many wrong thoughts, misconcepts and misbehaviour.

Everybody feels fear of old age. Everybody feels fear of loss of social status prestige and what others will say. So, we ever engage ourselves in money earning anyhow or somehow. To survive effectively in this competitive world, we try to compete materially with others and forget to compete with increase in skill & strength of personality.. Our cost of maintenance of life is kept high.

Middle age starts when we start rearranging our hairs rather than combing hairs.
We are obsessed with youth.

Aging:

Average age of man has increased to 60-65 years in last few decades. So, more and more people have chance to live longer. But due to over population, problem of survival of fittest, our ambitious nature, greedy thinking, hat red nature, negative behaviour and increased number of attractive wrong factors we have become a victim of stress, materialism, irresistible desires of enjoyment, addictions of wrong food, wrong drinks, wrong sleeping habits, wrong way of taking rest, wrong way of thinking and mob behaviour.

Many of us so easily become victim of aging. So, we have started looking older in comparison to our physical age. Some things have happened about diseases. Those diseases which were used to develop in 6th or 7th decade of life have started developing in age of 2nd or 3rd decade like high blood pressure, diabetes, joint and bones problems, Aging skin problems, cancers, constipation etc.

Our capacity to face environmental, pollution has decreased and we are addicted to live in subnormal or mild unhealthy state or silent diseased state. Diseases grow in us but we often come to know about their existence only when they become non-suppressable by our body. Although we are not aware of such silent existence of diseases, and we are not having any symptom or sign of these diseases, we still unknowingly suffer from their bad effects.
Due to reduce ozone layer in the enviroment, increased chemicals gases and particles in the air, contamination of food and water by pollutants like chemicals, bacteria etc. due to changed unnatural food, food habits, stress of survival, negligence to maintain one’s fitness to face such changes makes us victim.

Our thinking:

We are often misled by absence of symptom or signs of disease or diseases in subclinical form. So, we tend to leave in over confidence that ‘I am healthy because I do not have any perceptible symptoms’, ‘Nothing will happen to me because I can tolerate’ ‘even if it will happen I know tablet or I know good doctor. I will take a treatment & will manage to be healthy’ ‘I cannot tolerate the losses caused by not doing certain action. So let me tolerate the trouble and do that work immediately in spite of my limitations or sickness. We have become slave of our routine life. We are victim of family insecurity and unstable future, economical hurdles and unstable professional future. In other words, our insecurity, thinking and blind adaptation of way of life, we tend to live for survival rather than fitness for survival. So, to overcome aging, let us accept such right need as basic need. Let us do not do good action, maintain good habits, think positively. These automatically substitute wrong actions, bad habits, negative thoughts.

We age earlier if due care is not taken on this world of pollution, competition of survival, insecurity of future, feeling of being thrown out of main stream of social life, persistent urge of carrying prestige, increasing activities. So, our beauty of body, mind and social life and soul gets affected. Various factors affect us and makes us aged at physical, mental, social and spiritual levels. So we have become victim of early aging. We hide our aging by use of cosmetics, good stylish clothes and adopting stylish social life. So we have started adapting more unnatural things in the form of food, habits, thinking etc. factors which affect our face makes us aged earlier. So due to wrong physical habits, lack of proper exercises, victimization of exertion, lack of balanced physical exercises leads to early changes in our face. Even if we do not like these changes, they develop. We cannot run away these changes. We start hiding these changes from our conscious state and from others. We hide them from our conscious conscience by saying it cannot be avoided in today’s world of competition. It happens with many of us and so it has happened to me. I cannot prevent it. I have no time to adopt. Habit of physical exercise or yogasana. If I keep these habit, I will not be able to cope up with modern way of life. So let me live to my convenience. Instead of myself enjoying life, let my senses enjoy my life and let me be slave of my senses. Instead of preventing my suffering. Let me prevent suffering of my body so that my senses will not trouble me.

True aging:

Every part of the body undergoes aging. So, aging is of mind over the matter (body). If you do not mind, it does not matter. Aging is biological phenomenon. Aging creates changes which affects health. So, many changes takes place in body, mind, social life and professional status. Aging affects sensory organs, joints, skin, heart, blood vessels, kidney, etc. of the body. It reduces capacity, tolerance and power of adjustment. Duration of sleep is reduced. Stage IV sleep is reduced. So, in morning, he wrongly feels that sleep was not enough. Due to aging, there is delayed erection and delayed ejaculation. In females, arousal and vaginal secretions decrease. Males can be sexually active upto 70-85 years of age and females can be sexually active till death. Sense of physical activity decreases. Veins enlarge and trauma develops easily. Function of sebaceous glands and sweat glands decreases. Sensory perception decreases. Nails become more brittle and develop leaded ridging. Then, ingrowing fungal infection develops easily. As immune system becomes weak infection develops easily. Rhytids, erythema, mottled pigmentation, descrete pigmentation develops.

Aging affects health, mind, ethics, aesthetic sense and professional life. Aging first imparts wrinkles on mind and then on the body.

The depth of skin and thickness of the skin reduces with increase in age. Skin becomes less hydrated, less elastic. So, skin becomes more dry, flaccid and so itching develops easily. Skin easily permits drugs into skin. Dryness, sagging of skin and size of pores increase. Aging with sun damage leads to wrinkles, unevenness of the skin and pores. It also increases ephelide, lentigo, mottled pigmentation, keratosis (in males). Dryness laxity, poor healing, tendency, hot flushes. Collagen is simple helical proteins secreted by fibroblasts and is present in extracellular matrix. UVB degrades collagen. With increasing age, there is decreased collagen synthesis and degradation of elastic fibres.
80% aging changes are due to environment and sun damage. Skin changes are also affected by gravity.
Skin is indicator of functional status of internal organs of the body.

As age increases melanin in melanocyte reduces. So, more solar damage is seen in elderly person in the form of dermal changes. So, elder people need more sun protection.

As we age, we lose tension of muscles, and mass of muscle. We truly lose our tissue in subcutaneous area, cutaneous area and other parts of body. Our tissue gets gradually atrophied. So we lose quality of healthy natural figure. The triangular face of young age may become round. Fat in cheek is reduced. Cheeks become more round in middle age to increase in age. Then gradually we lose fat in cheek. So in old age, cheek again become flat. Wrinkles increase on face due to further atrophy of cutaneous and subcutaneous tissue. So tip of the nose slowly goes down due to loss of elastin tissues and gravity.

When we sleep on one side or on face, due to persistent pressure, certain creases or lines develop on the face after many years. This process goes on very slowly every day. These lines develop on forehead in men and on the cheeks in women.

As age increases, slowly lines become more prominent and easily noticeable.

Due to gravity of earth, the fatty tissues and muscles are pushed down continuously over so many years. So our angle of mouth turns down. Both the eyelids are pulled down. The upper eye lid cannot be kept in proper level. So vision may be obstructed in some elderly people. The weight of pad of fat in eyelid and gravity pulls these pad of fat in downward direction. So hollow develops under such level. Skin becomes more thinner. Face becomes more puffy. The oblique field develops in front part of cheek which is parallel to the nose. It is called as naso-labial fold. Slowly it becomes more prominent. As facial muscle move down ward and centrally along with overlying skin and subcutaneous fat. Upper lip becomes small and loses its attractive shape. This upper lip recedes into the mouth and flatten out the angle of mouth and turns down due to gravity. So, groove forms in the mid chin area i.e. 2-3 centimeter above the chin in horizontal direction.

Fat accumulated just below the jaw on either side. So prominent jaw line or well-defined jaw line becomes a round area. Slowly in middline just below lower jaw, mandibular lines develop. As skin in this area continuously pulled downward it forms turkey neck. So skin loosely hang below be level of chin and 3-4 cm behind the chin. Ear pinna gradually elongates in length and becomes more thick. We use muscles of face frequently every day while speaking or expressing our emotions. So, certain muscles of the face pull down the skin or contract the skin. On our forehead, horizontal lines (worry lines) develop. Due to frequent over expression or persistent indirect expression of anger, worry, stress vertical lines develop in between the eye brows (frown lines). Due to over expressions of emotions and stress, lack of massage or facial exercises and use of muscles of mastication deepening folds develop. Additional lines develop on the rest part of the face: nasal labial lines develop on the cheek vertical lip line develops around the lip due to underlying muscle’s action. Crow feet lines develop lateral to the eyes. More lines develop from area near angle of mouth downwards. These are called commissural lines, cheek lines and marionette lines. Lines on the neck develops in vertical direction and horizontal direction. Due to aging, blood conducting vessels break and collagen support of blood vessels get reduced. Skin initially shows slight wrinkles which increase gradually.
Due to overweight and over age, hanging skin folds develop near jaw margin which are called as jowls. Thickening develops behind the chin. Hairline on forehead recedes back and so height of forehead increases. In males, it is initiation of baldness on the head. The orchard shape of eye brow slowly changes to flat. Eyelids become more non elastic and redundant. The externally swollen middle part of cheek becomes hollow.

Western:

People get crows feet and wrinkles earlier. Indians develop comparatively less wrinkles. Volume in cheek reduces. Malar prominence and chin prominence reduces. Skin becomes thinner. Nasolabial fold becomes more prominent.

The size of nose increases as compared to proportion of parts of face. So the middle 1/3 rd part of face increases in height and lower 1/3 rd part of face reduces. The jaw bone tissue reduces in volume. The chin begins to point downwards. The face of young person is somewhat triangular. In middle age, it becomes circular. Upper lip becomes thin and flat. Vertical wrinkles develop on both the lips.

Aging face:
Due to aging, usually puffiness develops around the eyes. Person having such face looks tired and old. Fat deposit at unusual place makes the face puffy. When fat deposit increases in the area just below the chin, jaws and cheek. Face appears more saggy. Sometimes ligaments under the skin of the face become weak and so fat herniates through the ligament & person’s face becomes less attractive. With increasing age, skin loses its elasticity. It further sags due to stretch over a long period. Thus, excess stretch on the skin and natural aging process by age of fifty makes the skin of face droopy.

Do we age ungracefully?

Yes. It is often seen.

Why we age ungracefully?

We take for granted our youthfulness and neglect its maintenance care. Most of us are aware of maintenance care but we do not implement. So, we age ungracefully.

Why we do not try to age gracefully? Do we accept that we are aging ungracefully?

Man has a tendency to deny his mistakes. Even if he accepts his mistakes, he hold out side factors or factors which are beyond his control.

Old age:
Old age is a state of mind and not of body, so, old age is more socially constructive.
Many old people make shame to young people when it comes to fitness, regularity and discipline.

Similarly, every type of beauty feels fear of old age. Men face aging with more calm mind. Old is not that bad when we consider positive alternatives to live life in healthy way.

People above 65 years have multiple health problem. So, 25% of them take more than one drugs and so they may suffer from drug interaction. They have a tendency to take home medicine and herbal medication without bothering for their side effects.

In USA, old people are considered undesirable. In Japan, old people are given more respect. By year 2005, more than 800 million people will be of more than 65 years.

Add not only years to life but also colour to life. Be ready to learn and travel through the geriatric age.

Most of us have strong will to look younger and fairer. When you live longer, you wish to look younger. No wiseman ever wished to be younger. We cannot become young but one can slowdown aging process. In skin disease treatment, every patient responds differently.

Medicine for Antiaging:
Antioxidants, Vit. C, soyabean, zinc, pranayam, sharing of feelings, experiences, phytocomplex antiwrinkles, hormones. Estradiol, testosterone, growth hormone.
Chemical peeling may be done with topical glycolic acid, retinoid, azeiliec acid, Kojic acid, Vit. C. our motto should be to prevent photoaging. Aging starts from birth to death.

3.14 PHOTODAMAGE/ SUN DAMAGE:

Everyday we are exposed to sunlight. Frequent exposure to sunlight since the childhood leads to cumulative effect. Ultra violet rays in sunlight develop damages in the skin in the form of skin laxity and leathery, deep wrinkles, pebbly coarse skin texture. As this damage increases skin becomes more thin, dry, rough, dyspigmented. Its bruise ability increases sunlight damage is more prominent in perioral periorbital, glabellar and naso labial area. In beauty these areas are to be most bothered.

Protect from harsh sunlight:

UVA and UVB are harsh to the skin and cause photo damage in the form of increased pigmentation, freckles, premature aging etc. Sunlight contains 10-15 % UVB and 85% of UVA. In noon to afternoon sunlight, UVB is more. UVB is more harmful than UVA. UVC is absorbed by ozone layer. So, only UVB and UVA reach to earth surface.
Ultraviolet exposure accelerate and magnifies the physiological changes of normal aging. Angiogenesis, melanogenesis, free radical formation, apoptosis, DNA mutations, degradation of connective tissue, immunosuppression, matrix, melano proteinase injection etc. develop.

Histologically, collagen is reduced, elastin fibres club abnormally in the superficial dermis. Epidermis becomes more thin and relatively gets flattened. Chronic inflammation and vasculature increases. Elastic material accumulates in collagen bundles. Collagen fibres deposit randomaly. So, skin becomes lax, Rhytides, yellow discoloration and telangiectasias develops.

Clinically, photodamage is classified as Type I, II and III. In type I photodamage, telangiectasis, solar lentigenes develop. So, also there is increase in coarseness of the skin and symptoms of rosacea. In type II, photodamage skin laxity, rhytides dermatocholasis and comedone develops. In type III, photodamage actinic keratoses, melanoma and non melanoma skin cancer develops.

People with dry skin should use sunscreen having SPF 15 or more 20 minutes before exposure to sun. Use umbrella or wide brimmed hat. Sun damage leads to mottled pigmentation, thread veins, acne scarring, skin laxity, enlarged pores, altered skin texture.

To treat it, use sunscreen. After a week, do peel and then, after 2 weeks, do photorejuvenation by IPL.
Non ablative skin resurfacing includes the terms such as subsurfacing non invasive resurfacing, skin toning, wrinkle reduction due to derma neocollegenesis and photorejuvenation.
There is epidermal improvement and dermal collagen remodeling.

3.15 BOTOX/MOVEMENT WRINKLES/DYNAMIC WRINKLES:

Dynamic wrinkles on the face & other parts of body are unavoidable due to aging of the body. Wrinkles are of two types: Static wrinkles & dynamic wrinkles.

These are caused by same frequent or continuous movements of expressions frequently e.g. frequent frowning, raising eye brows, excess smiling, frequent other emotional expressions. These expressions keep certain muscles under the skin active and strong. Superficial muscles of the face are attached to the skin and so we can express variety of emotions and body talk. Due to aging and damage caused by sun exposure, tissue under the skin becomes atrophied or it is partially lost. It results into static wrinkle. These wrinkles can be corrected by fillers or fat or collagen injection.

Due to frequent expressions on the face and due to same type of frequent expressions, as one’s age increases certain tissue changes create fine lines, wrinkles and folds on the face and other certain parts of the body. After smiling, frowning and squinting for years changes increase. These are dynamic wrinkles. These can be vanished by blocking the action of certain muscle fibres which are responsible for frown lines or crows feet or worry lines etc. Thus, smooth surface is produced.

Initially dynamic lines are more on upper half of face. In late stage, lower half of face is affected.
During facial expression certain muscles contract and so lines appear on the face (dynamic lines). These disappear when that muscle relaxes.

Botox affects on the muscles in which injection of botox is used.

Other muscles are not affected at all. Skin sensations are also not affected. So it is safe non surgical approach.

Injection of Botox in forehead, prevent wrinkling in fore head and worry lines. Patient can raise his eye brow. Thus, forehead and upper eye arc become more youthful.

Botox:

What you meant by Botox treatment?

Botox blocks impulses from the nerve to contracting muscle and so keeps them relaxed. Botox weakens the contracting muscles and keep them relaxed. Thus, wrinkles disappear & face becomes smoother and softer. It prevents formation of new wrinkles. It is injected in contracting muscle.

Botox is safe and simple way to minimize wrinkles which are caused by contractions of underlying facial muscles. Results last for 3-6 months. Duration of results increases on repetition. Botox is injected by micro needles. It takes few minutes. The injection shows result in 3-5 days. Do not massage after injection. It can also be used in axillary and palmer hyperhydrosis, excess sweating.

Reconstituted botox can be preserved upto 8 weeks. Do not freeze it. Do not use it, if it is thawed. If 5 ml is added, it provides 2 units/ml. In case of Full palmer hyperhydrosis work point at 2 cm x 2 cm square. Inject 2 units per site, 50 to 100 units can be injected at a time. In crow’s feet, injection is given subcutaneously because the muscle is very thin and it is present in subcutaneous layer. Do not inject upto 1cm above internal one-third of eye brow. Mezotak is injected in mesoderm for skin tightening.

What is botox?

Botulinum toxin type A is called botox.

It is produced from bacterium Clostridium botulinum. This toxin blocks the release of acetyl choline and relaxes the muscle. It is naturally occurring proteins prepared by botulinum toxin bacteria which paralyses motor end plate by reducing secretions of Acetyle choline. Very small therapeutic dose is injected every year. About one million patients are using botox. Botox is safe and so it is safe non surgical approach for facial rejuvenation.

Safety of botox:

Although botox is a toxin, it is very safe. It is used in minute doses. These doses do not spread to other parts of the body. Person can resume his work immediately. Treatment requires about ten minutes. Results are seen in 4 to 5 days. Repetition of botox: Effects of botox lasts for about 6 months. If repetition is done, gradually time interval required increases. So, fewer treatment will be required to obtain same effects. Repetition of botox breaks habit of contracting the muscles and so lines reduce. Botox is not used in pregnant and lactating mothers. Some patients need touch up to improve the results further. It costs ¼ to ½ the cost of initial treatment. Side effects are less common. 10% patient may develop small haematoma which resolves in due course. Drooping of eye lid may develop which reverses after 3 to 5 months. Rarely patient may develop double vision which reverses in three to six months. Avoid aspirin or anti-inflammatory drugs 2 weeks prior to botox treatment. Precautions after the treatment: Do not massage locally after injection. Do not lie down for 4 hours after the treatment. Exercise the muscles for 15 minutes every one hour after the injection for better attachment of botox to muscles.

Botox cosmetics:
Botox is not skin filler but it is relaxant of muscles. Botox can be used with filler. It is used to reduce worry lines (between the eye brows), horizontal lines on fore head, and crows feet. Smoker’s lines (multiple fine lines on the lips) can also be smoothened. It helps to lift turned down corner of the mouth, reducing two prominent vertical neck folds. Excess perspiration of arm pits, palms, soles can also be corrected.

Botox is usually injected in muscle like corrugator, proceras, orbicularis, oculi, frontalis and nasalis muscle. So, know the anatomy of these muscles. In deep crow face injection sites are besides the eyes. Safer zone for botox injection is between the eyes and just above it on the forehead. Point for nasalis muscle i just below it. The mental crease can be treated with botox. Platysma cannot be treated with botox. Botox: results appear after 3 weeks. In crow feet injection, is given just subcutaneously. Pinch test for lower eye lid to lift the skin by pinching. In ideal patient, after leaving pinching skin. Skin goes to original position immediately. If it takes time then that patient is bad patient for botox. While injecting nasalis muscle inject as medially as possible to protect effects from injection of botox. When you take with patient area and observation muscle when you find dynamic wrinkle. It helps to decide sites to be treated by botox injection.

Very small amount is used. In neurological cases, about 100 units are required. Man cannot have toxicity upto 3000 units. It can be used to shape mandibular contour to reduce massetor hypertrophy or thickening. To prevent widening of facial scars, if incision is at right angle to langer lines a week prior to surgery. 2 units of botox is given in local area of muscle. In patient having depression, the angle of mouth is depressed to elevate if botox can be given. To treat nasal wrinkles botox can be used. When one wants to use botox on neck & palm dilute it with 2.5 ml. In case of pre-existing asymmetry of face, use unequal amount of dose. Always let the patient know about asymmetry. In boggy eyelid, do not use botox as patient has redundant skin. In lower face one should be conservative. Inject 1-2 units of botox in the belly of the muscle & not in fold in case of nasolabial fold. In marrione line, in prominent upper lip, inject 2 units. To reduce broadening. To reduce mental crease use 1 unit

Dimple chin:
For hypertrophy of massetor, inject deeply in the muscle. Ask the patient to clinch. Inject in lower part of the massetor. Reduce expectation of patient. In early & moderate cases of platysmal band, botox can be used.
For horizontal line, use 1-2 units. For vertical fold use, 2-4 units. Always stay above the larynx. In massetor muscle hypertrophic 25 units are used on each side. Due to excess chewing gum massetor muscle hypertrophies. Spirit is allowed to dry before injecting botox because spirit reduces efficiency of botox. Spirit should also be allowed to dry before injecting insulin. Botox is good supplement to laser. Botox is injected in muscle and not in the skin.

3.16 MESOTHERAPY:

Mesotherapy is in the form of an injection given under the skin to improve meso layer under the skin. It is also used to treat this area of the skin. Multiple injections of certain medicines are given to treat the problem.

It is used to improve quality of skin in facial rejuvenation, pigmentation, hair loss. It is also used for lipolysis, cellulites. For rejuvenation, HA, AHA

For cellulite- Phospotidylcholine, aminophylline. Load 3 time more quantity than required due to compensate over spilling. Ant: Phosphotidyl choline, Liptine, Titratrical- used for new drug for lipolysis, Refill- resurface –relax & resuspend.

3:17 LASER SURGERY OF MOLE

Moles are considered as beauty marks by many of us. Moles are dark spots and smaller dark swellings, black spots, naevi & freckles present on the skin anywhere on the body. These are bothersome in some individuals. Some people feel self-conscious about its appearance. Some people feel itching on it. Some moles are pre-cancerous and so their removal reduces the risk of cancer. Unwanted moles can b removed and skin can be made cleaner & spotless. Moles can be removed by various methods like excision, shaving and LASER treatment. LASER treatment is most superior. It is done under local anesthesia. It requires 15-60 minutes for removal. No down time is required. One can go home after certain time. Pain is minimum. Wound heals in 7-14 days.

3:18 LASER SURGERY OF DEPRESSED SPOTS, DEPRESSED SCARS, DEPRESSED HEALED WOUNDS

Treatment with the help of LASER machine heals wound faster & it is the latest and the most effective treatment to reproduce smooth & scarless skin. Patient does not need any admission.

3: 19 TATTOO REMOVAL

Person chooses to have permanent mark on his body. Some people cover whole body by tattoo. Why people choose to have tattoo? It is a puzzling question. Tattoo is done for prestige and as love symbol or as holy relief. 25% population have at least one tattoo marks. Tattoo is permanent. After few years, many feel embarrassed by it. An unhygienic procedure of tattooing can cause hepatitis.

During formative process of tattooing, pigment is inserted into the skin by trauma. This pigment is present in keratinocytes, phagocytes and melanocytes.To remove tattoo, procedures like excision, dermabrasion, LASER removal etc. are used. Each procedure have a certain limitations, risk and benefits. Removal by laser treatment is accepted by most of the patients worldwide.

Black and blue tattoo responds best to Q-switch 1064. Red and orange coloured tattoo responds to moderately and yellow and green respond poorly. Ruby laser helps to break yellow and green colour. Flash lamp pumped dye laser can treat purple, orange, yellow colours. Aemla /Prilox is applied 2 hours prior to treatment. Whitening is achieved during Q-switch laser treatment. It takes about 3 to 10 sittings for removal. It is easy to treat black and blue tattoo but difficult to remove other colours of tattoo.

Nasolabial fold:
It is formed by peripheral margin of arbicularis oris and levator muscle. It can be treated by gartex implants or fillers or surgery.

RF:
RF can be used in all skin types because it is colour blind. RF is effective below the age of 70 years.
In skin tightening and RF rejuvenation epidermal remodeling is done by microdermabrasion.

Hair transplant while stitching donor area, take more bite on lower edge that appears for overlapping on the skin. In recepient site, too much tumescent should not be injected to prevent peeping out of the graft.

To prevent trauma to the hair root hold the graft at epidermis level. Implant 45-50 grafts per sq. cm. Women want hair only on head and not on other parts of the body.

3:20 OUR CENTRE

Our centre exudes elegance and warmth. We offer the highest degree of confidentiality. We offer facilities for education and comfort of the patient. Service and safety is our motto. Centre tries to bring back, refashion and restore wholeness of beauty which is absent or destroyed.

Ours is the first multilaser centre in North Maharashtra. We have done pioneering work in educating patients, beauticians, cosmetologists, doctors & masses by arranging lectures, demonstrations, media programme through media like TV, radio, news papers, magazines. We have our websites. We have a facility to guide at free of cost.

We have the world's most powerful & latest laser machine approved by FDA of America. These machines are available everyday. We do not borrow any machine from others because we have own fully equipped centre.

Nd:YAG machine at our centre:

Our LP Nd:YAG 1068 is the most advanced latest generation. It has all features of modern and up to date machine as follows:

It has 3 modes like:

• Standard mode
• Treatment mode
• Users mode

It has powerful integrated cooling system to protect epidermis. It has computerised automatic control system with touch screen. When machine is made on, it has automatic caliberation features which is absent in machines of early generations. This is fixed heavy machine and so it has great stability and control as compared to other mobile laser machines used in other centres who practicing occasionally in a month. Side effects like burns, hyperpigmentation and hypopigmentation are very very negligible by our machine in comparison to mobile smalller sized machines brought once or twice from other cities.

So, we can offer a variety of modern laser treatment and procedures according to the need & choice of particular person.

Q-Switch Nd:YAG Medlite C6 Laser machine:

This is the most powerful machine imported from USA which is the most suitable for fair skin & dark skin people in India. It is effective in rejuvenation of the skin anywhere on the body. It is effective in eradicating or removing hyperpigmentation, dark spots, depressions on the face, acne scars, acne pits, etc. It helps in transformation of the skin in fair colour. Smooth texture and it also improves the glow of the skin.