Boca Raton, Fla., dermatologist Robyn Siperstein, MD, FAAD, says a layered cake is the perfect analogy for understanding facial structure and the need for combination therapy in rejuvenation. In this Next Steps in Derm interview, in partnership with the ODAC Dermatology Conference, Dr. Siperstein outlines each layer of the face, from bone to skin, and which therapies work best for each layer. Energy based devices, fillers, neuromodulators, intense pulsed light, and laser resurfacing are all part of Dr. Siperstein’s facial rejuvenation tool box. Learn her multimodal approach – it just might change the way you view aesthetics.
Further Reading
If you want to read more about injectables and energy-based devices, check out the following articles published in the Journal of Drugs in Dermatology:
ABSTRACT
Background: Poly-l-lactic acid (PLLA) is an injectable biostimulatory filler used for restoring facial fat volume loss.
Objective: To evaluate the safety and efficacy of injectable PLLA injections for volume loss in the temples using dual plane injections. Assessments included live ratings and ratings of standardized pictures and ultrasound imaging at weeks 4, 8, 12, and 16 by a trained
evaluator.
Results: At the 8-week follow-up, there was a statistically significant increase in temporal volume and improvement in skin elasticity in PLLA-treated subjects. Treatment was well-tolerated with minimal self-resolving adverse effects. Ultrasound imaging confirmed that
the injection plane was free of vasculature, posing no safety risk.
Conclusion: Repeated PLLA treatments in the temporal region elicited a global improvement in facial shape, particularly the mid and upper face region. The temple hollowness and facial laxity improved over time with no safety sequelae.
ABSTRACT
Background: Medical aesthetic procedures for facial antiaging with laser and energy-based devices (EBDs) are rapidly increasing, but standards integrating skincare before, during, and after these treatments are lacking. The algorithm for integrated skin care for facial antiaging treatment with EBDs aims to stimulate healing, reduce downtime, and improve comfort and treatment outcomes.
Methods: A panel of 8 global physicians employed a modified Delphi method and reached a consensus on the algorithm integrating skincare based on the best available evidence, the panel’s clinical experience, and opinions.
Results: The algorithm has a pretreatment (starts 2 – 4 weeks before the procedure) and treatment (day of treatment) section, followed by care after the procedure (0 – 7 days) and follow-up care (1 – 4 weeks after the procedure or ongoing). Applying a broad-spectrum sunscreen with an SPF 50 or higher, combined with protective measures such as wearing a wide-brimmed hat and sunglasses, is recommended to protect the face from sun exposure. Dyschromia is a significant concern for those with skin of color (SOC). Clinicians may recommend skincare using a gentle cleanser and moisturizer containing vitamins C and E, retinoid, or other ingredients such as niacinamide, kojic acid, licorice root extract, azelaic acid, and tranexamic acid, depending on the patient’s facial skin condition.
Conclusion: Medical aesthetic procedures for facial antiaging with EBDs integrating skincare or topical treatments may improve outcomes and patient satisfaction. Topical antioxidants and free radical quenchers can combat photodamage and may offer a safe alternative to topical hydroquinone.
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