SKIN REJUVENATION Renewing the remedies

Blinking lights and radio waves are the new frontier of skin rejuvenation.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
BOARDMAN -- The cutting edge of cosmetic facial and skin rejuvenation does not necessarily involve sharp metal instruments.
Treatments for sagging skin and wrinkles was, and for the most part still is, especially for the older population, a nip here, a tuck there, stitches, chemical peels and lasers.
But today's nonablative (nonsurgical) technology -- blinking lights (photo modulation) and radiofrequency waves, is the new frontier for many skin rejuvenation patients.
For a select group of people, particularly those in their late 30s and into their 40s (the aging baby boomers), nonablative techniques can be a less invasive way to chase away crows feet, eye bags and drooping eyelids, at least temporarily, said local plastic surgeon Dr. Richard D. Gentile.
Dr. Gentile is medical director of the Facial Plastic and Aesthetic Laser Center, with offices in Boardman, Howland and Akron. He specializes in facial cosmetic surgery. He doesn't do body or breast work.
"Nonablative treatments are very hot right now," said Dr. Gentile, who started using lasers in the 1990s for skin resurfacing.
Leader in the field
Also, Dr. Gentile, a member of the New Devices and Technology Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), began using Botox in the early 1990s. When Botox (botulinum toxin A), approved by the FDA in April 2002 for cosmetic use, is injected into the muscles surrounding the eyes, for instance, the muscles are paralyzed for a period of time (usually four to six months). That means they don't scrunch up, so wrinkles in that area are temporarily lessened.
Botox injections are the most requested cosmetic procedure in his practice as well as nationally, he said.
Dr. Gentile serves as chairman of publications for AAFPRS and oversees the academy's consumer newsletter and informational brochures about various procedures. As publications chairman and a member of the new devices and technology committee, he gets a first look at new technology.
"We have a chance to determine if new technology and devices are going to work, and get to review them for our patients before they are generally available," Dr. Gentile said.
He said many of the new products and procedures are aimed at reducing the pain of treatments and the downtime needed to heal.
"People are looking for endoscopic and minimal incision surgery," Dr. Gentile said.
Researching ventures
Other new products on the skin rejuvenation scene include dermal fillers, one of which is Artefill, which replaces collagen, the principal component of bone, skin and tendon. Artefill is being used in Europe and Canada, and Dr. Gentile believes it will be approved for use in the United States by the FDA next year. Another, Restylane, should be available by the end of the year, he said.
Also, he said, bio-engineered human collagens are becoming available, but they are pricey.
Midface research
In the surgical arena, Dr. Gentile said the midface is the hot area for facial rejuvenation work.
In the past, the typical face-lift most often involved the jowls and neck. However, during the past five years, the triangle under the eyes to the corners of the mouth -- the midface -- has been the area for surgical innovation and a more natural looking face-lift.
In August, Dr. Gentile will present his techniques for midface rejuvenation, in which tiny incisions are made inside the mouth to help elevate and smooth this area, at a national plastic surgery meeting in Newport Beach, Calif.
Another new and minimally invasive technique involves elevating the midface with several threads. The technique, known as the 72-hour face-lift, can be accomplished under local anesthesia, Dr. Gentile said.
Dr. Gentile said the most asked for procedures (besides Botox) in his practice are rhinoplasty (a nose job), eye lid surgery, and facial and skin rejuvenation procedures, as well as laser hair removal.
The major lure of nonablative treatments, besides being typically less expensive than surgery, is less downtime for healing, he said.
Casting doubt
But, Dr. Gentile is not totally sold on all the new technology.
Radio wave treatments include ablative and nonablative technologies, such as the Thermacool procedure. These newer nonablative skin radiofrequency treatments will be featured as nonsurgical face-lifts, Dr. Gentile said, even though they are skin treatments.
The early reports on nonablative skin radiofrequency treatments, according to Dr. Gentile, indicate that the results may not justify the investment for the procedures.
However, Dr. Gentile has combined the Erbium laser and Coblation, a technique he dubbed Erblation, which he plans to present at the fall meeting of AAFPRS, a specialty society of the American Medical Association (AMA).
Coblation, which stands for 'cold ablation,' uses radio frequency energy to remove tissue through a cooler process (150 degrees) than that of lasers. Coblation disintegrates tissue one layer at a time, giving the surgeon more precise control and causing less damage to adjacent healthy tissue, which results in a shorter healing process and fewer side effects.
Dr. Gentile said the advantage of his Erblation technique is it can produce skin rejuvenation without the degree of side effects or recovery time, which occur after some surgeries or laser treatments.
As a skin treatment, Erblation will not sufficiently elevate sagging tissue such as the neck and jowls, he said.
Nonablative radiofrequecy treatments are attempting to achieve that without the surgery, but the jury is still out for this new technology, Dr. Gentile said.
Light as a remedy
A recent addition to his practice, in the late '90s, was intense pulsed light (photo rejuvenation), which is used for skin rejuvenation and hair removal.
Like nonablative lasers, the skin is not damaged on the surface with these techniques, therefore the recovery is rapid. Also, he has purchased a new laser that specializes in tattoo removal and nonablative wrinkle reduction. The laser wave bypasses the outer layer of skin to act on interior layers. The wave length of the laser indicates how deeply it penetrates.
All skin improvement treatments involve an injury phase, followed by a healing phase that builds collagen, which temporarily fills in and reduces wrinkles. Nonablative lasers tend to stimulate collagen growth in the dermis, which leads to inside-out filling of wrinkles or acne scars, Dr. Gentile said.
"We treat the skin until it is mildly red, a condition which generally lasts only a few hours," he said.
The nonablative skin treatments are also effective for treating age spots and spider veins.
Dr. Gentile has been a member of AAFPRS since 1984 and was recently nominated for treasurer-elect of the society. If elected, he would serve on the board of directors and the executive committee for the aacademy.
Dr. Gentile is board certified in facial plastic and reconstructive surgery, otolaryngology and head and neck surgery, one of 12 such dual board certified surgeons in Ohio.
Dr. Gentile, a Struthers native, is a 1982 graduate of University of Cincinnati College of Medicine; he completed his residency at Baylor College of Medicine in Houston. He also earned a master's of business administration degree from Youngstown State University in 1991.
alcorn@vindy.com