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Facial Rejuventation
Facial Rejuventation
Ross J. VanAntwerp, DOLaser Center of MarylandRoss J. VanAntwerp, DOLaser Center of Maryland
Trends in Facial Rejuvenation
• Trends towards minimally invasive procedures
• Moving away from old fashion coronal facelifts
• More options on market
• Lasers
• Dermal fillers
• Neurotoxins
• Patients want less downtime (still want same results!)
Tell us about your goals
• Laxity?
• Vascularity and Redness?
• Sun Damage?
• Fine Lines and wrinkles?
• Scarring and Textural changes?
• No downtime
• 24 hours downtime
• 3-5 days
• 1 week or more
What do you wantto achieve?
Maximal Results Minimal Downtime
The Aging Face
• Facial shape changes over time. The triangle become inverted with increasing age
Layers of the Skinmicroscopic viewLayers of the Skinmicroscopic view
Epidermis: 5 layers
60-100 microns thick
Epidermis: 5 layers
60-100 microns thick
Papillary Dermisthin layer of collagen
100 microns thick
Papillary Dermisthin layer of collagen
100 microns thick
Reticular DermisDense Collagen
1000 microns
Reticular DermisDense Collagen
1000 microns
Stratum Corneum: 10 microns dead skin cells
Stratum Corneum: 10 microns dead skin cells
Model courtesy of Jared Mallalieu, DO.Model courtesy of Jared Mallalieu, DO.
What’s a wrinkle?
Lines and wrinkles are caused by collagen loss and sun damage and are improved with laser, neurotoxins, and
skin care
Folds are caused by volume loss and respond best to filler
Tell us about your goals
• Can treat variety of conditions
• Rhytids
• Dyschromia
• Rosacea
• Laxity
• Scarring - Acne and surgical
Lasers
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
UV PHOTO(After 20 then 30 micron
MicroLaser Peel)
UV PHOTO(After 20 then 30 micron
MicroLaser Peel)
Profractional(4 weeks after 3rd tx )
Profractional(4 weeks after 3rd tx )
Photos courtesy of G. Todd Bessinger, M.D. PhDPhotos courtesy of G. Todd Bessinger, M.D. PhD
Profractional & MLP(4 weeks after 2nd tx )Profractional & MLP(4 weeks after 2nd tx )
Photos courtesy Adam Baker, MD
Profractional(3 weeks after 2nd tx )
Profractional(3 weeks after 2nd tx )
Photos courtesy of G. Todd Bessinger, M.D. PhDPhotos courtesy of G. Todd Bessinger, M.D. PhD
Healing(20 micron MLP with 250 Pfxc)
Healing(20 micron MLP with 250 Pfxc)
Before &Immediately
After tx
Before &Immediately
After tx
Day 1 to Day 2
Day 1 to Day 2
Day 2 to Day 3
Day 2 to Day 3
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Mole RemovalMole RemovalPhotos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Mole RemovalMole RemovalPhotos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Fraxel RepairFraxel RepairPhotos courtesy of Ross VanAntwerp, D.O.Photos courtesy of Ross VanAntwerp, D.O.
Longevity(5yr. Post deep Resurface)
Longevity(5yr. Post deep Resurface)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
Photos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
SkinTyte - 4 weeks s/p 4 treatmentsSkinTyte - 4 weeks s/p 4 treatments
SkinTyte - 4 weeks s/p 4 treatmentsSkinTyte - 4 weeks s/p 4 treatmentsPhotos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
Adjuvant Surgical Procedures
• Can treat the submental region with single 3mm incision
• Two stage process
• Fat melting - 1064 nm
• Skin tightening - 1319 nm
Laser Assisted Liposuction
Blepharoplasty• Upper and lower procedures may be done at the same time
as other services
Adjuvant ProceduresLaser ASsisted Liposuctionwith SkinTyte 4 sessions
Adjuvant ProceduresLaser ASsisted Liposuctionwith SkinTyte 4 sessions
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
Laser ASsisted LiposuctionLaser ASsisted Liposuction
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
Laser Assisted Liposuction NeckLaser Assisted Liposuction NeckPhotos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
Laser Resurfacing with Upper and Lower Blepharoplasty
Laser Resurfacing with Upper and Lower Blepharoplasty
Photos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
Dermal Fillers
• Minimal downtime - “liquid lift” and “lunchtime lift”
• Multiple Products on Market
• Hylauronic Acids - Juvaderm, Restylene, Belotaro etc
• laser 9-12 months
• Semi-permanent - Artefill (polymethylmethacrylate microspheres and bovine collagen
• lasts 2 plus years
• Sculptra (Poly L-lactic acid) - restores volume to face
Facial Fat and Bone
Lip Filler - Juvaderm 1ccLip Filler - Juvaderm 1cc
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
NLF - 2cc fillerNLF - 2cc filler
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
Filler - Sculptra 3 sessionswith Profractional Laser
Filler - Sculptra 3 sessionswith Profractional Laser
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
Argyria
• Case of a 25 year old Russian male who had previously taken elemental silver as dietary supplement
• Skin and mucous membranes develop blue discoloration
• Treated with Q switch 1064 nm laser
Treatment of ArgyriaTreatment of Argyria
Photos courtesy of Ross J. VanAntwerp, DO.Photos courtesy of Ross J. VanAntwerp, DO.