• #12-1. Wrinkle Treatment



    In this article, we will take a look at the latest treatment techniques used in wrinkle removal. Some parts of this article may overlap with the previous ones on lifting and tightening procedures but we will try to keep our focus on local treatment of wrinkles.


    Wrinkle removal procedures largely consist of injections and device treatments. A great variety of treatments are being used around the world. As it would be difficult to list all these methods, we will focus on the treatment options that have become available in Japan in the recent decades.


    Treatments using photomedical devices have limited efficacy. Expression wrinkles or deep wrinkles with sagging tissues may not respond to these treatments. Laser has been empirically shown to reduce or remove wrinkles. It was found that laser used in one side of the face to treat Ota’s nevus or hemangioma in elderly patients unexpectedly smoothed wrinkles in the treated side of the face.


    This may have been due to the existence of chromophores such as melanin and hemoglobin that allowed collagen remodeling through thermal damage from laser. As the treatment used strong parameters, the improvement was drastic. Normal skin lacks such targets for laser but may still experience limited improvement. Targeting water, which exists in greater abundance than melanin or hemoglobin, may also bring a good outcome.


    Traditionally, CO2 laser was used in wrinkle removal. However, CO2 laser causes long-term erythema, pigmented lesions and texture change in the Japanese population (not in Caucasians). For these reasons, CO2 laser is rarely used in Japan. The Er:YAG laser was introduced in Japan but it did not become popular due to downtime. In Japan, non-invasive methods are favored over invasive options.


    In 2000, new treatments using Cool Touch and N-Lite were introduced. Cool Touch uses 1320mm near infrared light to induce strong thermal action in the dermis, while protecting the epidermis with cooling. This promotes collagen remodeling. Afterwards, the 1450mm Smooth Beam and 1540mm Alamis, which have similar mechanisms of action, entered the market.


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    N-lite is a dye laser. It does not use heat but stimulates blood vessels to release cytokines to indirectly remove wrinkles. This product is no longer available and Vbeam (most popular dye laser in Japan) has replaced it. However, Vbeam is mainly indicated for hemangioma and other skin diseases and only a few doctors are applying it in wrinkle removal. However, non-invasive photomedical treatments came to fall out of favor with many doctors due to their limited efficacy.


    The Nd:YAG laser is still being widely used in wrinkle removal procedures. In the beginning, laser resurfacing with Q-switched Nd:YAG laser was used in the overall face to increase elasticity. Then, the long pulsed Nd:YAG laser (pulse duration of 0.3~0.4msec) given 4,000 shots over the entire face became popular in Japan. As it was painless, this treatment was more widely accepted among Japanese patients. Despite its minimal efficacy, many patients still seek the treatment. 


    -To be continued.

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