Facial skin rejuvenation is the use of medications, procedures or surgery to restore the appearance of skin damaged by factors such as inflammatory skin disorders (e.g., acne), aging and exposure to the sun. Sometimes, a combination of treatments is used to help reduce wrinkles and sun spots, tighten loose skin, improve skin texture and color, remove blotches or damaged blood vessels, and lessen the appearance of minor scars.

Several categories of facial skin rejuvenation are available to patients. These include products applied to the skin surface (topical), soft tissue fillers, botulinum toxin, chemical peels, dermabrasion, microdermabrasion, lasers, intense pulse light (IPL), surgical excision and liposuction.

A physician will consult with a patient to determine which of these techniques is most likely to effectively achieve facial skin rejuvenation. Factors that will be considered when making a decision include the patient's skin type, the type of damage that has occurred and treatment goals. In some cases, a combination of techniques may produce better results than using a single approach.

According to the American Society of Plastic Surgeons, which tracks cosmetic facial procedures, there is a steady increase in these kinds of procedures as the Baby Boom generation ages. This increase is happening among both men and women.

Facial skin rejuvenation is the use of techniques designed to restore damaged skin to a youthful, healthier-looking appearance. It may involve medications, procedures, surgery or a combination of these treatments, and is used to repair damage caused by factors such as illness, aging and exposure to the sun.

The skin is the largest organ in the body. Over time, the skin fibers that keep the skin taut - collagen and elastin - weaken as a combination of gravity and internal and external factors pull the skin downward. In addition, years of exposure to the sun can create superficial blemishes that become more pronounced with time, and disorders such as acne can cause scarring that is cosmetically unappealing.

Dermatologists and dermatologic surgeons use facial skin rejuvenation to combat this deterioration and improve the skin's general appearance. Different techniques may be performed depending on the condition to be treated. A person's skin type is a critical factor in determining which procedure can best restore facial skin health.

Facial skin rejuvenation can help reduce wrinkles and sun spots, tighten loose skin, improve skin texture and color, remove blotches or damaged blood vessels, and lessen the appearance of minor scars. Over the years, advances have helped make such procedures less invasive and safer, and they are steadily increasing in popularity. According to the American Society of Plastic Surgeons, in 2007, there was:

• A 14 percent increase in facelifts
  
  
• A 14 percent increase in botulinum toxin treatments among women and a 4 percent increase among men
  
  
• A 123 percent increase in filler treatments with calcium hydroxylapatite among women and a 134 percent increase among men
  
  
• A 32 percent increase in laser resurfacing for men and women
  
  

Although women still comprise the vast majority of facial rejuvenation patients, procedures among men and women are both increasing rapidly. Because these procedures are usually elective, they are rarely covered by insurance plans.

There are several main categories of facial skin rejuvenation, including:

• Topical products. These are drugs or cosmetics that are applied to the skin. They usually are used to treat fine lines, superficial wrinkles and other milder signs of aging. Some topicals can also be used to prevent skin damage or to reduce or delay the need for other procedures. Topical medications include tretinoin (a substance within the vitamin A family), alpha-hydroxy acids (derived from fruit and dairy products) and topical antioxidants (including vitamins C and E).
  
  
• Fillers. Soft tissue fillers are used to elevate facial furrows and hollows, reduce wrinkles and give the skin a smoother appearance. They are especially effective when used around the lips and mouth and for correcting depressions and scars. Substances used for this purpose include bovine collagen (fibrous protein substance derived from cows), fat removed from another part of the patient's body, hyaluronic acid derivatives, calcium hydroxylapatite, poly-L-lactic acid (PLLA), polymethylmethacrylate (PMMA), and silicone and polymer implants. Results from these procedures may last from several months to several years, depending on which filler was used. Some products may result in permanent changes.
  
  
• Botulinum toxin. This agent, a purified version of the bacteria that cause botulism food poisoning, can be safely injected in tiny amounts into individual muscles to create a nerve block that relaxes that muscle's movement. Botulinum toxin is used to treat lines and wrinkles associated with facial expression. The Food and Drug Administration (FDA) approved use of this product for glabellar wrinkles, or wrinkles between the eyebrows. However, many dermatologists and plastic surgeons also routinely treat other areas, such as forehead lines or crow's feet around the eyes, safely. Botulinum toxin also may be used to relax muscle bands that may be visible in the neck. Treatment results typically last for three to four months.
  
  
• Chemical peels. Chemical solutions such as alpha-hydroxy acids, trichloroacetic acid and glycolic acid may be applied to remove outer layers of aged, discolored or irregular skin. Depending on the specific type and concentration of the acid used, the skin exfoliates or peels over a period of days, leaving behind new skin that is smoother, has fewer wrinkles and is more even in color. Chemical peels are often used to treat wrinkles around the eyes and mouth, skin discoloration, age spots, mild acne scars and dull skin. They may range from mild peels (for fine lines and wrinkles) to medium-depth peels (for moderate skin damage, such as age spots, freckles and precancerous growths such as actinic keratoses). Chemical peels cannot remove deeper scars.
  
  
• Dermabrasion (or dermaplaning). Resurfacing procedure in which skin is mechanically "sanded" with an abrasive instrument, such as a rapidly rotating brush. This removes outer skin layers and smoothes the skin overall. It is used to treat significant scarring, including acne scarring, pigmentation and sun damage. Although healing time may take several weeks, results are often impressive and long-lasting. These procedures can be performed under local anesthesia or general anesthesia, depending on how much skin will be treated.
  
  
• Microdermabrasion. A technique similar to dermabrasion that uses either micro-particles or a diamond-tipped wand to remove part of the top skin layer (epidermis). This helps stimulate proteins involved in cell differentiation and growth. Key advantages of microdermabrasion are that it is noninvasive, does not require anesthesia and creates little or no discomfort. In addition, it does not require significant recovery time. It is usually performed in several treatment sessions, two or three weeks apart.
  
  
• Lasers. Used to remove layers of skin with laser light energy. Lasers work by creating an intense beam of light that travels in one direction. They may be either ablative (remove the top layer of skin) or nonablative (treat layers beneath the surface layer). Lasers are used to vaporize or improve wrinkles, scars, skin discoloration, broken blood vessels and precancerous skin growths. Lasers also may be used to treat lines and blemishes on the neck and to improve folds and creases by tightening loose skin. Finally, lasers often enhance other treatments, such as chemical peels, liposuction of the face and neck, and blepharoplasty (eyelid surgery).
  
  
• Intense pulse light (IPL). Makes use of broad-spectrum light that filters out harmful wavelengths. It is used to treat vascular (blood vessels) lesions and problems involving texture, pigmentation and pore size. IPL is often combined with techniques such as microdermabrasion or botulinum toxin.
  
  
• Light-emitting devices (LED). Makes use of light, delivered through light-emitting diodes (LEDs), to activate skin cell receptors, stimulating them to produce new collagen and elastin. It is used to treat fine lines, hyperpigmented lesions (brown spots and freckles) and other skin problems associated with sun damage. LED is often combined with other facial rejuvenation treatments such as botulinum toxin, dermal fillers and nonablative laser, IPL and photodynamic therapies.
  
  
• Radiofrequency technology. Using radiofrequency waves, these noninvasive techniques result in skin contraction and tightening that can lead to lifting of the face, brow and cheeks without surgery or a prolonged recovery time.
  
  
• Photodynamic therapy. Involves the application of a topical medication called 5-aminolevulinic acid (ALA) to the skin. ALA is left on the skin for a specified period of time. The area is then treated with colored light (blue, yellow or red) using LED, IPL or a pulsated dye laser. Photodynamic therapy also can effectively treat early precancerous changes of the skin.
  
  
• Surgical excision. Removal of tissue using a scalpel or other sharp instrument. Excision may be used to remove moles, scars and benign (noncancerous) skin growths that enlarge with aging. Surgical excision may also be used to treat droopy eyelids by removing excess fat pads and skin (blepharoplasty), reduce severe lines in the forehead, raise the eyebrows (browlift), and tighten and trim excess skin on the cheeks, chin, neck and around the mouth (rhytidectomy, or facelift).
  
  
• Liposuction. Surgical removal of local fat deposits by applying suction through a small tube inserted into the body. Liposuction can be used to remove excess fat and improve the contour of the face and neck areas. Local anesthetic is often used in liposuction procedures.
  
  
• Neck and jowl treatments. Many different techniques may be used alone or in combination to treat problems such as sagging jowls or double chins. Techniques include chemical peels, botulinum toxin therapy, laser resurfacing, liposuction, radiofrequency procedures and neck lifting.

The choice of technique used to treat a patient may vary depending on several factors. A patient's skin type and treatment goals are important factors in determining which technique is best. In some cases, a combination of techniques may produce improved results.

Patients who are considering facial skin rejuvenation will consult with a physician to discuss various aspects of the procedure. It is important to search for a qualified dermatologist who has experience performing facial skin rejuvenation. In some states, no medical license is required to perform some procedures, such as chemical peels and lasers. However, this is not advised, and patients should seek out licensed and experienced physicians.

Dermatologists are skilled in the use of a wide variety of surgical and nonsurgical methods of treating skin conditions. As a result, they will be able to recommend a procedure based on:

• Type of skin condition being treated
• Location of the skin being treated
• Degree of damage
• Patient's skin type
• Patient's treatment goals
• Time required for recovery
• Patient's age
• Patient's medical history

Prior to the procedure, patients should follow any preparatory advice recommended by their physician. This may include dietary restrictions and changes in medication regimen. The choice of technique will dictate how the procedure unfolds. Some procedures, such as botulinum toxin injections and others that may take place in a physician's office, can be completed in as little as 30 minutes without the use of anesthetics. However, more invasive surgical procedures (e.g., eyelid surgery) may require use of anesthetics and a brief hospital stay.

Recovery time for facial skin rejuvenation varies significantly, depending on the technique used to treat patients. Many techniques - such as soft tissue filler and botulinum toxin injections, microdermabrasion and some laser and intense pulse light (IPL) treatments - require no recovery time. Most invasive procedures can require between several days to weeks of recovery time. Patients will be asked to avoid sun exposure while healing and limit exposure once healed to maintain the results of the procedure.

In most cases, patients will feel no significant pain as a result of the procedure. Minor discomfort may occur, however, in addition to mild redness and swelling. In many cases, repeat procedures will be necessary at some point to maintain the restorative effect achieved during the initial procedure.

Facial skin rejuvenation is generally safe, and new surgical techniques and technological advances have made surgical procedures less risky. However, there are risks associated with any type of treatment, especially surgery. Side effects may include:

• Mild redness
• Inflammation
• Discomfort
• Sun sensitivity months or years after treatment

More significant side effects also may occur, especially when more invasive procedures are used. These may include:

• Scarring
• Persistent redness
• Permanent pigment changes

Processes such as chemical peels and dermabrasion sometimes cause reddening and peeling of the face that is similar to a sunburn. This typically lasts from a few days to several weeks, depending on the strength of the solution used and the depth of the skin peel in chemical peels, or the amount of skin surface removed in dermabrasion. Medications may be prescribed to reduce discomfort or prevent infection, and patients will be advised to remain out of the sun until the new skin is ready for such exposure.

Strong chemical peels can also produce significant swelling, even sometimes causing the patient's eyes to swell shut. Patients with this type of chemical peel might be placed on a liquid diet for a day or two and advised to stay at home until the swelling subsides.

It may take several days for the swelling to subside and/or the skin to peel. Use of emollients, ice and antihistamines are helpful. Avoidance of sun is of utmost importance, as the peeling skin will be damaged and possibly hyperpigment with exposure.

Current facial skin rejuvenation is being refined, and research into new techniques is ongoing. Several methods that show promise as tools for facial skin rejuvenation have been identified. These include:

• Coblation. Use of micro-electrical radio frequency to remove precise amounts of tissue. It involves using cold electrical energy, which helps minimize any potential skin damage.
  
  
• Laser treatments. Research is continuing into nonablative lasers (that work beneath the surface skin layer to stimulate collagen growth and tighten skin) including the mechanisms by which they work. New kinds of lasers are being refined for use in treatment of serious skin disorders (e.g., psoriasis).

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about facial skin rejuvenation:

1. Am I a candidate for facial skin rejuvenation?
   
   
2. Which technique is best for my condition? Why?
   
   
3. Are you qualified to perform facial skin rejuvenation techniques, or should I seek another physician?
   
   
4. Is it possible that I will benefit from more than one technique?
   
   
5. How much pain will I experience?
   
   
6. How long will my recovery take?
   
   
7. Will I have to avoid exposure to the sun? If so, for how long?
   
   
8. What risks do I face by undergoing facial skin rejuvenation?
   
   
9. What type of results should I expect?
   
   
10. Will I have to undergo the procedure more than once?
    
    
11. Does my insurance cover facial skin rejuvenation?