One of the most apparent manifestations of aging, of course, is seen in the skin. And where skin of older patients is concerned, some skin rejuvenation should be tailored to best treat conditions that often have multifactorial causes.
“The most basic therapy should necessarily include an anti-aging topical agent as retinoic acid or one of its derivatives,” says Marcia Ramos-e-Silva, M.D., Ph.D., associate professor and head, sector of dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro. Brazil, “And also a sunscreen," she continutes, "whether or not associated with an antioxidant substance.”
For more severe wrinkles, Dr. Ramos-e-Silva advises chemical peels of varied depths (depending on the degree of aging) or phototherapy application for rejuvenation (but no ablatives, as pulsed light or photodynamic therapy). She also notes very satisfactory results with botulin toxin, fillers and laser for rejuvenation.
“In Brazil, we rarely use high-power ablative lasers,” Dr. Ramos-e-Silva says, “First, because our population is very mixed and there is a high index of late irreversible hypochromia; and second, because there is a great rejection on the part of the patients when they see the post-surgical pictures with hypochromia or other adverse reactions.” Dr. Ramos-e-Silva says that another important issue is to effectively ask the patient what really most bothers him or her. The physician may look at the older patient, and just assume that the patient desires a specific procedure. “It is very common that what is an unaesthetic aspect of patient’s skin to the physician – an intense neck flaccidity, a completely folded chin, severe elastosis solaris – does not inconvenience the patient at all. But what he or she thinks is ugly is something very discrete to the physician, such as a fallen tip of the nose, caused by the intrinsic aging.”
It’s also important to consider the patient’s type of professional and/or social activities, Dr. Ramos-e-Silva points out. Find out the patient’s tolerance for down-time, and be sure that he or she understands what type of down-time or healing timeframe to expect from any particular treatment. Just as with the younger patient subset, an older patient who wants results with the absolute minimum down-time is a candidate for certain procedures and not others. For instance, for a person with a very intense photo-aged skin and some degree of flaccidity with wrinkles, if only botulinic toxin and fillers are used, without having a relatively aggressive treatment for the photo-aged skin, the patient may not realize the most benefit.
When determining what treatment modality is best suited towards a particular older patient’s skin, Dr. Ramos-e-Silva says it’s most important to, “Differentiate the predominant type of the patient’s skin aging; in other words, is there prevalence of extrinsic aging (represented mainly by the action of the sun) or is there is more intrinsic aging? If the physician does not pay attention to these items,” when considering treatment modalities, she says, chances are that the patient will probably be unhappy with the end result. CST
