الفهرس 
Rejuvenation: an overviewOnly 14 pages are availabe for public view
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Abstract
In the last few decades, there has been a substantial increase in the expected age of people over 60 years of age. Most of them maintain a good general health and physical activity and fitness. For these individuals there is a good number of dermatologic procedures, medications, and cosmetics that can be prescribed to improve the aspect of skin aging, providing an improvement in their self-esteem and quality of life as a result of their better look.
Human skin, like all other organs, undergoes aging. There are two main processes of skin aging: intrinsic and extrinsic. Intrinsic aging (chronological aging) refers to those processes that result purely from the passage of time. It reflects the genetic background of an individual. It is inevitable; thus, it is beyond voluntary control. These effects start to become visible around age of 30 to 35 years. While Extrinsic aging (photoaging) is primarily due to the effects of environmental ultraviolet radiation (UVR) and other external factors such as smoking, exces¬sive use of alcohol, poor nutrition.
Sun exposure is the most important factor causing extrinsic aging of the skin, hence the name photoaging. This process is not inevitable and refers to premature skin aging. It has been said that 80 % of facial aging is attributa¬ble to sun exposure.
Although primarily photoaging is an aesthetic problem with significant psychological effects, it constitutes the background for the development of precancerous and cancerous skin lesions.
Solar damage of the skin leads to epidermal abnormalities, such as lentigenes, actinic keratoses, and the degeneration of collagen, which results in the formation of rhytids and telangiectasias.
Although there are many treatments available for aged skin, prevention is still paramount and should be emphasized to all patients.
To struggle against skin aging, the first of all is to prevent it by means of an efficient photoprotection using sunscreens to block or reduce skin exposure to UV radiation, an adequate general life style and preventive treatments as retinoids to inhibit collagenase synthesis and to promote collagen production combined with antioxidants to reduce and neutralize free radicals.
A variety of different treatments have been used for the rejuvenation of sundamaged skin, including topical retinoids, bleaching agents, chemical peeling, dermabrasion, lasers, In¬tense pulsed light, photodynamic therapy, radiofrequency, infrared light, mesotherapy, botox, fillers, facelift and the recent entry of plasma technology.
Skin Regeneration is based on the idea of damaging the skin in a controlled manner triggering the healing response, which eventually leads to skin remodeling and improvement in various signs of aging with a more tight skin and better organized, younger dermal matrix.
Both ablative and nonablative resurfacing have been reported as solutions for photoaging, the former providing excellent results, but has a long patient downtime, and the latter giving little or no downtime, but less than ideal results.
In recent years, much research has been done in the field of non-ablative skin rejuvenation. That came as a response to the continuous demand for a simple method of treating rhytides, UV exposure, and acne scars.
The physician has an important role in understanding which treatment options are appropriate for mild, moderate, and severe photoaging, and in educating patients on the risks and benefits of each.
Plasma skin regeneration (PSR) is an exciting new device that allows for both ablative and non-ablative treatment of facial photodamage rapidly and safely within few minutes for full face regeneration.
Carbon dioxide (CO2) laser resurfacing which is considerd the gold standard treatment of facial rhytides has decreased in popularity due to the high morbidity and downtime associated with its use. It has significant side effects such as scarring and pigmentary alteration. Laser complications may also be transient: erythema, pruritus, milia formation, and acneiform pustules. Hypopigmentation rates may reach 16% and may worsen with time. This complication is permanent, the potential mechanism being a deep follicular melanocyte injury. Postoperative long-lasting erythema following laser treatment is a major drawback and is commonly responsible for the increased laser downtimes.
There is still a demand, however, for a technology that can provide the degree of improvement obtained with resurfacing without the complications associated with its use.
The ideal rejuvenation tool would therefore aims to avoid these side effects yet provide long-term benefit with a minimal postoperative recovery period and a rapid return to normal activities. Plasma skin regeneration (PSR) is an FDA approved device developed to be such a tool.
PSR technology uses energy delivered from plasma rather than light or radiofrequency. Plasma is the fourth state of matter in which electrons are stripped from atoms to form an ionized gas. The plasma is emitted in a millisecond pulse to deliver energy to target tissue upon contact without reliance on skin chromophores.
PSR is a novel method to rejuvenate the skin and has shown good results in the improvement of fine lines, textural irregularities, dyspigmentation, and acne scar. High-energy protocols (which are PSR2, PSR3) can offer the added benefit of skin tightening.
PSR has shown improvement of photodamaged skin and increased collagen production. It is safe and effective at inducing precise and chare-free skin de-epithelithation and neocollagenogenesis with minimal healing time and absence of scarring, hypopigmentation, discoloration, or other complications associated with other more aggressive anti-aging treatment
To date, there is no incidence of charring or pigmentary changes with any setting on the PSR. It has been found to be quite safe.
The depth of effect varies from superficial epidermal slough to deep dermal heating similar to CO2 laser but without tissue vaporization or wiping between passes so it differs from CO2 or Er:YAG laser, in that it does not produce explosive effect on tissue. It should be pointed out that PSR can be used to remove benign skin lesions with the same efficacy as CO2 laser but with lower complication.
PSR does not require a dedicated operating facility or specialized safety equipment, and will have significant cost savings compared to lasers.
The only equipment needed is the device itself. Other than using topical anesthetic, no special patient preparation is needed. There is no dye involved, and no eye protection is required in most instances.
Patients can apply topical anesthesia at home or at the office. The procedure is not as painful as regular resurfacing. Anyone who performs a lot of laser treatments is going to be very comfortable with the procedure. The technology is also a little more straight forward than for ablative lasers.
The handpiece is very simple and easy to manipulate around areas with complex contours.
PSR treatment doesn’t immediately ablate the skin; it leaves the skin intact for the first few days until around day 4 to 7 when the skin begins to desquamate. Higher energy treatments result in more immediate desquamation. Similar to a chemical peel, patients will have browned skin in the first couple of days. Patients look their worst between 2 and 5 days post treatment, and then they improve. PSR will offer more tightening than a chemical peel.
Another benefit is that the improvement seen after trearment sessions with PSR continues with time. The treatment has less risk, less downtime and is better tolerated than deep phenol peels.
Results from patho-histologic studies indicate that plasma treatment actually reorganizes and regenerates the skin architecture. The structure of the dermis improves. This happens through the course of time, as demonstrated by biopsy studies. Even up to one year there continues to be histologic improvement.
By the time the injured epidermis was ready to slough off; there was already a new epidermis that had grown beneath that barrier. The preservation of the epidermal layer on top of the thermally modified papillary dermis during the first 24–48 h post-procedure offers the same benefit as a biological dressing, with an associated improvement in healing time. This is absolutely unique and does not occur with any of the other resurfacing techniques, including CO2 or erbium.
PSR is cleared by the Food and Drug Administration (FDA) for the treatment of facial rhytides and superficial skin lesions. Clinical studies have been completed to support an application to the FDA for perioral, periorbital, and full face low and high fluency treatment of wrinkles and photodamage.
PSR is a promising tool in the field of rejuvenation. It improves fine lines, dyspigmentation, texture irregularities, with the added benefit of skin tightening with the high energy protocols. It is safe and no major side effects have been reported until now. It allows patients of skin types (l- IV) to have an effective treatment for facial and nonfacial rejuvenation with minimal impact on day-to-day activities. More studies are carried in the mean time to address the effects of PSR on higher-grade skin types (V, VI).