Skin Analysis

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At your first consultation with the patient you should carefully notice:

  1. The overall colour of the skin. This will give you a good idea of the care against photoageing that the patient is taking. All of these signs will respond to competent skin care combined with intensive treatments to enhance penetration through the skin. At times it may be necessary to employ serial light peels.
  2. Are they excessively tanned or too pale?
  3. Are there pigmentary blemishes? Check if the patient has been on hydroquinone, which tends to cause secondary, aggressive melanosis that is very difficult to treat. Advise patients not to use hydroquinone.
  4. Check the texture of the cheek skin to the side of the nose to see if the "pores" are dilated.
  5. Is the submental area hypopigmented?
  6. Does the patient have poikilodermia of Cervat?
  7. Is there telangiectasia on the cheeks?
  8. Is there rosacea?
  9. The general elasticity of the face skin.
  10. Is the skin thick and firm or is it thin and does it stretch easily? If it is thin and has poor recoil, then intensive skin care will be required and also collagen induction therapy (CIT) [2].
  11. Are there wrinkles around the eyes? Are they there permanently even when the face is in repose? A blepharoplasty will not suffice to correct these. (Fig. 62.6).
  • Are they light or deep wrinkles? Light wrinkles may respond to skin care alone, or may need iontophoresis and sonophoresis treatments. Serial light peels, using low-dose trichloracetic acid (TCA) in the region of 2.55%, are also very useful. Deep wrinkles around the eyes will need intensive CIT [3].
  • Are there radiating wrinkles through the eyebrows? These are usually only found with significant depletion of collagen, and there is reduced subreticular fat even though the skin may feel thick. This will not improve significantly with skin care alone. CIT is definitely required. Hormonal therapy may also be required.
  1. Are there "crisscross" wrinkles on the cheeks (which indicate more severe photodamage)? This will require intensive skin care treatments and can be alleviated with iontophoresis and so-nophoresis.
  2. Are there wrinkles on the chin? This is found with severe sun damage and usually also indicates some degree of hormonal insufficiency. This will respond slowly to skin care, intensive treatments and CIT.

Fig. 62.3. a One year after a full face- and neck-lift. The loss of elasticity is due to photoageing and cannot be corrected by surgery. b One month after the patient had completed 24 treatments of iontophoresis and low-frequency sonophoresis (The Environ DF IONZYME machine for pulsed iontophoresis and low-frequency sonophoresis was used. The products used were Environ Crystal Masque and Environ C-Quel. Home treatment was with Environ Ionzyme C-Quence.) of vitamins A and C in conjunction with daily topical applications off vitamin A, vitamin C and antioxidants. c Five years later showing that the result could be maintained by daily skin care (Environ Ionzyme C-Quence and Crème 2001) and eight to ten iontophoresis and sonophoresis treatments a year done at about monthly intervals. The change in the elasticity of the skin is not temporary owing to swelling, etc. No surgery or other intervention was done between a and c

  1. Are there signs of elastosis in the lower neck and décolleté? It is good to get an impression of the concentration of the elastotic nodules prior to treatment and surgery. Surgery will not improve this. Intensive skin care, however, will make a big difference. Are there fine vertical skin creases especially below the laryngeal cartilage? In severe cases the combination of skin care with iontophoresis and sonophoresis can at times yield stunning results (Fig. 62.3).
  2. These changes are not of short duration but with maintenance treatments, the skin can be kept smoother for many years after the initial course of treatment.
  3. The presence of lines on the upper lip will give you an idea of the hormonal nourishment of the skin. Check the lip vermilion to see if it is smooth or creased by radiating lines as well as transverse lines, which indicate severe tissue loss which cannot be corrected by simple skin care. Besides tissue augmentation, the best result will probably require percutaneous CIT of the lip skin.
  4. Look for actinic keratoses, skin cancers.

By looking carefully at the skin you will be able to determine the degree of photoageing and intrinsic ageing so that you can work out the best skin care for that patient.

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5 Common Skin Problems Answered

5 Common Skin Problems Answered

Our skin may just feel like a mere shield that protects us from the world outside. But, the fact is, its more than just the mask that keeps your insides in. It is a very unique and remarkable complex organ that reflects our general health.

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