The demand for safe, long-lasting, and effective hair reduction for aesthetic as well as medical indications is on the rise. A variety of options for hair removal are available, such as epilation by plucking or waxing, depilation by shaving, chemical depilatories, electrolysis, eflornithine cream, and laser, Diode and intense pulsed light (IPL) systems.
Lasers for skin treatment work on the theory of “selective photothermolysis.” This term implies a site-specific, thermally mediated injury of microscopic tissue targets by the selective absorption of pulses of radiation by the targets and the chromophores. The natural or artificial chromophores absorb monochromatic or broadband electromagnetic radiation of specific wavelengths. The chromophore employed in laser hair reduction is melanin. Melanin absorbs light in the range of 300 to 1200 nm, and lasers in this range of wavelengths can be effectively used for hair reduction.
The “extended theory of selective photothermolysis is a principle applied to laser photoablation. Melanin content is much higher in melanin-bearing structures like the hair shaft and matrix cells than in the hair follicle. Thus melanin captures energy from the laser and distributes it to the surrounding follicular structures. This results in the destruction of the hair matrix and hair bulge stem cells
Diode Laser (810 nm) – Penetrates deeper, delivers better fluence, less epidermal damage, safer in darker skin (skin types I-V)
Acne vulgaris is estimated to affect 60 million people in the India, the majority of whom are young adults. Acne has a prevalence of over 90 percent among adolescents and persists into adulthood in approximately 12 to 14 percent of cases, often with resultant psychological and social consequences. Key pathogenic factors that play an important role in the development of acne include follicular hyperkeratinization, microbial colonization, sebum production, and inflammatory mechanism. Contributing factors to acne development may include hormone levels, stress, family history, hair and skin products.
Current treatment options range from topical agents like benzoyl peroxide, antibiotics, and retinoids; laser and light therapy; mechanical disruption of sebaceous glands; to systemic therapy including oral antibiotics, hormonal therapy, and isotretinoin.
The HydraFacial Treatment uses its proprietary vortex technology in combination with topical solutions to cleanse and exfoliate oily and congested skin. Exfoliation and suction remove cellular, keratinized, and sebaceous debris from follicular orifices that act as a nidus for acne lesions
In a study conducted in UNITED STATES; Twenty eligible adult patients with mild-to-moderate acne were enrolled at one of two treatment sites and were to undergo six HydraFacial Clarifying Treatments, one every two weeks for 12 weeks. Treatment occurs in three steps: cleansing and peeling; suction to extract dead skin cells, sebum, and debris; and application of blue LED light. Acne severity was graded by investigators and by patients using the Global Acne Severity Score (GASS).
The proportion of patients with no acne or almost clear skin (GASS ≤1) at baseline versus final treatment increased from 20 to 65 percent per investigator assessment (p=0.0027), and from 5 to 55 percent per patient self-report (p=0.0016). At final treatment, more than 80 to 100 percent of both investigators and patients agreed or strongly agreed there was an improvement in skin appearance across multiple assessment parameters. Treatments were generally well tolerated
Chemoexfoliation, also known as chemical peeling, is a method of targeted cutaneous ablation using specific caustic agents that allow for rapid, predictable, and uniform thickness of chemoablation to a desired cutaneous depth, ultimately resulting in an improved appearance of skin. The goal of a chemical peel is to remove a predictable, uniform thickness of damaged skin, which subsequently allows for normal wound healing and skin rejuvenation to occur, while simultaneously minimizing complications, such as scarring and unwanted pigmentary change. The caustic agents used for chemical peels cause controlled keratocoagulation and denaturation of the proteins within the epidermis and dermis.
Such targeted inflammation activates the normal healing signal cascade, including stimulation, development and deposition of new dermal collagen and elastin, reorganization of structural scaffold proteins and dermal connective tissue, and regeneration of new keratinocytes. This results in rejuvenation and thickening of the epidermis and an increase in dermal volume.
Chemical peels are divided into three categories, depending on the depth of the wound created by the peel. Superficial peels penetrate the epidermis only, medium-depth peels affect the entire epidermis and papillary dermis, and deep peels allow for controlled tissue injury to the level of the midreticular dermis (and sometimes subcutis, if not used properly)
Indications for treatment can be classified into four categories: chronic chrono- and photoaging, acne and acneiform eruptions, dyspigmentation, and pre-malignant epidermal neoplasms. Selection of agent type is determined by a number of factors, including treatment indication, desired depth of ablation, pertinent exam findings, Fitzpatrick skin type, and relevant dermatologic history of the patient. When used for the appropriate indication with the proper technique, nearly all peel solutions and depths have demonstrated excellent clinical success in improving skin tone and texture, and are cost-effective compared to invasive procedures.
Skin-whitening agents, either in topical, oral, or intravenous preparations, are widely available in markets. Glutathione, one of the skin-whitening agents in cosmetic industries, is an antioxidant commonly found in the human body. It is known that glutathione may promote pheomelanin synthesis, inhibit intracellular melanogenic enzymes, and demonstrate antioxidative as well as antiaging effects.
Glutathione, a small, water-soluble thiol-tripeptide with low-molecular weight, is made from three amino acids: glutamate, cysteine, and glycine. Glutathione is commonly found in two forms: reduced glutathione (GSH) and oxidized glutathione (GSSH). Its biological function serves as a potent antioxidant in human body.
Melanin, a skin pigment, consists of blackish-brown eumelanin and reddish-yellow pheomelanin. Higher pheomelanin proportion will make skin brighter. Hyperpigmentation is caused by the exposure to ultraviolet radiation, resulting in the formation of reactive oxygen and nitrogen species between cells. Oral antioxidants will reduce melanogenesis by suppressing those free radicals.
Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle with a usually characteristic pattern distribution of hair loss in genetically predisposed men and women. Individuals with higher genetic predisposition to hair loss, start losing their hair earlier and to a greater degree than those with a lesser predisposition. By the age of 25, approximately 20% of men will shows the signs of hair loss which increases to 75% by the age of 60 years. Of the 75% of men, about half of these will show significant hair loss at frontal and vertex region. AGA affects up to 80% of men and 40% of women. Hair loss in women occurs usually postmenopause, and they experience thinning of hair due to hair follicle’s genetic programming. PRP which is a 1st generation platelet concentrate, may act on the stem cells in the bulge area of the follicles, stimulating the development of new follicles, and promoting neovascularization. GFC is a 2nd generation platelet concentrate which is applied topically on scalp fibrin rich growth matrix which releases PDGF, transforming growth factor-β1 (TGF-β1) and β2 (TGF-β2), fibroblast growth factor (FGF), VEGF, brain-derived growth factor (BDGF) and insulin-like growth factor (IGF) stimulating cell proliferation, matrix remodeling and angiogenesis. Microneedling (MN) with platelet-rich plasma (PRP) therapy has been proven to improve the micro-circulation and thus improve hair growth.
Deepening of the nasolabial fold with reduced malar highlight caused by sagging of the midface is one of the most important characteristics of facial aging. The use of 18-G polydioxanone (PDO) cog threads improve midface soft tissue sagging and achieve satisfactory results through a minimally invasive procedure. As facial aging progresses, soft tissue ptosis occurs in every part of the face due to gravitational effects. Particularly in the case of the anterior cheek, which can signify youth, the downward migration of adipose tissue and volume can lead to a deeper-appearing nasolabial fold and an older-appearing face.
Thread lifting using PDO threads perfectly encompasses these recent trends. Unlike in conventional lifting surgery, general anesthesia is not necessary, and the surgeon can perform the procedure on the day of the patient’s visit to the clinic.
The operative time is less than 30 minutes. There are no postoperative complications, with the exception of mild bruising and swelling, which may last for up to 1 or 2 weeks, and there is almost no postoperative scarring.
In FUE, the extraction of intact follicular unit is dependent on the principle that the area of attachment of arrector muscle to the follicular unit is the tightest zone. Once this is made loose and separated from the surrounding dermis, the inferior segment can be extracted easily. Because the follicular unit is narrowest at the surface, one needs to use small micropunches of size 0.6–0.8 mm and therefore the resulting scar is too small to be recognised.
It is a sutureless method of hair restoration in which hair follicles are extracted from the back of head under local anaesthesia with the help of special micropunches and implanted in the bald area.
3 FORMS OF FUE TECNIQUE:-
ADVANTAGES OF FUE:-
Sunscreen is not needed during rainy, cloudy, cool days or cosmetics with SPF would protect us from the sun or sitting indoors by a window would not require sunscreen – all these are myths. Ultraviolet (UV) rays are causing the sun damage, not the temperature of the environment. Cosmetics with SPF 30 and above are better for prevention of sun damage, yet a separate sunscreen is required for extended period under the sun. Visible light, the portion of the electromagnetic spectrum that can be perceived by the human eye, is emitted by the sun and artificial sources like screens and light bulbs. Visible light penetrates much deeper into the skin than UV radiation, and is detrimental to the skin such as more noticeable, persistent hyperpigmentation.
There are three different types of UV rays: UVA, UVB and UVC. UVC is most insignificant as it does not reach earth’s ground. UVA’s intensity is constant in daylight. UVA rays can penetrate into the skin layers triggering skin ageing. UVB rays affect the epidermis which contributes to your sunburn and skin reddening. UVB intensity varies with the season, temperature and altitudes.
Difference between chemical and physical sunscreens is the method on blocking off UV rays. To help patients understand better, physical sunscreen acts as a shield while chemical sunscreen acts as a sponge. Physical Sunscreen (ingredients are zinc oxide and titanium dioxide) have small particles that rest on the epidermis and physically preventing UV rays from penetrating into the skin. Chemical sunscreen (the AAD lists oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate) allows UV to penetrate into skin with organic compounds that catalyze a chemical reaction where light converts to heat, thereafter dissipates from the skin.
Tinted sunscreens combination of broad-spectrum physical UV filters with added pigments, pigmentary titanium dioxides and iron oxides, makes the visible, skin-tone color that reflects visible light rays. The colored base of tinted sunscreens is a mixture of red, black and yellow iron oxides with pigmentary titanium dioxide. Tinted sunscreens are known to reduce hyperpigmentation and production of melasma which is due to this key ingredient: iron oxide.
5 Recommendation tips for tinted sunscreen:
Melasma is a common skin problem caused by brown to gray-brown patches on the face. Most people get it on their cheeks, chin, nose bridge, forehead, and above the upper lip. It is more common in women than men. Pregnancy is a common cause of melasma. It also affects woman taking oral contraceptives and hormones. This activity reviews the evaluation of melasma and highlights the role of the interprofessional team in managing patients with this condition.
Etiologic factors include genetic influences, ultraviolet (UV) radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications.
Melasma stimulates melanocytes by the female sex hormones estrogen and progesterone, producing more melanin pigments when the skin is exposed to the sun.
Genetic
Genetic predisposition may be a major factor in the development of melasma.
Sunlight Exposure
UV radiation can cause lipids peroxidation in cellular membranes, resulting in free radicals which could stimulate melanocytes to produce excess melanin.
Hormonal Influences
Hormones may play a role in developing melasma in some individuals.
Thyroid Disease
There is a four-fold increase in thyroid disease in melasma patients.
The best treatment is a topical combination of hydroquinone cream and avoidance of sun or estrogen exposure. In addition to the avoidance of sun exposure, discontinuing the use of high-SPF sunscreens (50 or higher) can prevent the development of melasma. First-line therapy for melasma consists of effective topical therapies, mainly in the form of triple combinations (hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%) and when triple combinations are unavailable or when patients have hypersensitivity to them, then dual ingredients or single agents be considered.
Skin Peels: Peels use glycolic or salicylic acid-based compounds which may increase turnover of hyperpigmented keratinocytes.
Lasers
The efficacy of lasers for the treatment of melasma has been associated with cosmetic results. Their use should be considered in cases of extensive disease
Chemical peeling, or chemical exfoliation, involves applying a chemical substance to the skin, intentionally causing controlled epidermal damage with or without affecting the dermis. This controlled damage prompts skin regeneration and remodeling, thereby improving overall skin appearance and texture. Skin resurfacing with a chemical peel can restore a youthful appearance of the aging face, neck, and hands while addressing medical conditions such as acne and actinic keratosis. Chemical peels are of various types—each with a unique pH level, application method, time, and associated risks and complications. A comprehensive understanding of appropriate patient selection, peel choice, and contraindications, as well as associated risks and potential complications, is imperative before administering chemical peels to individuals. This topic delves into patient selection, evaluation, and the supervision of individuals undergoing chemical peeling while highlighting the integral role of the interprofessional team in enhancing the overall patient care undergoing this procedure.
Chemical peels are typically categorized based on their depth of skin penetration, which can range from light to medium to deep. Several factors, including pH and concentration, application technique, and the patient’s skin condition and sensitivity, influence the extent of the therapeutic effects.
The diagnosis of Androgenetic Alopecia (AGA) is usually based on the history and on clinical findings. The duration and location of hair loss are important factors to consider, as well as whether shedding or thinning has occurred. In patients with increased shedding or thinning, a thorough evaluation of potential triggers for telogen effluvium (TE) should be done (e.g., new medications, systemic illness, weight loss, general anesthesia). The provider should review the patient’s medical and family history, medications, basic labs [e.g., thyroid stimulating hormone (TSH), complete blood count (CBC), iron, ferritin, vitamin D], and gynecologic history (for women) to rule out other causes of hair loss.
The clinical evaluation for patients with suspected AGA involves establishing where the hair loss is occurring, the extent of shedding, and if there are signs of inflammation (perifollicular erythema and/or scale). The severity of hair shedding can be determined by the pull test. This is done by grasping 40–60 strands of hair between the thumb and the forefinger and applying gentle traction away from the scalp. Extraction of three or fewer hair strands from a single area is considered a negative or normal pull test and extraction of six or more is considered a positive pull test. Trichoscopy is helpful in determining the specific type of hair loss and whether perifollicular erythema and/or scale are present. The earliest and diagnostic feature of AGA is a hair shaft diameter variation of more than 20% of the hair shafts. In addition, there is an increased proportion of vellus hairs. Yellow dots may also be present in severe AGA representing hypertrophied sebaceous glands.
Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.
Essential questions to determine candidacy
Caveats to avoid Misdiagnsosis
For all patients:
In each consultation, get a thorough current and past medical history to identify any conditions that could be contributing to hair loss or which could impact on surgery. A detailed history of the development and character of the hair loss must be obtained. When did the hair loss start? Is it now stable or worsening slowly or rapidly? Is there a family history of hair loss; if so, who and what patterns? What treatments have been used? Diagnoses by other doctors who were consulted.
Examine the entire scalp thoroughly. This means combing through the whole scalp while looking at the condition of the scalp and quality and density of the hair. During this examination, pay attention to miniaturization of hair (which is the hallmark of PHL), variations in density, scaling or redness of the scalp, and loss of follicular ostia and shininess. Is there gross evidence of hair loss? Note the degree of loss for each location. Is the loss patchy? Diffuse?
Routinely use dermascopy/densitometry in both the recipient and donor areas to determine density and the degree of miniaturization, percentage of loss density, and further characterize any scalp findings.
Hair of 60 to 65 microns is considered fine hair, 65- 80 microns is considered medium hair, and greater than 80 microns is considered coarse hair. Less than 60 follicular units (FUs)/cm 2 in the donor region is considered low density.
If this examination shows only findings consistent with PHL, if the donor area is of good density and condition, and if the there are areas of sufficiently developed balding, hair transplantation can be undertaken.
On the other hand, if there are scalp findings or unusual patterns of hair loss and/or miniaturization in the donor area, further evaluation is needed before undertaking transplantation. This means possible biopsy and dermatology consultation.