Minimally Invasive Percutaneous Collagen Induction

We live in a time when more people are living to a greater age than ever before. At the same time, there is an accent on youth such that our patients are asking us to make them look as young as possible. Obviously, surgery helps restructure the face into a more youthful shape, but the old skin remains. Today, many patients come before they need surgery, searching for a rapid solution that will make them look 10 years younger. How do we help our older cosmetic patients or the much younger men and women who want to prolong their tenure in a youthful bracket? This quest for younger-looking skin has spawned many different topical techniques that share the same principle of damaging the skin to cause fibrosis. The fibrosis then causes tightening of the skin. Historically, skin peels were the first method of skin rejuvenation. The principle of peeling is to destroy the epidermis partially or almost completely to damage the fibroblasts and dermal structures. This damage then sets up an inflammatory response proportional to the damage, which results in the deposition of collagen. Peeling sacrifices the epidermis to achieve the desired result. The experience with partial-depth burns misled many into believing that the epidermis is a self-renewing organ that rapidly grows over the damaged area, which is why peels became progressively more destructive for the epidermis (eg, the deep phenol peel) until the accumulated problems forced clinicians to recognize that smoother skin comes at a very heavy price for many patients and also leads to a significant thinning of the skin many years later. The proponents of peeling looked only at the increase of collagen in the papillary and reticular dermis but did not pay any attention to the epidermis. The epidermis suffered by becoming less undulating due to the destruction of the dermal papillae and subsequent impaired nourishment and, in turn resulted in a thinner epidermis with fewer cells in the stratum spinosum than before treatment. The stratum corneum is then less likely to act as an efficient barrier, so it is not surprising that many patients feel that their skin is too dry for years after the treatment. Consequently, hydration of the dermis also is affected.