Index of Photoaging

Posted Thursday, September 13, 2007 to INDUSTRY > Medical Devices

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Birmingham dermatologist & cosmetic surgeon Gary Monheit MD talks to Jodi Thiessen about recognizing and treating sun damage.

We often hear the words "sun damage" and "photo-aging" thrown around as a blanket term to describe every facial youth-diminishing problem. But what are these problems specifically and individually? To treat "sun damage" we first must know what it is composed of.

Often cosmetic surgeons are confronted with patients complaining about their aging face, who don't specifically know what it is they don't like. Dermatologist and cosmetic surgeon Dr Gary Monheit helps such patients to recognize any sun damage they may have. To understand the treatments for their individual problems he devised an Index of Photoaging.

This index divides damage created by the sun into two categories: Texture Changes and Surface Changes (or lesions). Then each into sub-categories made up of specific problems that can exist on the face. "We use the index during the consultation because it answers a number of relevant questions," explains Dr Monheit. "Patients come knowing there are things they don't like when they look in the mirror, but don't know exactly what it is."

Once each problem is recognized and categorized and then given a point score, the appropriate treatment can be sourced.

The lowest score (from 1-4) is usually obtained by a younger person up to 35 years old who may have very early signs of sun-damage. "They may have a small amount of wrinkles, some dullness in color and a few telangiectasia," says Dr Monheit. "We treat these problems with a skin care program, exfoliants, a tretinoin or retinol derivative and a light glycolic. You want to rejuvenate the skin by peeling off the dead skin layer."

A score of 5-9 usually represents the 35-45 age group where there are more wrinkles and the dull color is more obvious. The skin starts to have a leathery appearance and they are likely to have telangiectasia. and some comedones. "For this score you need a more aggressive peel like a TCA or Jessner peel and they may respond to a series of microdermabrasions. If they have particular lesions a pigmented lesion laser (Alexandrite or Q-switched yag laser) is used. I also suggest a vascular laser for any blood vessels," explains Dr Monheit.

A score of 10-14 means the patient has more than one of the problems outlined in the index. They need something a little more aggressive such as a medium depth peel. They may also need skin fillers, such as collagen or fat, and Botox for crow's feet and frown lines.

A score of 15 plus usually means the patient would benefit from laser resurfacing.

Each successive category treatment requires more down-time than the previous. Score 1-4 can be a lunch-time treatment. Score 5-9 requires a weekend for recovery and a week is usually needed for score 10-14.

"The index gets the patient involved in the process," says Dr Monheit. One of the most important things in cosmetic surgery is ensuring the patient has a realistic expectation of what can be changed. The Index of Photoaging allows the patient to see what's going to change and what's not going to change at each level. It allows the patient to become involved in their own diagnosis and treatment.

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