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The Photo Face Lift

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					            The Photo Face Lift 
                                By

                    Robert P.K. Keller, M.D.




LOCATION:

            950 CASS STREET SUITE B, MONTEREY, CA 93940
             TEL 831-373-1100        FAX 831-373-1630
How Skin Ages… The Basics
      The most obvious sign of aging is the appearance of our skin. But to fully understand
how skin ages, we need to review the basics of skin and the aging process.

        Figure 1 shows a microscopic view of skin. One of the most important layers in the skin is
the basal cell region. We have a saying in cosmetic medicine that “ye who controls the basal
cells layer, controls the aging of skin”. Basal cells migrate upward to form new skin and they
also influence the production of collagen and elastin, among other things.

       Life is good for basal cells, until they become damaged. Once this happens, they do
one of two things: either they go wild and form cancer cells, or they become dysfunctional
and fail to make healthy skin. In the latter case, basal cells become dormant. I call this the
“Sleeping Beauty Syndrome”. These beautiful cells are in suspended animation waiting for
“Prince Charming” to kiss them awake.

      How, then, do they become damaged? And who is Prince Charming? First, let’s talk
about the theory of cellular damage, and then we’ll introduce you to the Prince.

       Imagine going inside one basal cell, deep into its interior to a structure called
mitochondria. This powerhouse produces energy pellets, which allow the cell to make
proteins, etc. All this production is dependent on oxygen, a key player in cellular function.
When an oxygen molecule becomes damaged, our problems begin.

      To see how oxygen gets hurt, we can use ultra violet light (sunlight) as a general model
to understand cellular dysfunction. For example, UV light travels in the 350-nanometer


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09/10/2004                        BY ROBERT P.K. KELLER, M.D.
wavelength range. Picture a marble (a photon) traveling at this speed. When this marble
collides with an oxygen molecule inside the mitochondria, the photon punches an oxygen
                                                    electron out of its orbit. Now we have
                                                    oxygen without one of its electrons…
                                                    a state oxygen hates. This is what we
                                                    call a ‘Free Radical’. It will do
                                                    anything to get an electron and
                                                    indeed, pulls rank to take one. After
                                                    all, it IS oxygen and we must have it
                                                    to live (i.e.-produce energy). So, what
                                                    does kingpin oxygen do? It steals an
                                                    electron from DNA. Taking an
                                                    electron from DNA is like pulling a leg
                                                    from a table. The DNA ‘collapses’ and
                                                    becomes damaged. When DNA is
                                                    damaged it cannot make products,
                                                    like skin, collagen, elastin, etc.

                                                                    As a result, this cell becomes
                                                             impaired. It slows way down in
                                                             producing anything useful; in fact, it
                                                             becomes dormant. One less cell is
                                                             able to make good skin. Now the
                                                             aging process begins in earnest.
                                                             Multiply this scenario times a billion
                                               and you can appreciate what is happening to your
                                               skin. Remember, sunlight is just one of many things
                                               which cause ‘oxidation’ of our skin cells. Smoking,
                                               for example, produces ten thousand free radicals
                                               per puff of smoke!

                                                     Incidentally, ‘anti-oxidants’ like vitamin C,
                                               supply a rich source of electrons to free radicals.
                                               Oxygen takes its missing electron from the anti-
                                               oxidant, leaves DNA alone and the cell remains
                                               undamaged.          Aging,    therefore,    is  free
                                               radicalization  of    oxygen     with    subsequent
                                               damaging of DNA.


                                               In the oxidation of skin cells, an interesting thing
                                               happens. These damaged basal cells go to sleep.
                                               The stage is set for Prince Charming to make his
                                               appearance. Recall that 350-nanometers is ‘bad’
                                               UV light, causing free radicals. As it turns out, there
                                               is a ‘good’ light. Like so many things in nature, ‘that
                                               which hurts, also heals’. We have discovered light
                                               at 590-nanometers is Prince Charming. A photon
                                               traveling at this wavelength actually ‘energizes’ the

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09/10/2004                      BY ROBERT P.K. KELLER, M.D.
damaged cell. This Prince Charming frequency re-awakens Sleeping Beauty, causing the
dormant basal cell to manufacture new skin. In addition, other dysfunctional cells (such as
fibroblasts) are rejuvenated to produce collagen.


How the Photo Face Lift Works

       Finally, we can turn our attention to the LunchTime face-lift. Using an Intense Pulsed
Light laser, 590-nanometers and other beneficial frequencies are generated and used to
restore damaged skin.

       The procedure is simple, affordable and has no downtime. Shining this light on aging
skin causes immediate and long-term restorative changes (figure 2).

       Observe figure 3. These are biopsies of skin before and after IPL treatment. Notice how
the ‘before’ microscopic slide shows an epidermis as thin, wavy wrinkles are present and how
disorganized the collagen layer appears. In the ‘after’ slide, the surface is smooth, the
epidermis is thick and the collagen layer is organized and healthy. This is young, rejuvenated
skin!

        Things get even better, though, for IPL treatments attack aging skin on several fronts.
First, consider brown spots or pigment on the face. This is a subtle sign of aging. If we revisit a
damaged basal cell, one of the few defense mechanisms it has is to throw up an ‘umbrella’ to
protect itself from the sun. Every freckle, liver spot or age spot has underneath it a damaged
cell. Our eyes compare people with brown spots against the uniform color of young skin. Over
time, we can guess a person’s age by the amount of uneven color on the face.

                                                       IPL treatments erase brown spots.
                                                Figure 4 shows how effective this laser is in
                                                removing age spots. To illustrate how uneven
                                                color (Dyschromia) makes us appear old,
                                                consider one of my patients. She is a famous
                                                model, known for her youthful, athletic
                                                beauty. During a recent magazine shoot, she
                                                noticed the camera crew using light filters on
                                                her. She also was told to put on more make-
                                                up. As her trademark is ‘natural beauty’, she
                                                was understandably upset. She came to me
                                                to find out why her ‘look’ was changing. As it
                                                turned out, she was developing very subtle
                                                pigmentation. After a recent pregnancy,
years in the sun and the stress of being a super model, her skin was changing. She was not
aware of how this dyschromia affected her beauty. We decided to treat with IPL and the
results were amazing. She sent me a photograph of a recent ad and her skin glowed. She was
back up top!




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09/10/2004                        BY ROBERT P.K. KELLER, M.D.
        This patient illustrates the principle of beauty and refractive defects. Consider this: When
you walk into a room, your image is the sum of the light, which bounces off your face, into the
retina of the observer’s eyes. Young people have a high refractive index and so almost all the
light, which strikes their face, reflects off and enters your retina. Hence, that image is complete
and seen as ‘young’. When dyschromia is present, the room light is absorbed by the brown
                                                                          spots or diffused by
                                                                          wrinkles. Fewer light rays
                                                                          are bounced back to
                                                                          your eyes and the image
                                                                          is incomplete. Our mind
                                                                          fills in the small holes, but
                                                                          we perceive this person
                                                                          as ‘old’. By melting away
                                                                          the liver spots with the
                                                                          IPL, our refractive index
                                                                          goes up, more light is
                                                                          reflected off the skin and
we appear younger. We now beam! In fact, one of the most frequent comments my patients
get is this: “You glow! Did you take a vacation, get some rest, win the lotto, etc., etc.” In fact,
there is a very good basis for these comments. Your refractive index got higher. You
are reflecting more light off your face. You are in fact, radiant!

       Another wonderful benefit of our magic 590 IPL is its affect on red, blushing skin (Figure
5). Fourteen million Americans suffer from Rosacea. Whether it is flushing cheeks, a WC Fields
nose, facial veins or adult acne, Rosacea is often mistaken for alcohol abuse. When a fifty-
year-old sales executive came to see me, he complained of losing clients. His customers
inferred he was drinking too much, when in fact he was a devote Mormon, shunning all
alcoholic beverages. He wanted the red out. IPL was successfully used and he later told me
people commented on how young he looked. No more references were made to suspected
alcohol. Plus, he looked vigorous and at the top of his game.

       The third benefit of IPL is on collagen production. Another tale-tale sign of aging is
sagging, lack luster skin. Much of this is due to decreased collagen production. IPL stimulates
the production of collagen with a resultant tightening of the skin and decrease in fine wrinkles.
Figure 6 shows how beauty is enhanced when collagen production increases.

      Still another advantage of IPL is the reversal of sun damage. Known as solar elastosis,
sun aging makes us look weathered. As Indiana Jones stated, “It’s not the years but the
mileage!”

        Finally, a consistent comment my patients make 10 minutes after treatment is how tight
their skin feels. Again, there is a very good explanation for this tightening. As we age, our
collagen gets ‘loose’. Our skin sags partly because the collagen molecules are lacked. When
IPL is passed over the skin, water is evaporated from the collagen molecule. This shrinks the
collagen and tightens the skin. Hence, you feel immediate tightening after IPL treatment.




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09/10/2004                         BY ROBERT P.K. KELLER, M.D.
Frequently Asked Questions…

What differences in my skin should I expect to see after an IPL? Immediately after IPL, the
skin is slightly red. Red is good. It indicates where the prior damaged skin was hiding. Red also
shows us the laser has treated that damaged area. This redness will usually disappear by the
end of the day. Within ten minutes after treatment you will feel and see your face tighter (the
water in the existing collagen has been vaporized and the collagen has tightened). The first
one to three treatments will target the dyschromia and reduce the age spots and
pigmentation. These brown spots will form ‘peppering’ and slough off over the next few days.
Underneath these melted brown spots beautiful, new skin will appear. Remember that a skin
cycle is 4-6 weeks; therefore, every month your skin will appear more improved as the old skin
sheds and the new cells migrate to the surface. In the intervening weeks, small blood vessels
will be eradicated and Rosacea will diminish. At this time, new collagen is being produced
and the skin takes on a youthful appearance. After the brown spots are gone, no barriers to
the IPL laser remain. Hence, the fourth treatment allows delivery of the light wave to reach the
basal layer in full strength. This is what we have been waiting for…complete absorption by the
basal cells. By now, people will comment on your fabulous appearance. “Did you lose weight,
go on vacation, win the lotto?” are common remarks my patients receive. Your friends and
family cannot figure out what is different except that you look radiant. And we know why!
Finally, an amazing thing happens about 6-8 months from the start of treatment. In a process
called ‘recruitment’, a critical mass of cells come together to produce new skin in a
coordinated effort. I call this the “fifth wow” of IPL.

How long do the results last? We have given you a fresh start. But remember: free radicals
will continue to be produced. The balance for youthful aging is a pull between oxidation and
production of new skin. Minimizing the oxidation process is paramount to maintaining healthy
skin. Use of anti-oxidants, avoiding sunlight, smoking, etc. help shift the scales to more
production of new skin and less destruction. A good homecare skin system is extremely
important and our consultants are here to assist you make the correct selection. Overall, we
find most patients come in for one touch up treatment every 6 or 12 months to keep the
rejuvenation process strong.

How many treatments are necessary?             We recommend 4 treatments. These can be
spaced every 3-4 weeks; however, many of my patients come from all over the United States
and Europe. In these cases, we can treat as infrequently as every 6 months.

Is there any down time? No! In at noon, diner at seven! As you are probably aware, many
of my patients are in the public eye. They cannot afford to lose time away from the camera or
boardroom. IPL is safe, fast, and affordable, with minimal discomfort.

       We hope this short explanation has made you curious about the Photo face-lift. Dr
Keller believes that well-informed patients get the best results. We want to exceed your
expectations…every time.

Please contact us at 831-373-1100 and join us in the journey of youthful aging.




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09/10/2004                       BY ROBERT P.K. KELLER, M.D.

				
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