• Cleansers: Cleansing the skin removes bacteria, environmental dirt, cosmetics, sebum, perspiration and desquamated keratinocytes. Abrasive scrubs, mechanical exfoliates, husk and many more    help to remove the dead skin. They can damage the skin if used vigorously. Toner: Toner, conditioning solution and astringent are same types of product. It helps to remove excess cleanser and    residue and helps to adjust the pH of the acid mantle with their low pH. It also provides a temporary tightening feeling to the skin. Exfoliants: Chemical exfoliants remove the dead cells on the    surface of the skin, contributing to a smoother texture and surface appearance.

• Moisturizer & Hydration: Moisturizers are necessary after cleansing or to hydrate dry skin. Moisturizers are applied during the morning program and may be used as needed throughout the day.

Active Treatment for Photoaging skin:
There are two types of the treatment for photoaging skin.
Topical treatment & Surgical treatment. Topical treatment has advantage of being noninvasive but also has certain disadvantages:

• There is latency period of 3-6 months before any measurable changes observed
• Maintenance of improvement needs continued, long term treatment regimen

Nonsurgical facial rejuvenation is three-part process:

• Pre-procedure skin care programme: which consists of product trial, skin treatments and oral or topical medication
• Procedure: involves to select the ideal modality to meet patients expectation for the best positive results
• Postoperative Care which involves assisting the healing phase and designing a long term programme and protocol

There are various component of Nonoperative technique:

1. Resurfacing techniques: Chemical peel, Dermabrasion, Laser
2. Botox Injection
3. Filling techniques
4. Suspension Techniques

Resurfacing Techniques:

Various resurfacing technique like chemical peels, mirodermabrasion or laser will help to rejuvenate skin. These procedures remove the superficial layer of skin and healing makes the skin smooth and blemishless. This also helps to remove the superficial wrinkles. The deeper layer of the skin are removed, better is the result. However, it also increases the changes of complication like pigmentation, scarring and others. Therefore, it is recommended to use these procedures very cautiously in dark skin. The most suitable procedure for the dark skin is microdermabrasion and superficial chemical peel.

These procedures are done without any anesthesia. Some burning, redness and swelling of face are expected for 24-48 hours. The most important part is skin care after the procedure. It is very essential to avoid sun exposure and use necessary protection as advised by the doctor. Carelessness in this area may increase the pigmentation of the skin.

Botox Injection:

Botox is a toxin of Clostridium Botulinum, which is use to temporarily, paralyses the muscle. It has many clinical application, however it is widely used in aesthetic practice for treatment of facial rhytides, soft tissue malposition and as an adjunctive treatment in facial aesthetic surgery. It is most commonly use to treat frown lines between the eyebrows, horizontal lines on the forehead and crowfeet at the lateral angle of eye.

The procedure is very simple and appropriate dose of Botox are injected at specific points depending on the demand of the patients. The action of Botox will start immediately, but the maximum effect will be shown after seven days. The effect will last for 5-6 months and then repeat injection is necessary. As the treatment continues for long time, the muscle becomes weak and duration between two injections will be more.

There are not major side effect except allergy to drug, which is very rare and resistance to the drug effect. Sometimes drug may gravitate to surrounding area and lead to unwarranted action like droopy eyelids, mild asymmetry of the facial expression. Fortunately, the effect is temporary and the shortcoming can be corrected in the next sitting. It is costly drug and needs repeated injection for long period of time to achieve the desired result.

Filling Techniques:

Facial aging includes the soft tissue volume depletion especially subcutaneous fat. Soft tissue augmentation is an important aspect of the facial rejuvenation. It is use to fill facial rhytides, scar or any other depression. There are many commercially available materials to be used as filler. Most of the filler share minimal risk of infection, extrusion, migration, inflammatory reaction, and duration of longevity. Many products are not available in India. The safest and cheapest is the fat filling, where the fat is collected from the other parts of body like buttocks and thigh. The desired result can be achieved by two or three sessions; it may need many more session before long-term result is achieved.

Suspension Techniques:

Facial aging includes the droopy soft tissue due to loss of vigour of the skin and gravity. To give a young look to the face, it needs lifting this pad of fats into higher position. There are special threads, which are used to suspend the facial pad at higher level taking help of the fix points. These techniques though promising, are at experimental level at present.

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