Dr. Ralph R. Reynolds

Oral and Facial Surgery

Loveland CO

970-663-6878

Facial Cosmetic Surgery

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Facial Cosmetic Surgery & Plastic Surgery Overview

The Skin Evaluation   •   Wrinkle Scale   •   Cosmetic Facial and Plastic Surgery Links

The Skin Evaluation

The most common skin complaint is wrinkles, although acne, blemishes and age spots are close behind. Two factors are involved in wrinkling of the skin; environmental factors and age. Exposure to the sun and smoking are the most important factors in causing wrinkles, otherwise known as rhytids. Both age and the environment cause loss of collagen and relaxation of elastin which results in loose and wrinkled skin. For many people years of sun exposure have resulted in premature aging of the face. Skin aging due to ultraviolet light exposure is called photoaging. Patients with fair colored skin are most likely to photoage. Other complications of sun damaged skin are pigmentary changes and rough spots called keratoses. Another change that occurs in skin with aging is telangiectasias development. Telangiectasias are commonly called spider veins.

When evaluating the skin, the following two classification schemes are commonly used.

The Fitzpatrick Sun-Reactive Skin Types classifies skin based on the amount of melanin content.

Fitzpatrick Sun-Reactive Skin Types

Skin Type

Skin Color

Tanning Response

I

White

Always burns, never tans

II

White

Usually burns, tans with difficulty

III

White

Sometimes gets mild burn, average tan

IV

Brown

Rarely burns, tans with ease

V

Dark Brown

Very rarely burns, tans very easily

VI

Black

Does not burn, tans very easily

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The Glogau Wrinkle Scale classifies skin based on wrinkle amount and offers treatment guidelines.

Glogau Wrinkle Scale

Skin Type

Classification

Recommended Treatment

I. No Wrinkles
  • Patient age: 20s or 30s
  • Early photoaging;
  • Mild pigmentary changes
  • No keratoses
  • Minimal wrinkles
  • Sunscreens and education
  • Topical tretinoin
  • Alphahydroxyacid Creams: 15%-30%
  • Glycolic acid peels: 40%-70%
  • Botulinum toxin
  • Photorejuvenation treatments

II. Wrinkles in Motion
  • Patient age: 30s or 40s
  • Early to Moderate photoaging;
  • Early smile lentigines visible
  • Keratoses palpable but not visible
  • Parallel smile lines appearing
  • Sunscreens and education
  • Topical tretinoin and AHA creams
  • Jessner’s peel
  • Jessner’s + 35% TCA
  • Superficial laser resurfacing
  • Soft tissue augmentation
  • Botulinum toxin
  • Photorejuvenation treatments

III. Wrinkles at Rest
  • Patient age: 50s and older
  • Advanced photoaging;
  • Obvious dyschromia, telangiectasia
  • Visible keratoses
  • Wrinkles even at rest
  • Sunscreens and education
  • TCA chemical peel;: 30%-50%
  • Combination TCA peels
  • Laser resurfacing (periorbital, perioral)
  • Photodynamic skin rejuvenation treatments and long-pulse erbium laser
  • Combination laser resurfacing
  • Soft tissue augmentation
  • Botulinum toxin
  • Combination procedures

IV. Only Wrinkles
  • Patient age: 60s or 70s
  • Severe photoaging;
  • Yellow-gray skin color
  • Prior skin malignancies
  • Wrinkled skin throughout
  • Full facial CO2 laser resurfacing
  • Combination CO2 laser and TCA peel
  • Photodynamic skin rejuvenation treatments and long-pulse erbium laser
  • Deep peel
  • Facelift
  • Browlift
  • Blepharoplasty
  • Botulinum toxin

Once the skin is evaluated and a complete aesthetic diagnosis has been established, Dr Reynolds discusses skin care and additional aesthetic options for treating all of your areas of concern.

For the greatest success combination therapy is often used. Skin care includes Obagi® Nuderm cosmeseuticals, Retin-A, light and medium chemical peels, laser and light treatments with selected laser resurfacing. For optimal results, surgical options such as rhytidectomies, liposuction, blepharoplasty and brow lift are often discussed in order to achieve the look you want.

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