Dermatologic lasers in the treatment of aging skin.

Skin aging includes intrinsic aging, a universal and inevitable process attributable to the passage of the time alone; and photoaging, changes attributable to chronic sun exposure, which are neither universal nor inevitable. The major clinical features of aging skin include xerosis, laxity, wrinkles, slackness, and the occurrence of benign neoplasms such as seborrheic keratoses and cherry angiomas. Photoaging is characterized by dryness (roughness), actinic keratoses, irregular pigmentation (freckling, lentigines, guttate hypomelanosis, persistent hyperpigmentation), wrinkling, stellate pseudoscars, elastosis (fine nodularity and/or coarseness), inelasticity, telangiectasia, venous lakes, purpura (easy bruising), comedones (maladie de Favre et Racouchot) and sebaceous hyperplasia. Current antiaging therapy consists of lasers, intense pulsed light as well as fillers, neurotoxins, radiofrequency, microdermabrasion and chemical peeling. Over the last 50 years, lasers applications in dermatology have become more specific and often irreplaceable. In this manuscript laser resurfacing and laser therapy of vascular and pigmented lesions of aging skin will be overviewed. Current trends show an increase in the number of nonablative and fractional resurfacing procedures because they are followed by less intense side effects and faster recovery rates compared to ablative laser rejuvenation, although producing mild improvement.