Jeffrey A. Fialkov, MD, MSc, FRCSC, Assistant Professor, Division of Plastic Surgery, Department of Surgery, University of Toronto; Staff Plastic Surgeon, Sunnybrook Health Sciences Centre, Toronto, ON.

This article reviews surgical and nonsurgical rejuvenation techniques as they relate to the anatomic changes that occur with facial aging. An understanding of the changes that occur to the facial soft tissues and their support structures over time and with exposure to the elements facilitates individualized treatment optimization for older adults seeking facial rejuvenation. In addition, treatment optimization must take into account the patient’s underlying medical status and personal psychosocial concerns.
Key words: facial rejuvenation, cosmetic surgery, facial aging, noninvasive rejuvenation, photoaging.

Joseph F. Coffey, BSc, MD, PGY4 Dermatology, University of Alberta, Edmonton, AB.
Gordon E. Searles, OD, MD, MSc, FRCPC, Assistant Clinical Professor; Program Director, University of Alberta, Edmonton, AB.

As the population ages, the corresponding rise in incidence of skin cancer and photodamaged skin necessitate skin assessments of older patients in the dermatology clinic. Sallowness, wrinkles, solar lentigos, and other benign conditions reflect extensive ultraviolet damage to the skin, and provide a background of mutagenesis for skin cancer formation. Some treatments available for photodamaged skin are cosmetic and only available in a dermatology or plastic surgery office setting. However, there are many treatments that improve sun-damaged skin as well as prevent progression to skin cancer formation; these tools are available in the primary care physician’s office. This article addresses ablative and nonablative treatment options for sun-damaged skin and encourages the promotion of sun-safe behaviours, including use of protective clothing and sunscreen.
Key words: photoaging, therapy, prevention, cosmetic, nonablative, ablative.

Joseph F. Coffey, BSc, MD, Currently PGY4 Dermatology, University of Alberta, Edmonton, AB.
Gordon E. Searles, OD, MD, MSc, FRCPC, Assistant Clinical Professor; Program Director, University of Alberta, Edmonton, AB.

Accumulation of sun exposure is an important factor resulting in aging of the skin and development of cutaneous malignancy. Unfortunately, most people think of suntanning as a healthy, natural process, and damaging effects of the sun are not experienced until 15-20 years after the initial damage has been done. By the time we see patients in our clinic, the majority of our older clientele has extensive, irreversible photo damage and precursors of skin cancer. It is difficult to treat many of these patients as multiple lesions are frequently present, and patients are sometimes unwilling to initiate sun-protective measures, are not ideal surgical candidates, and may not comply with treatments suggested by the dermatologist due to financial burden. We emphasize the critical role of sun exposure as a cause of skin aging, benign stigmata of aging, and development of skin cancers. Treatment options including topical therapies, oral medications, surgery, and new-age technologies are discussed.
Key words: photo-aging, therapy, skin cancer, dermatoheliosis, melanoma.

G. Daniel Schachter, MD, FRCPC, DABD, Consultant Dermatologist, Sunnybrook & Women's College Health Sciences Centre and St. John's Rehabilitation Hospital; Lecturer, University of Toronto, Toronto, ON.

During the past century, the amount of time spent at leisure and exposed to the sun has increased, yet we have also become increasingly aware of the detrimental effects of the sun. The skin ages slowly (intrinsic, chronologic aging), but this process is enhanced or accelerated by sun exposure (extrinsic aging, photoaging). The features of photoaging will be presented, followed by the importance of the prevention of sun damage by sun avoidance and use of sunscreens. Methods of treating or reversing photodamage will be reviewed, including topical agents, chemical peels and use of lasers and other light sources.
Key words: photoaging, ultraviolet radiation, prevention, sunscreen, skin rejuvenation.