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Laser - Peeling - Dermabrasion - Le Louarn Laser – Peeling – Dermabrasion
Lorsque la surface de la peau est abîmée par le photo-vieillissement, ou par suite d’un accident ou encore, à la suite d’un problème médical (par exemple une très forte acné juvénile qui laisse des cicatrices en creux à l’âge adulte), il est nécessaire pour obtenir une amélioration esthétique de « retirer » la peau abîmée afin de permettre la création d’une peau neuve, plus fraîche (rajeunissement) ou moins irrégulière (accident, séquelles d’acné).
Ces techniques dites « de lissage » peuvent utiliser une action mécanique : c’est la dermabrasion, chimique : c’est le peeling, ou thermique : ce sont les lasers, lampes pulsées, Fraxel, … Elles n’agissent pas ou peu sur l’excès de peau dû au vieillissement naturel, ni sur l’affaissement des volumes du visage qui sont mieux traités par le Face Recurve® ou le lifting, elles visent à améliorer l’aspect de la peau.
Le rapport 2005 de la Société Française de Chirurgie Plastique Reconstructrice et Esthétique met en garde à propos des techniques qui s’adressent aux signes cutanés du vieillissement : « Bien que non invasives (au sens de l’incision), elles peuvent présenter des complications, ce d’autant que la tendance est à la banalisation et à la sous-médicalisation du diagnostic initial et du geste qui y succède ».
Si la manipulation d’un laser semble répétitive et donc réalisable par une infirmière ou une esthéticienne, il est nécessaire à chaque fois d’ajuster la fréquence en fonction de la peau du patient. Non seulement notre peau est spécifique, mais elle est différente suivant les localisations, et son état peut aussi varier en fonction d’autres facteurs extérieurs : alimentation, température, …
Il est donc important que les techniques soient pratiquées par des praticiens expérimentés, seuls capables d’adapter leur geste et aussi en cas de difficulté de gérer au mieux une éventuelle complication. C’est pourquoi, le Dr Le Louarn préfère vous adresser à un dermatologue pour les techniques agissant spécifiquement sur l’épiderme : lampes flash, laser, peeling…
Vous trouverez ici des renseignements généraux sur ces techniques visant « à faire peau neuve ». Mais il n’est pas possible de détailler chaque appareil ou produit disponible sur le marché, rien ne remplace l’avis d’un praticien expérimenté.
Schématiquement, l’effet de lissage peut être obtenu en abrasant la peau de 3 manières :
1- Action mécanique : dermabrasion Principe : Au moyen d’une meule, le chirurgien retire la couche de peau superficielle.
Avantages : souplesse d’utilisation et plus de certitude sur le résultat, le praticien s’arrête à la profondeur désirée et, il peut adoucir davantage les reliefs puisqu’il peut aller « en diminuant » pour les scuplter.
Inconvénients : le résultat dépend énormément de la qualité du chirurgien et cette pratique est inutilisable sur les paupières (la peau trop fine s’enroulerait autour de la meule).
2- Action chimique : les peeling Principe : la peau est brûlée par l’application d’un acide : glycolique, trichloracétique, phénol… Plus le produit utilisé est fort, plus le peeling sera efficace, mais plus les risques seront grands. Les peeling profonds sont utilisés dans le traitement des peaux abîmées par le soleil et pour les ridules autour de la bouche tandis que les peeling légers sont utilisés pour des nettoyer la peau.
Avantages : Les peelings permettent de traiter des visages entiers.
Inconvénients : Ils sont plus imprécis dans leur utilisation. Ils nécessitent donc un praticien expérimenté, capable d’évaluer jusqu’où va pénétrer l’acide en fonction du type de peau et de son hydratation ce jour-là, à cet endroit … Les différents type de peeling :
– Les AHA et les Glycoliques permettent d’obtenir en douceur un épiderme plus lumineux et plus doux. Ils restent très intéressants particulièrement pour les peaux grasses.
– A l’acide trichloracétique, il s’agit de traitements plus efficaces mais restant modérés avec des risques donc limités.
– Au phénol, il s’agit de traitements profonds avec des risques importants. Ils provoquent une exfoliation importante avec des suites difficiles. Il semble plus facile aujourd’hui de choisir un laser (ou assimilé) qu’un peeling, si on recherche un résultat net, car avec des suites plus légères on obtiendra des résultats comparables. Les peelings profonds gardent cependant tout leur intérêt, pour les patient(e)s pressé(e)s et peu sensibles à la lourdeur des suites, notamment en termes d’éviction sociale.
Depuis quelque temps, beaucoup de marques cosmétiques proposent des « self – peeling » à faire à la maison. Ils sont intéressants , mais permettent des résultats plus limités qu’un peeling fait par un professionnel car les produits sont bien sûr un peu « bridés ».
3- Action thermique : laser et assimilés – resurfaçages aux lasers Principes : la peau est soumise à une source de chaleur par rayonnement ou impulsion électrique. Elle est « chauffée » pour obtenir une abrasion thermique. Cette technique est principalement utilisée pour traiter sur les peaux claires pas trop grasses, les effets du soleil, le contour des lèvres et des yeux et les séquelles d’acnée.
Avantages : Les lasers et assimilés permettent d’obtenir plus de régularité dans l’attaque de la peau car leur action est plus quantifiable (en nombre d’impulsion…) et dépend moins du geste du manipulateur.
Inconvénients : En plus de sa perte de substance, la peau doit récupérer d’une brûlure (rougeurs). Selon les procédés, les réactions, et donc les résultats, peuvent être très variables en fonction des différents types de peaux. Ces techniques sont généralement moins adaptées aux peaux très pigmentées.
Rappelons aussi que les procédés thermiques nécessitent un examen préliminaire attentif pour évaluer quelle sera l’intensité à utiliser en fonction du type de peau et de son état le jour de la séance et un manipulateur attentif et compétent. Les dernières nouveautés techniques assimilées à des lasers proposent elles de préserver l’épiderme tout en forçant sa régénération. Elles y parviennent selon deux procédés différents:
– Le Fraxel agit de façon pixelisée en créant des puits profonds tout en préservant à chaque séance 75% de la surface cutanée.
Le fractionnement permet d’obtenir les résultats des techniques lasers classiques sans leurs inconvénients (éviction sociale prolongée, soins locaux répétés, risque de dépigmentation définitive…).
Quatre séances sont en moyenne nécessaires avec 1 semaine à 1 mois d’intervalle entre les séances. Et compte tenu de la « néosynthèse collagénique » (renouvellement du collagène de la peau). Le résultat demande six mois pour apparaître pleinement.
Le Fraxel est proposé avec des séances légères pour agir sur les troubles pigmentaires et dermiques : teint brouillé, pores dilatés, rides et froissement. Il est également efficace, mais avec des séances aux suites plus contraignantes, sur des problèmes dermiques plus marqués : rides profondes d’origine héliodermique (solaire).
Il n’est pas adapté au traitement des rides d’expression.
Si on recherche un résultat net, au prix de quelques séances avec des suites modérées, il permet d’obtenir des résultats comparables aux lasers CO2 et Erbium. Ces derniers gardent néanmoins tout leur intérêt pour les patients pressés et peu sensibles à la lourdeur des suites.
Il faut savoir que le Fraxel est réalisé après que le praticien ait enduit le patient d’un colorant bleu « shtroumpf », ce qui assure une excellente sécurité puisque les faisceaux thermiques ne touchent que les régions préalablement bleuies, mais que c’est assez désagréable après la séance puisqu’il est nécessaire d’utiliser des produits de nettoyage assez abrasifs pour venir à bout du colorant.
– Le Thermage enclenche une réaction cutanée par chauffage du derme et non de l’épiderme (la surface est donc préservée).
Le procédé utilisé est une « radio fréquence mono polaire », c’est-à-dire des micros pulsions électriques en profondeur et un gros refroidissement de surface qui permet de faire passer le courant sans brûler l’épiderme. Une seule séance est nécessaire et il n’y a pas de réaction inflammatoire, donc pas d’éviction sociale. Mais, pour en bénéficier, il faut faire partie des « bons cas » : pas trop d’excès cutané et encore une certaine tonicité de la peau). Enfin même présélectionnés, 20% des patients restent réfractaires au traitement et n’obtiennent aucun résultat, tandis que 80% obtiendront une amélioration. Les suites des lasers, peelings et dermabrasions
Les suites, comme on l’a vue, sont variables en fonction de l’importance de l’agression subit par la peau et donc de la technique utilisée. L’arrêt d’activité peut aller de 0 à 15 jours.
Certains nouveaux peelings et nouveaux lasers, soit parce qu’ils restent très superficiels, soit parce qu’ils ne touchent qu’un pourcentage limité de la peau, permettent de mener une vie normale immédiatement après la séance, mais ils nécessitent alors des séances répétées pour être efficaces.
Dans beaucoup d’autres cas, les suites prévisibles sont plus contraignantes:
– Saignements pour la dermabrasion
– Peau noircie puis desquamation pour le peeling.
– Oedème, Rougeurs (plusieurs mois quelquefois), prurit modéré pour certains lasers
Dans les techniques les plus profondes, on peut avoir une sensation diffuse de chaleur ou de brûlure, voire même une douleur au niveau de la zone traitée. Il faut éviter le maquillage avant la constitution de la nouvelle peau, et le soleil pendant plusieurs mois (risque de créer des tâches définitives). Les risques généraux des techniques d’abrasions
Pas assez d’action ou trop d’action (intérêt d’effectuer un test pour les techniques les plus traumatisantes).
Troubles pigmentaires : effet de tâches plus blanches ou plus foncées. Ceci dépend du type de peau, de l’hygiène de vie (exposition au soleil, cigarette…) et de la surveillance post-opératoire.
La lésion d’un organe (par rayon laser), l’herpès et l’infection sont des complications tout à fait exceptionnelles, en principe évitées si les protocoles de sécurité (protection oculaire…), de propreté, les prescriptions d’antibiotiques et si nécessaire d’antiviraux sont respectés Risques spécifiques aux techniques
Rougeurs prolongées 3 à 4 mois pour certains lasers, notamment « Ultrapulse ».
Risque de choc anaphylactique et d’intoxication du foie lors des peelings au Phénol.
Allergie aux produits de nettoyages ou de désinfection pour certains lasers Résultat
Les techniques de lissage sont satisfaisantes si les risques de troubles pigmentaires ont été correctement évalués en fonction du type de peau et de son état , si le niveau d’abrasion est contrôlé et si l’exposition solaire est limitée dans les suites. Ce type d’action cutané, doit être utilisé en synergie avec des techniques agissant sur le vieillissement structurel pour obtenir un effet optimisé de rafraîchissement du visage. Dans le même esprit, il est difficile après un certain âge, d’espérer une cohérence de résultat lorsqu’un lifting ou un Face Recurve® Lift est effectué sans action complémentaire sur l’aspect cutané. Bibliographie et références :
Des informations sur le laser sont disponibles en français sur la fiche « Relissage cutané au laser » du site de la SOFCPRE (Société Française de Chirurgie Plastique Reconstructrice et Esthétique). www.plasticiens.org
Des informations sur les lasers et sur les peelings sont également disponibles en anglais sur les fiches « Laser facial resurfacing » et « Chemical peel » du site de l’ISAPS (International Society of Aesthetic plastic Surgery) section : « Info for patients ». www.isaps.org
Les informations spécifiques délivrées sur ce site sont fondées sur la pratique du Docteur Le Louarn ainsi que sur les publications et ouvrages suivants (cette liste est bien sûr non exhaustive et pourra être modifiée) :
1 – CAMPBELL R.M., HARMON C.B. : Dermabrasion in our practice J Drugs Dermatol. 2008 Feb;7(2):124-8 http://www.ncbi.nlm.nih.gov/pubmed/18335648
2 – MEZZANA P., VALERIANI M. : Rejuvenation of the aging face using fractional photothermolysis and intense pulsed light: a new technique Acta Chir Plast. 2007;49(2):47-50 http://www.ncbi.nlm.nih.gov/pubmed/17684841
3 – WEISS R.A., WEISS M.A., MUNAVALLI G., BEASLEY K.L. : Monopolar radiofrequency facial tightening: a retrospective analysis of efficacy and safety in over 600 treatments J Drugs Dermatol. 2006 Sep;5(8):707-12 http://www.ncbi.nlm.nih.gov/pubmed/16989184
4 – DIJKEMA S. J., VAN DER LEI B. : Long-term results of upper lips treated for rhytides with carbon dioxide laser Plast Reconstr Surg. 2005 May;115(6):1731-5 http://www.ncbi.nlm.nih.gov/pubmed/15861082
5 – KANG S., BERGFELD W., GOTTLIEB A.B., HICKMAN J. and coll. : Long-term efficacy and safety of tretinoin emollient cream 0.05% in the treatment of photodamaged facial skin: a two-year, randomized, placebo-controlled trial Am J Clin Dermatol. 2005;6(4):245-53. http://www.ncbi.nlm.nih.gov/pubmed/16060712
6 – HETTER G.P. : An examination of the phenol-croton oil peel: part IV. Face peel results with different concentrations of phenol and croton oil Plast Reconstr Surg. 2000 Mar ; 105(3):1061-83 http://www.ncbi.nlm.nih.gov/pubmed/10724270
7 – GOODMAN G. : Dermabrasion using tumescent anesthesia J Dermatol Surg Oncol. 1994 Dec ; 20(12):802-7 http://www.ncbi.nlm.nih.gov/pubmed/7798411
8 – LITTON C., SZACHOWICZ E.H.II : Chemical Face peels Chapter 7 in Complications and Problems in Aesthetic Plastic Surgery Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6
9 – REES T.D. : Chemabrasion and Dermabrasion Chapter 27 Volume II in Aesthetic Plastic Surgery Edited by Thomas D. REES – Saunders 1980 : ISBN 0-7216-7521-2