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Terminology 

Accutane – drug used to treat acne; it decreases the amount of oil produced by the skin’s sebaceous (oil) glands.

Acne scar - see Scars.

Actinic keratosis - a precancerous condition of thick, scaly patches of skin.

Age spots - Also called liver spots, lentigo simplex and senile lentigines, these flat, gray, brown or black spots affect more than 90 percent of fair-skinned people after age 50. They range from freckle-size to a few inches across. They’re most common on the face and the backs of the hands – areas most exposed to the sun. They may darken with sun exposure. True age spots never become cancerous and don’t need treatment. However, they can look like cancerous growths. For cosmetic reasons they can be lightened with skin-bleaching products or removed. One can help prevent new spots by avoiding the sun and using sunscreen.

Alpha hydroxy acids - used in over-the-counter cleansers, lotions and other products, cause mild shedding of surface skin, a process called exfoliation; higher concentrations of these acids are often used in salon “mini-peels” or in chemical peels.

Angiogenesis - Development of blood vessels.

Antioxidant vitamins - laboratory studies suggest that topical forms of vitamin C may reduce signs of aging and increase production of collagen in skin.

Artecoll – a tissue agent comprised of three ingredients. One of the ingredients, PMMA, is a material used to bind bones and artificial hips. For cosmetic purposes, the PMMA is prepared in smooth microscopic beads specifically sized to go through a fine needle. The two other ingredients include collagen, as a delivery system, as well as a trace dose of anesthetic to minimize discomfort. Artecoll is injected into the target area where the beads provide a lift and support structure beneath the skin. While the injected collagen eventually dissipates, the procedure stimulates production of the patient’s own collagen so that it can grow around the beads and serve as a permanent filler.

Atrophic scar - see Scars.

Atrophy – usually refers to thinning of the epidermis leaving an easily wrinkled and/or shiny surface. Atrophy may also apply to dermal and/or subcutaneous tissue, with or without changes in the epidermis.

Augmentation – Patients seek to augment one or more of the facial regions to give a more youthful and defined appearance to the face. The nasolabial creases and lips usually are augmented with small, soft synthetic implants that are placed deeply in the skin and underlying subcutaneous tissue. Examples are Articoll and Soft Form.

Blepharoplasty – a plastic surgery procedure of the eyelids which removes bags under the eyes and the extra skin of the eyelids. The procedure can be done with a scalpel or with a CO2 laser.

Botox – a purified and weakened form of the same toxin that can cause botulism. Injected under the skin, the toxin can temporarily weaken or paralyze small facial muscles, decreasing frown furrows and laugh and squint lines. The procedure must be repeated every 3 to 6 months. Side effects are rare. In another promising new technique, small, synthetic fibers are injected into your skin to stimulate the growth of collagen at the site.

Café au Lait spots - “Age spots” or “liver spots” which are directly related to sun exposure and have nothing to do with either age or the liver.

Chemical peel - In this procedure, the doctor applies an acid that is stronger than is available in topical creams. The acid (trichloroacetic acid is generally preferred) burns the outer layer of the skin, which peels off, causing new, smoother skin to regenerate. The skin has a scab for about 10 days and is pink for about 3 months. The patient may be left with small scars, and the skin will be permanently lighter and more susceptible to sunburn. Chemical peels can cause blotchy skin in people with darker skin.

Cherry hemangiomas - small red dots that appear as we get older; they are completely harmless and may be hereditary. They often appear on the face, chest and back, although they can appear anywhere.

Collagen – A fibrous insoluble protein found in the connective tissue, including skin, bone, ligaments, and cartilage that keeps your skin taut. Collagen represents about 30% of the total body protein.

Collagen injections - Collagen from cattle can be injected into deeper wrinkles on the face. The injected collagen smoothes out wrinkles and fills in furrows, such as those around the nose and mouth and between the eyebrows. The collagen degrades over several months but may trigger the body to produce new collagen. The procedure may need to be repeated every few months.

Collagen regeneration - the process whereby the human body produces more collagen and replaces old, worn down collagen secondary to sun damage and aging. Heating of the dermis results in the body regenerating its own collagen.

Compression therapy - Application of sustained, graduated pressure to the lower leg with bandages, elastic stockings, or rigid supports, in order to prevent edema and promote resorption of existing tissue fluid in patients with varicose veins.

Cosmetic unit - an area of the body often treated separately from others. Examples of cosmetic units: the skin around the eyes, the skin around the mouth, the cheeks.

Deoxygenated vessel - Blood vessel that is stagnant, not close to the capillary supply; blue or purple in color.

Dermabrasion – Fine wrinkles, age spots and scars can be “sanded down” with a small, rotating wheel. Scabbing and swelling generally last a couple of weeks. Complete healing takes longer.

Dermis – The dermis, which lies under the epidermis, makes up about 90 percent of the thickness of your skin. It contains a dense meshwork of collagen and elastin fibers, two types of protein. This meshwork supports lymph and blood vessels, nerves, muscle cells, sweat and sebaceous glands and hair follicles. Collagen and elastin fibers give your skin its strength and elasticity. Sebaceous glands produce an oily substance called sebum, which keeps your skin smooth and moist.

·      Papillary dermis – small elevations of the layer of the skin that lie immediately under the epidermis that indent the inner surface of the epidermis; it is 113 microns thick.

·      Reticular dermis – layer of connective tissue forming the deeper portion of the dermis; lies beneath the papillary dermis

Doppler ultrasonography - Ultrasonography applying the Doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow.

Elastin – proteins in the skin responsible for elasticity, tone and texture.

Epidermis – The skin’s outer layer, the epidermis, is a robust and resilient structure and is as thin as a pencil line. It provides a protective layer of skin cells, which are continually shed. The very outer surface is made up of dead skin cells and functions as a physical barrier to protect the deeper dermis, retaining the skin’s hydration. Squamous cells lie just below the outer surface. Basal cells, which produce new skin cells, are at the bottom of the epidermis. The epidermis also contains cells (melanocytes) responsible for producing the pigment melanin. The amount of melanin in the skin determines the skin color.

Erosion - a loss of epidermis above the basal layer leaving a denuded surface.

Erythema - Diffuse redness over the skin caused by capillary congestion, usually due to dilatation of the superficial capillaries as a result of some nervous mechanism within the body, inflammation, or some external influence such as heat, exposure to sunlight, or cold.

Feeder vessel - see reticular vein

Description of the various types of skin amongst humans as it relates to pigmentation.

·      Type I       Very white or freckled, always burns

·      Type II     White, usually burns, tans less than average (with difficulty)

·      Type III    White to olive, sometimes mild burn, tans about average

·      Type IV    Brown, rarely burns, above average – black

·      Type V     Dark, very rarely burns, risk of pigmentation is common

·      Type VI    Black, never burns, risk of pigmentation very common

Folliculitis - inflammation of a follicle or follicles

Folliculitis barbae - inflammation of a follicle or follicles of the beard; commonly seen in black skinned individuals

GAG’s (Glycosaminoglycans) – substances in the skin that hold in moisture.

Hair bulb - the expanded portion at the lower end of the hair root; growth of a hair results from the proliferation of cells of the hair bulb.

Hair bulge - has cells that replenish hair matrix germinative cells during the telogen phase.

Hair density - the thickness of an individual hair

Hair follicle - an invagination of the epidermis which forms a cylindrical depression, penetrating into the connective tissue which holds the hair root and from which a hair develops. Sebaceous glands, which secrete an oily fluid, and tiny muscles (arrector pilli) which cause the hair to stand are attached to the follicle.

Hair growth cycles - hair grows in cycles called anagen, catagen and telagen. The cycles are defined as:

·      Anagen – hair cells actively dividing, lengthening the hair shaft; known as the growing stage

·      Catagen – period between anagen and telagen cycles (transitional or breakdown stage)

·      Telogen – dormant stage where hair is not growing

Hair shaft - the portion of a hair which extends from a hair follicle beyond the surface of the epidermis.

Hemangioma – a benign tumor of blood vessels; hemangiomas usually occur at birth or in childhood; some will disappear with time, while others do not.

Hirsutism - condition characterized by the excessive growth of hair or the presence of hair in unusual places, especially in women.

Hyperemia – Reddish area on the skin as a result of an increase in the quantity of blood flowing through the area. Passive blood flow.

Hyperpigmentation - localized increase in skin pigment

Hypopigmentation - localized decrease in skin pigment

Hypertrichosis – growth of hair in excess of normal.

Keloid scar - see Scars.

Keratinocytes - The basic cell type of the epidermis; containing keratin, a fibrous protein, they are produced by basal cells in the inner layer of the epidermis.                      

Laser skin resurfacing - a controlled vaporizing of the outer layer of skin (epidermis). Layers of skin underneath shrink to tighten skin and eliminate wrinkles. The underlying skin (dermis) eventually heals more tightly and smoothly.

Lentigines – Freckles. Solar lentigines, or “age spots” or “liver spots” are directly related to sun exposure and have nothing to do with either age or the liver.

Matting – Same as neovascularization. The new appearance of previously unnoticed fine red telangiectasias which occurs in a number of patients (5-75%) after either sclerotherapy or surgical ligation of varicose veins and leg telangiectasias as a result of the body’s attempt to create collateral veins to aid in the formation of a new channel for return of blood flow to the heart. Telangiectatic matting may appear anywhere on the leg and almost never on the face, chest, and hands after sclerotherapy. Probable risk factors for the development of telangiectatic matting in patients with leg telangiectasias include obesity, use of estrogen-containing hormones, pregnancy, and a family history of telengiectatic veins. Excessive standing does not appear to influence their development.

Melanin – The pigment of the skin. The amount of this substance accounts for variations in skin color in different people and different races.

Melanocyte – melanin forming cell

Microdermabrasion - Aluminum oxide crystals are projected onto the skin in a uniform manner to exfoliate layers of the epidermis. These crystals, along with dead skin cells, are vacuumed into a closed filter container and discarded. Microdermabrasion leaves skin smooth and clean with mild erythema. Blackheads are loosened, whiteheads become unsurfaced, hyperpigmentation lightens and acne scars, enlarged pores and epidermal wrinkles become less prominent. Blood, containing oxygen and nutrients, is drawn to the surface to feed and repair cells. Microdermabrasion is performed in a doctor’s office by a doctor, esthetician or nurse, or in a spa by an esthetician.

Neovascularization – Development of new blood vessels in a structure.

Nevus of Ota - A benign bluish or gray-brown facial lesion of the eye and the surrounding skin that has melanosomes lying deeply within the dermis and been reported to occur rarely in Caucasians but is common in Asians (about 1 in 200 people in Japan); it is a dermal melanocytic disease which causes discoloration of the face, induces a remarkable disfigurement to patients and is a serious cosmetic problems for affected individuals; due to its large size and periocular location, has been notoriously difficult to treat. It is an anomaly of the dermal melanocytes, which lies primarily in the deep dermis. It is characterized by its distinctive cutaneous distribution involving skin innervated by the trigeminal nerve. Most cases are clinically manifest at birth or around puberty; however, acquired lesions in adults have been reported.

Non-ablative skin rejuvenation - non-invasive treatment to reduce the signs of aging; does not require the removal of surface tissue to accomplish collagen regeneration, wrinkle reduction and a more youthful appearance.

Non-ablative skin resurfacing - Resurfacing means to re-surface or replace the surface, which can not be done without ablating the old surface. This term is a contradiction.

Non-invasive - devices or procedures which do not require entering the body or puncturing the skin.

Oxygenated telangiectasia - Very small blood vessel that is close to the capillary supply; tends to be more red in color.

Permanent hair reduction - reduction in hair count lasting 12 months or longer.

Photoaging – Skin damage caused by the sun.

Pigmentation – Coloration due to deposition of pigments.

·      Hyperpigmentation – Increased amount of coloration from pigments Ex: Café au lait spots, freckles. Permanent hyperpigmentation can occur as a complication post-sclerotherapy.

·      Hypopigmentation – Decreased amount of coloration from pigments Ex: vitiligo.

Poikiloderma – A skin disorder characterized by pigmentation, telangiectasias, purpura, pruritus (itching), and atrophy.

Port Wine Stain - A superficial purplish red birthmark which occurs usually at birth or in childhood. This benign lesion is due to hyperplasia and malformation of superficial capillaries and is classified in the general skin lesion group, nevus vascularis and in the subgroup of hemangioma. Port wine marks usually appear on the side of the face and usually become thicker as the child gets older, so early treatment is recommended.

Pruritis – itching.

Purpura – A condition with various manifestations and diverse causes, characterized by hemorrhages into the skin, mucous membranes, internal organs and other tissues. Hemorrhage into the skin shows red, darkening into purple, then brownish-yellow and finally disappearing in 2 – 3 weeks. Areas of discoloration do not appear under pressure.

Q switching – Refers to an electro-optical switch within the laser cavity that allows the release of all of the laser energy stored up in the laser cavity in one brief powerful pulse. Power outputs in the megawatt to gigawatt range are common. The target is heated at such a rapid rate that it shatters and supersonic shockwaves are created in the tissue. Lasers in the 5 – 500nsec range including Q-switched ruby, alexandrite and Nd:YAG lasers are used to target smaller structures such as melanosomes and tattoo ink particles.

Reticular veins - Abnormally dilated subcutaneous veins that are blue and nonbulging, measure 1 – 3 mm in diameter, and are directly associated with telangiectasias; most commonly seen over the posterolateral aspect of the thigh and the lateral aspect of the calf. They appear to drain toward the popliteal fossa (behind the knee) with the associated telangiectasias radiating away from the knee.

Rhytides - wrinkles

Rosacea – Common skin condition that causes redness and swelling on the face. Often referred to as “adult acne,” rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin and nose. It also may involve the ears, chest and back. As the disease progresses, small blood vessels and tiny pimples, some of which contain pus, begin to appear on and around the reddened area; however, unlike acne, there are no blackheads. In more advanced cases of rosacea, a condition called rhinophyme may develop. The oil glands enlarge causing a bulbous, enlarged red nose and puffy cheeks. Thick bumps can develop on the lower half of the nose and nearby cheeks.

Scar - A hard plaque of dense fibrotic tissue covered by a thin epidermis. A mark of injury from any sort of process (physical or pathologic). The injured tissue has been replaced by connective tissue. Scars may result from wounds that have healed, lesions of diseases, or surgical operations. When first developed, a scar is red or purple, later whitish and glistening.

·      Atrophic scar – Scar that is depressed below the skin

·      Hypertrophic scar – Scar that is raised above the skin

·     Keloid scar – This fibroid growth of epidermal tissue results from the healing process of surgical incision or traumatic skin injury. There is a greater tendency towards keloids in blacks and fair skinned Caucasians. The etiology is unknown.

Acne scar - depressed scar that results when acne is picked. Types of acne scars include ice pick, rolling and boxcar.

·      Ice pick scars are deep, well defined and narrow

·      Rolling scars are subtle with an undulating appearance

·      Boxcar scars can be superficial (shallow) or deep

(shallow boxcar scars respond best to lasers) 

Selective photothermolysis - This theory, described by Rox Anderson, is the basis for lasers that selectively destroy a target with little or no injury to surrounding tissues. Selective light-induced thermal damage occurs by selecting a wavelength that is maximally absorbed by the targeted structure combined with a pulse duration that is less than the thermal relaxation time of the target, or the time required for the target to dissipate 50% of the heat acquired following laser irradiation.

Skin Turgor - tissue hydration of the skin.

Soft Form - synthetic tissue augmentation implant placed in the face; used to smooth out wrinkles and furrows.

Solar elastosis - Excessive exposure to sunlight over many years damages collagen and elastin fibers that support skin. This can lead to loose, sagging, tough skin that can look 15 to 20 years older than normal. Solar elastosis is most common in light-skinned people who are often exposed to intense sunlight.

Spider veins – A branched growth of dilated capillaries on the skin resembling a spider. Linear and “spider” telangiectasias develop on the legs, especially in women beginning in the second to third decade, secondary to multiple factors including genetic predisposition, gravity, pregnancy, and trauma.

Subcutaneous tissue - Under the epidermis and dermis lies subcutaneous tissue composed primarily of fat. This skin layer insulates and protects your inner organs and helps give your skin its resilience.

Telangiectasias – Telangiectasias are red dilated, broken blood vessels, commonly seen on the face or thigh. They develop secondary to genetic predisposition, chronic actinic damage, collagen vascular disease, topical steroid application, and disorders of vascular regulation including acne rosacea. Linear and “spider” telangiectasias develop on the legs, especially in women beginning in the second to third decade, secondary to multiple factors including genetic predisposition, gravity, pregnancy, and trauma. They arise from backflow from reticular veins. Blue dilated veins are also referred to as telangiectasias however their correct name is venulectasia.

Thermal Relaxation Time - A characteristic “cooling” time is needed for an object to cool about 2/3 of the way down to the ambient temperature after having been heated. For most chromophores in the skin, this time is determined only by the size of the object.

Urticaria – Medical word for hives. Hives are formed by blood plasma leaking out of small blood vessels in the skin. This is caused by the release of a chemical called histamine. Histamine is released from cells called “mast cells” which lie along the blood vessels in the skin. Allergic reactions, chemicals in foods, or medications can cause histamine release. The most common causes are foods, drugs, infections, insect bites, internal disease, pressure, cold, sunlight, vibration and pressure. The best treatment is to find and remove the cause.

Varicose veins – Dilated tortuous veins exhibiting reflux because of valvular insufficiency. The primary mechanisms are defective venous valves that are unable to close properly or weakness of the vessel wall that leads to distention and reflux. Since varicose veins are abnormal, they cannot be used for any bypass and their removal or destruction does not adversely affect the patient.

Venous insufficiency – Any abnormality of the peripheral venous system that reduces or impedes venous return. Includes not only veins themselves and their patency, wall properties and valves but also the muscle pumps of the foot, calf and thigh which are dependent on proper neuromuscular function and joint mobility, especially the ankle and connective tissue support by fascia.

Venulectasia – Blue dilated veins which are also referred to as telangiectasias however their correct name is venulectasia. See Telangiectasia.

Vitiligo – Skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few too many milky-white patches. The white skin of vitiligo has no natural protection from the sun. These areas are very easily sunburned.

Wrinkle class - a way of classifying wrinkles as Class I, II or III; the description follows:

Wrinkles - With aging, the skin becomes thinner. Oil-producing glands become less active, and skin becomes drier (which is why moisturizing is one of the best things one can do). The number of blood vessels in the skin decreases, and the dermis, which lies right under the top layer of the skin, thins and becomes more fragile. The skin replaces old cells more slowly, and cells repair themselves less effectively. Collagen and elastin, two fibrous proteins that keep skin taut, start to diminish, contributing to wrinkling and sagging.