Photodynamic therapy (PDT) using aminolevulinic acid (ALA) is a promising new technique that is being studied extensively and used in a variety of cosmetic facial plastic arenas. These applications include U.S. Food and Drug Administration-approved treatment of premalignant and malignant skin conditions, as well as off-label uses for photorejuvenation, and the treatment of acne vulgaris, sebaceous gland hyperplasia, rosacea, and hirsutism. This article reviews the interplay of factors that contribute to the appearance of actinically damaged or photoaged skin, also known as dermatoheliosis. This is followed by a brief review of the mechanisms of action of ALA-based PDT and some of its cosmetic facial plastic uses.