How does the skin age?
Skin health and the maintenance of skin health involves numerous strategic molecules and processes. Our skin is at its best while we are still children. Up to the age of 10 years skin can be defined as being smooth, even in colour, firm, tight, well moisturised, tolerant and the process of skin cell repair and regeneration is regular. There is no sebum production, no inflammation, no dryness and no sensitivity. During our teenage years skin health begins to deteriorate and function becomes altered. Our skin starts to produce sebum, becomes inflamed, and as a result we start to develop irregular textures and enlarged pores, acne, uneven skin colour, and a dull appearance.
By the age of 30 years, skin become inactive. The turnover of skin cells becomes extremely irregular. The skin’s barrier function becomes weak. A lack of cellular activity means critical structures within the skin become depleted, abnormal in structure and hence skin starts to develop lines and wrinkles. There are three main components of skin that are the focus of the majority of anti ageing treatments. These are collagen, elastin and hyaluronic acid. Treatments that are aimed at increasing their levels as well as optimising the conditions for their production, repair, and regeneration produce the best anti ageing effects.
What is Collagen?
Collagen provides the skin with its tensile strength and is dependent upon a lattice formation in the dermis (deep layer) of the skin. As we age the amount of collagen reduces and it loses its lattice arrangement. As a result skin is thinner and loses its strength. Excessive sun exposure, smoking and high caffeine consumption can accelerate this process.
What is Elastin?
Elastin forms a unique relationship with collagen and provides the skin with its elastic properties. With age the amount of elastin reduces and its interaction with collagen is compromised. Skin becomes lax and loose. It tends to sag. Excessive sun exposure and smoking can worsen this process significantly.
What is Hyaluronic Acid?
Hyaluronic acid is found in large quantities in healthy skin. It is responsible for carrying large numbers of water molecules and provide skin with hydration and gives it a plump and soft feel. With ageing levels of hyaluronic acid reduce and skin can dry out and become sallow and dull. As is the case with collagen and elastin, the process of ageing and reduction of hyaluronic acid is significantly accelerated by excessive sun exposure and smoking.
What anti-ageing treatments are available for skin?
Treatment specifically targeted at the skin includes topical skincare products including serums and creams that help to increase fibroblast activity. Fibroblasts are responsible for collagen and elastin production. Retinol and vitamin A derivatives are the best studied products and have been shown to increase collagen and elastin levels. Platelet rich plasma in tandem with micro needling can have a dramatic effect on up regulating fibroblast activity and can give an uplifting glow to aged skin. This can last up to 18 months. Ultimately the effects of these treatments will be short lived if specific lifestyle changes are not made including reduced sun exposure and cessation of smoking. Healthy skin function can be maintained irrespective of age as long as a good skincare program is used.
What happens to fat with ageing of the face?
As mentioned earlier facial ageing is a three-dimensional process. Below the skin of the face is a complex arrangement of self contained parcels of fat. These parcels of fat are arranged either side of the SMAS (muscular system of the face). The deep parcels of fat provide the mid-face with volume and youth. As we age is the deep parcels of fat reduce and essentially deflate. This results in loss of volume of the mid-face. The superficial parcels of fat are more variable in their behaviour. In some people the superficial fat parcels can increase in size and alongside weakened ligaments result in sagging of the mid-face and jawline producing tear troughs, nasolabial folds and jowls. When the superficial fat parcels deflate in certain people with age, there is overall loss of volume in the face. The face can then take on a skeletonised facial appearance. A thorough understanding of the location of different parcels of fat and how they are behaving can lead to excellent results when seeking mid-face rejuvenation and hence more youthful appearance.
How is volume loss treated in facial rejuvenation?
Regions of volume loss can be addressed using dermal fillers. Injections of hyaluronic acid into the deep fat compartment can go a long way to restoring a youthful appearance.
How are sagging cheeks and jowls treated in facial rejuvenation?
Where there is excessive volume in the superficial fat parcels and together with weakening of ligaments, there is a general sagging of the face. Gravity also plays a significant role over time. In this case a lifting effect is required. This can be achieved with appropriate placement of dermal fillers, to emphasise cheek regions find a lifting effect to the lower parts of the face. Sagging jawline can be hidden with clever placement of hyaluronic acid dermal fillers. A direct lifting effect can be provided by the use of threats such as Silhouette soft that can be used to lift the jawline and cheek as well as tighten the neck.
What happens to muscle with ageing of the face?
With ageing there are changes to the muscles of the face. Most notably with the increased use of facial muscles with age they hypertrophy (increase in size and become stronger). As a result they can over stretch the skin and deeper structures. Alongside increased laxity and thinning of the skin with age, as well as sagging of fat parcels in the face, there are increases in wrinkling especially around the forehead and the corner of the eyes (crows feet). The down turn of lip corners (marionette lines) and cords in the neck can also form as a result of muscle hypertrophy (increase in size and strength).
How are forehead lines and crows feet treated in facial rejuvenation?
The use of wrinkle relaxation injections is amongst the oldest aesthetic techniques. Injection of botulinum toxin type a into regions of the forehead and corners of the eyes as well as around the bridge of the nose can help in the reduction of dynamic facial lines. Dynamic lines are lines that are only seen on moving certain parts of the face in frowning, smiling and in raising eyebrows. Static lines describe wrinkles and fine lines that are always present irrespective of facial movements. These are partially treated with wrinkle relaxation injections but are essentially the result of skin ageing.
A thorough understanding of all the aspects of ageing can enable the creation of a bespoke anti-ageing treatment program. Combination of treatments tackling each of these factors can produce stick results especially with a focus on strong evidence-based treatments - treatments that have a scientific research to back them up alongside proven results in large numbers of patients.
At Rejuvence we have a thorough understanding of the processes involved in the ageing of the face. We are keen to emphasise the 3 dimensional nature of the ageing process and hence ageing at multiple levels need to be addressed in order to achieve good results. In addition we are passionate about using evidence based treatments. Over recent years doctors have realised that treatments, however simple or complex, are about discussing options and shared decision making with their patients. As doctors we have a responsibility to our patients to provide them with treatment options that have the best levels of evidence to prove their efficacy. In the cosmetic industry this, unfortunately, is not always the case. At Rejuvence we are passionate about offering our clients evidence based treatments that have been shown to work. Where the evidence base is not very strong we are quick to point this out. We are the experts in anti-ageing and aesthetic medicine but we also acknowledge you are the experts of your face.