Solutions for Wrinkles and sagging skin

Happy New Year, everyone!

Last year I wrote several posts about different treatment modalities and how they work. I’m going to approach things a bit differently today and answer the question: What concerns can be improved or corrected through non-surgical facial rejuvenation? What might be bothering you (now or down the road) and what can be done?

Facial rejuvenation is defined as a cosmetic treatment (or series of cosmetic treatments), which aims to restore a youthful appearance to the human face. Non-surgical procedures can target specific depths of facial structures and treat localized facial concerns such as wrinkles, skin laxity, hyperpigmentation, and scars.

As we age many of us do wish to restore a more youthful appearance. In this post, I’ll address wrinkles and skin laxity, two of the most common aesthetic complaints.  (I’ll cover hyperpigmentation, scars, and more over the next few posts.)

Wrinkles

If you surveyed 100 people and asked, “What are the main characteristics of facial aging?” Wrinkles would undoubtedly be the number one answer. Lines and wrinkles creep up on us over time, but thankfully there several ways to combat them. Did you know that not all wrinkles are created equally? There are two kinds of wrinkles in fact: Static and dynamic. They appear on our face for different reasons, and each has an entirely different treatment protocol.

Dynamic Wrinkles

 

Dynamic wrinkles are the result of repetitive facial motions and expressions. Furrowing your brow, smiling, or frowning are examples of facial movements that lead to wrinkles over time. If you take a sheet of paper and fold it over and over again in the same way, a distinct line is going to form. As we age, reduced elasticity and collagen make the skin more susceptible to these wrinkles. It becomes less flexible and resilient.

The most common dynamic wrinkles are found horizontally across the forehead, vertically between the eyebrows, around the mouth, and around the eyes (also known as crow’s feet).

How are they treated?

Photo Credit: Dr. Gerald Pierone. This male patient received Botox for his forehead and glabellar (between the eyebrow) lines

Neurotoxins like Botox are the first line of defense against dynamic wrinkles. Botox not only softens lines and wrinkles–it can prevent them. It works by relaxing the precise muscles in the face responsible for lines. It’s effective for 3-4 months and with repeated treatment will last longer.

A study published in JAMA Facial Plastic Surgery in 2015 found that in addition to relaxing the culpable muscles, Botox improves the elasticity and flexibility of skin. This improvement seems to also last for 3-4 months (researchers were unable to explain this phenomenon).

Treatment with Botox requires no downtime for recovery. Injections take no more than twenty minutes, then you go about your day as usual, with just a couple of precautions (don’t rub the injected area, try to sleep elevated). It can take seven to ten days to see the full results of Botox.

Several other treatments can work synergistically with Botox injections against dynamic wrinkles. Modalities like microneedling, the Aerolase, and Clear + Brilliant* lasers, platelet rich plasma (injected or microneedled), and Ultherapy help build collagen, tighten, and take your results to the next level. They’re also great for preventing or postponing the appearance of future wrinkles.

There are additional benefits to each of these treatments, which you can read about by clicking on its highlighted name. If the treatment isn’t highlighted, you’ll find out more about it later in this post. Each of the above modalities offers striking results on their own. But, to tackle dynamic wrinkles, they work best as a complement to a neurotoxin like Botox.

Static wrinkles

Static wrinkles are due to the natural loss of collagen and elasticity that occurs as we age. There are things we can do to slow this process, but it happens to all of us to some degree. Facial tissue loss and bone resorption lead to a reduction in facial volume that is also responsible for static wrinkles. Think folds, like the ones that form between the nose and mouth. Gravity plays a role in creating this type of crease as well.  Static wrinkles can occur just about anywhere on the face. If it isn’t a result of repetitive movement, it’s a static wrinkle.

How are they treated?

Photo Credit: Dr. Gerald Pierone. Female patient before and after treatment with Volbella dermal filler

One solution for static wrinkles are dermal fillers. Dermal fillers are an injectable treatment that smooths wrinkles by adding volume to the face. Fillers are a quick, safe treatment with instant results lasting from eight months to five years. It all depends on the type of filler and where it’s placed. You might remember this post where I talked about my experience with various fillers, including Bellafill. There is no downtime associated with dermal fillers. You can be treated on your lunch break and return to work without issue or any tell-tale signs.

Another excellent option for static wrinkles are PDO threads. PDO threads lift targeted areas of the face and help build collagen in areas where the skin is becoming thinner, like the undereyes or neck. PDO stands for polydioxanone: A safe and absorbable material implanted in the body for certain surgeries. The threads dissolve entirely within four to six months, leaving no scar tissue. After PDO threads are injected underneath the skin, the body begins to heal around them, creating new collagen. Read more about PDO threads here.

You’ll see a drastic reduction in static wrinkles with the help of dermal fillers and PDO threads. They are often used together to restore volume and balance to the face. You’ll achieve even better results when you add in one or more of the tightening, collagen stimulating treatments I mentioned earlier. Some of them shouldn’t be done on the same day, so you’ll want to inquire about the best combination of modalities for your concerns.  Amie at One Aesthetics is my go-to aesthetic consultant. She’s extremely knowledgable and helpful.

Skin Laxity

Next to wrinkles, loose or crepey skin is probably one of the most significant aesthetic concerns of aging. Lax skin can show up anywhere on the body. It’s common along the jaw, neck, around the eyes, on the hands, knees, thighs, and more. Skin can appear thinner, sag, be crinkly, and cause darkness and bags under the eyes. Skin laxity is a result of less collagen and elastin, which serve as a framework for the skin. Without collagen and elastin, skin loses its firm, taught quality. The body produces less over the years, but extrinsic factors like sun exposure, smoking, diet, or weight fluctuations all contribute to a loss of collagen and elastin as well. And of course, we have gravity to thank for some of the sagging we inevitably see.

How is it treated?

Depending on the location of lax skin, there are a few options for addressing it. Similar to treating wrinkles, the best course of action is usually a combination of modalities that complement one another.

Ultherapy is a very effective way to improve the overall appearance of laxity. Focused ultrasound energy can reach the foundational layer of the skin, without disturbing the surface. With minimal pain, the ultrasound energy creates a controlled injury deep within the skin, causing fibroblasts to produce more collagen to heal and tighten the “injury” over time.

Think about when you get a scratch or cut: Collagen is what causes the skin to pull together slowly until the cut closes and heals. This contracting or tightening is how our collagen reacts to controlled injury as well.

There’s no downtime after an Ultherapy procedure. You can return to your everyday activities with perhaps some temporary redness or mild swelling. Very rarely patients will have slight bruising or fleeting numbness in treated areas. The full results of Ultherapy are visible 2-3 months after treatment. Skin will be visibly tighter and lifted. 

 

Photo credit: Dr. Gerald Pierone. Female patient before and after Ultherapy treatment

PDO threads and dermal filler are also important modalities to lift, stimulate collagen, and add volume where needed. Barbed threads provide lift, as does replacing lost volume. This reduces the appearance of sagging. Smooth PDO threads trigger collagen production to help thicken and tighten thinning skin. It’s important to find a skilled injector, who will know the right combination of therapies to treat your skin laxity concerns.

Photo credit: Dr. Gerald Pierone. Female patient before and after a combination of non-surgical treatments known as the Symmetry Lyft

Photo credit: Dr. Gerald Pierone. Male patient before and after a combination of non-surgical treatments known as the Symmetry Lyft

Microneedling, platelet-rich plasma, and the Aereolase, and Clear + Brilliant* lasers are all effective add-on treatments that will continue to encourage the production of collagen; keeping skin laxity at bay. They also have unique benefits like fading hyperpigmentation, reducing broken capillaries, brighter, smoother skin, elimination of acne, and more.

Prevention

Don’t forget that protecting your skin from UV rays, as well as using a quality skincare regimen can help prevent or postpone the appearance of wrinkles and skin laxity. Your lifestyle makes a big difference too when it comes to how your skin will age. Read about the different ways we can either damage or promote collagen here and here.

*Clear + Brilliant is a skin resurfacing laser that removes old, damaged skin cells and age spots, diminishes pores and fine lines, and improves skin tone and texture. It’s different than other resurfacing lasers because there isn’t an extended downtime (where you look scaly, peeling or discolored). Your skin may feel a bit rough for a day or two, but no one will notice you’ve had anything done, and by day three or four, new, fresh, “clear and brilliant” skin will be revealed. Multiple treatments are recommended for best results. The laser also has the effect of stimulating collagen, so while you will see quick results, you’ll notice your complexion continue to improve over the next few months.

 

References:

https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/2293061

Lip Injections & Dermal Fillers | Dallas, Tx | Dr. Ellen … (n.d.). Retrieved from https://www.dermofficedallas.com/cosmetic/injectables/dermal-fillers.html

Say Goodbye To Crow’s Feet With Botox In Georgetown, Tx … (n.d.). Retrieved from https://idealweightandskin.com/blog/blog/say-goodbye-crows-feet-botox-georgetown

Eye Face Institute – Committed To Health And Beauty Of The … (n.d.). Retrieved from https://eyefaceinstitute.com/

Filler Injections Sacramento | Elite Medical Aesthetics. (n.d.). Retrieved from https://www.elitemedclinic.com/fillers-sacramento/

Elle Man: Male-envy Makeovers | Elle Canada. (n.d.). Retrieved from http://www.ellecanada.com/beauty/makeup-and-nails/article/elle-man-male-envy-mak

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