Minimising wrinkles

Facing up to those lines!

Since our skin is the first thing anyone sees when they look at us, it makes sense to take good care of it; to repair some of the damage already done, and delay any subsequent ageing. As an aesthetic doctor, I believe in non-surgical skin treatments to help patients look rejuvenated yet authentic. I believe in honouring a patient’s natural beauty instead of trying to change them into something they are not. My aim is to help you look refreshed, healthy and glowing, not distorted, unnatural or strange.

“I’m tired of all this nonsense about beauty being only skin-deep. That’s deep enough. What do you want, an adorable pancreas?”  

– Jean Kerr.

The medical term for a wrinkle is a “rhytide” ‒ a fold, ridge or crease in the skin. Habitual facial expressions,  sun damage, smoking, and poor hydration all promote wrinkles. Not all wrinkles are problematic. Some lines give us character and have positive associations , such as smile lines. Even crow’s feet can denote happiness. The tiny lines under our eyes are present even in toddlers and make us real .

I encourage a realistic and sane expectation when it comes to wrinkles. The best approach is to see which ones make you look angry, worried, stern or tired. Minimising these will help you look refreshed and happier.

There are two types of wrinkles: Dynamic and static. Dynamic lines are a normal part of human expression. Even children have them. But eventually, they become static lines etched into the skin; grooves that form a permanent furrow. Static lines are harder to treat. Don’t wait till your dynamic lines have become static and then run to the aesthetic doctor. Preventative care is best!

Causes of wrinkles

The natural ageing process along with sun damage, causes collagen and elastin fibres to stretch and loosen like worn rubber hands, resulting in less elastic skin that appears thinner and crêpey.

Imagine the skin as a three-dimensional lattice with the structure mostly composed of collagen (which are like large intertwined ropes) and elastin (which are like coils giving it bounce). As we age our skin loses elastin and collagen, losing strength and thickness, making it more prone to the downward and inward pull of gravity and the development of wrinkles.

• Hyalonuric acid (HA) is the gel that naturally occurs in our tissues holding everything together. Found between the collagen and elastin this is a glycoprotein “ goo” that acts as a type of cushioning in the skin ensuring plumpness and hydration. HA diminishes as we age. Think of the difference between a baby’s cheeks full of HA and an old lady’s dry,paper-thin skin

• Gravity: The human face ages in a downward and inward direction due to the gravitational pull on the weakening tissues. As we age our faces undergo a slow and subtle change from the “Triangle of Youth” to the “Pyramid of age”.

• Sleep lines: As we sleep, squashing our faces on the left or the right causes vertical folds in our cheeks,  foreheads and eye areas. Best to sleep on ones back!

• Loss of subcutaneous fat: Caused by ageing this can aggravate wrinkles and result in hollow temples, flattened cheeks and deepened eye sockets, causing us to lose volume in the face.

• Hyperdynamic muscles: Some muscles of the face hypertrophy (get bigger) and become hyperdynamic or hyperactive. Shortening of muscles can result in mouth drooping. The purse-string muscles around the mouth and eyes pucker inwards as they strengthen and shorten, causing crow’s feet and smokers lines. The combination of thinner weaker skin with underlying overactive shortened muscles causes permanent emotional expressions such as worry, anger, sadness or tiredness ‒ even if you don’t feel that way at all!

• The skin surface itself is also very important: Damage done by the sun, environment, and smoking changes the skin’s texture, pigmentation and tone.  Sun spots, age spots, freckles, coarse texture, veins and enlarged pores develop. The stratum corneum, the skin’s most superficial layer comprises dead skin cells that should naturally shed to allow plumper healthier cells in the layers below to come to the surface. As we get older we no longer exfoliate naturally and so the skin becomes dull and coarse, losing its youthful luminosity or glow.

Ironing out the wrinkles

• Botulinum Toxin temporarily relaxes the hyperdynamic shortened facial muscles. It does not alter the collagen, elastin or hyaluronic acid (HA) in the skin, nor address loss of subcutaneous fat . It cannot get rid of superficial imperfections like age spots or solar keratosis. So, by all means, use botulinum toxin to soften the smile lines around your eyes, reduce the down-pull of the mouth corners, slow down the progression of the horizontal lines on the forehead or the frown lines. Botulinum toxin is just the tip of the iceberg when it comes to wrinkle management!

• Dermal fillers are bio-identical to natural HA. Your body cannot differentiate between synthetic HA and natural HA so it will never be rejected. Since it is a clear gel, it cannot be seen and has a very natural feel. Modern dermal fillers can be injected directly into wrinkles around the mouth, eyes,or neck, without causing lumps. Fillers hydrate the skin and give it a healthy glow. However, if a line is caused by an underlying muscle pulling, then this needs to be treated with a muscle relaxant as well. 

No more tear troughs

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Increasing collagen and elastin in your skin

• Mesotherapy improves the integrity of the skin. Mesotherapy solution literally feeds the skin with growth factors, HA, anti-oxidants,  minerals, nucleic acids and amino acids. Mesotherapy improves hydration, radiance and tone of the skin as well as reducing fine lines and wrinkles. It is great for crêpey skin. The skin becomes denser and firmer. Meso has a very natural outcome. It is done by a doctor and involves hundreds of minute little injections into the face, neck, décolletage and backs of hands after the application of a local anaesthetic. Mesotherapy is injected manually, via a meso-gun or infused using a micro-needling device.

• Micro-needling is an amazing way to induce collagen synthesis. The principle of creating a controlled injury to the skin which results in healing and collagen induction is not new.  The Dermapen 4 has revolutionised medical microneedling and can give up to 1800 pricks per second. It’s so fast and the needle so tiny that patients say it just feels like a tickle or a scratchy sensation. The micro-injury promotes a natural inflammatory response with a proliferation of growth factors and fibroblasts. These are the cells that produce collagen and elastin. New collagen will be laid down and deposited with new tissue formation. The skin is strengthened and tightened. It is effective to treat scars and stretch marks too.

• Carboxytherapy is another way to stimulate your skin to create its own collagen. It involves the micro-injections of tiny amounts of medical carbon dioxide gas to stimulate blood flow, lymph drainage and to induce collagen formation.  Carboxytherapy increases the number of growth factors in the skin. It has a multitude of uses from anti-ageing to cellulite to scar repair.

• Chemical Peels or microdermabrasion: Regular exfoliation using superficial peels (chemical exfoliation) or microdermabrasion ( mechanical exfoliation) will help shed the skin’s dead superficial layers and create a healthy glow. Regular superficial peels and microdermabrasion will also lift any superficial pigmentation such sunspots and even out skin tone.  Winter is a great time to do peels as it is not good to expose your skin to the sun for two weeks after a peel.