Wrinkles and Lax Skin
what causes them?
Wrinkles are lines and creases that form as part of ageing.
As people get older, their skin becomes drier, thinner, less elastic and less able to protect itself from damage, with less fat.
Faint wrinkles can become deep furrows or crevices over time. Grooves form under the skin during facial expressions. Young flexible skin springs back into place, but as skin ages, it loses its flexibility and springing back becomes harder and less frequent, resulting in permanent grooves.
Ultraviolet light exposure and smoking accelerate wrinkle formation and the ageing process.
Wrinkles can be divided into
- dynamic wrinkles - present only during movement but not at rest
- static wrinkles - present even at rest
Winkles that we've treated frequently:
- Glabellar frown lines
- Crows feet and fine undereye wrinkles
- Bunny lines
- Forehead line
- Horizontal neck lines
- Vertical neck bands
- Cobblestone chin
Evidence-Based Treatments
to treat scarring and stretch marks safely and effectively
Neurotoxins
Neurotoxin injection for treatment of facial wrinkles is one of the most frequently performed cosmetic procedures. Neurotoxins inhibit release of acetylcholine at the neuromuscular junction. Treatment of specific overactive muscles causes localized muscle relaxation that smoothens the overlying skin and reduces wrinkles.
Dermal Fillers
Injectable dermal fillers are intended to fill in the lost volume in wrinkles, giving a smoother appearance. Most fillers are temporary and are eventually absorbed into the body. Temporary fillers can be classified into 2 broad groups:
- mainly volume replacement - these are most commonly composed of hyaluronic acid, which draws and binds water to itself and the surrounding skin
- collagen stimulating - contain materials such as polynucleotides, calcium hydroxyapatite, polycaprolactone or poly-L-lactic acid that cause the body to produce collagen in response
Fillers can be injected directly into deeper lines. They can also be injected more superficially using an injector gun to hydrate the skin and ameliorate fine lines (Hydrashine / Skinboosters).
Subcision and Filler
Deep facial lines may be tethered down to the deeper structures such as the superficial musculoaponeurotic system (SMAS) or bone. In subdermal incision (subcision), surgical tools inserted under the skin via small needle punctures are used to release the tethering of the wrinkles to the deeper layers.
Filler is then interposed to prevent the two layers from sticking back together during the healing process.
Fractional Energy Devices
Fractional Infrared Lasers
Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.
Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy.
Fractional Picosecond Laser - Discovery Pico Plus
Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating collagen production with almost no downtime.
Fractional Bipolar Radiofrequency
Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.
Fractional Microneedle Radiofrequency
Skin remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.
Medications
Topical medications such as peptides, retinoids, hydroxy acids and antioxidants may help prevent and improve wrinkling and other signs of ageing. They tend not to work so well for deep wrinkles.
1Aesthetics's View
dr wan's perspective
Dr Wan believes in a tailored combination approach using all the tools available:
Neurotoxins
Wrinkles with a dynamic component should have neurotoxins wherever feasible. This will help to smoothen out the wrinkle and prevent it from getting worse. Long-term treatment with neurotoxins can actually prevent the development of imprinted facial lines, so Dr Wan prefers to initiate treatment early rather than wait for the wrinkles to progress into static lines. Dr Wan prefers to initiate treatment at a lower dosage of toxin and aim for a natural reduction rather than the total elimination of wrinkles.
Fractional Energy Devices
These help to build up collagen and tighten the skin. The choice of which treatment to use depends on:
- Skin thickness in the area of the wrinkle
- Depth of the wrinkle
- Skin colour
- Patient’s budget and tolerance for downtime
Subcision and Fillers
These usually give rapid improvement for depressed, static wrinkles. Rheology of filler should be appropriate for the wrinkle (e.g. hydrashine / skinboosters for very fine wrinkles vs harder, longer lasting fillers for deep glabellar troughs). Subcision is indicated to lift deeply tethered wrinkles first before filler.
Topical therapy
Helps to potentiate the effect of energy devices and maintain collagen stimulation
