Options to Restore Your Youthful Appearance

Facial rejuvenation is the term used to encompass all forms of restoring a youthful appearance to the face. It includes the broad categories of:

* Injectables (Botox® & fillers) (See BotoxFacts.ca for additional uses of Botox®);
* Resurfacing procedures (laser treatment, microdermabrasion & chemical peels);
* Surgical rejuvenation (brow lifts, eyelid surgery; facelifts, nose jobs, face and chin augmentation, and neck lifts);
* Topical tretinoin and tazarotene which reverse sun damage and enhance collagen production.
The normal changes associated with facial aging are the result of both:

* intrinsic (age related fat and bone loss known as atrophy, and skin laxity for example) and
* extrinsic factors (like ultraviolet light / sunlight, chemicals, and smoking).

These factors contribute to biological changes associated with age and create predictable patterns of facial change. An over-simplistic analogy is mimicked by the changes in the helium balloon your child wouldn’t let you throw away. With time there is loss of internal volume (gas in this example) and as a result the covering loses its taught shape, luster, and becomes wrinkled. Moreover, there is a marked change in shape of the entire structure. Naturally, similar changes on your face can be highly distressing especially since many available treatments are being promoted.

Physicians can treat facial aging three ways: through reduction (making the skin “fit”), augmentation (“stretching” the skin back to normal) or a combination of the two.

When it comes to choosing a rejuvenation procedure, the severity of the facial aging must be considered. Here’s a review:

* Wrinkles (individual fine or deep rhytids) are managed well by Botox® or injectable fillers. Although other agents are touted to produce similar results, Botox® is currently unsurpassed in its ability to soften or eliminate wrinkles caused directly by the action of underlying muscles of facial animation. (Botox Facts has more information for you)

* For wrinkles that may not be contributed to directly by facial movement or for depressed scars; superficial or deep fillers (ranging from collagen, hyaluronic acid and poly-L-lactic acid to silicone particles and bone cement and even your own injected fat). These can also be used for wrinkles, scars, and soft tissue augmentation (most commonly lip augmentation).

* When you have wrinkles involving larger areas or if it’s related to sun-damage, the underlying problem commonly lies in the biological changes in the skin itself. Here rejuvenation methods such as laser resurfacing, microdermabrasion, and chemical peels act to restore some of the lost intrinsic biologic properties of the skin and can provide a significant restorative change over these large areas. These treatments use light associated heat, physical sanding, or chemicals, respectively, to remove the surface layers of the skin and hence stimulate a regenerative-like process. Many common skin creams advertised to improve facial wrinkles contain glycolic or other acids used in light chemical peels to help improve the taughtness of your treated skin.

* As the severity of skin aging increases, injection and resurfacing procedures may be combined themselves or with surgical rejuvenation (possibly in a staged fashion).

* Surgical management of more severe forms of facial aging can be through an additive (implants), reductive (excisions or tucks), or combined approach. Modern rhinoplasties (“nosejobs”) are a good example where combined approaches of reduction by excision and augmentation through cartilage grafting are employed. As these procedures typically address changes in the three-dimensional volume (deep structures) and in the skin (envelope or cover) they obviously provide the greatest extent of rejuvenation and can address the greatest degrees of facial change. That said, they do come with a limited amount of scaring and the possibly some temporary numbness. Often these scars, created in lines of election, are fine and highly acceptable with some rare exceptions.

* Topical tretinoin and tazarotene can improve fine lines and the general appearance of the skin. The down-side is that you need to continue to use these topical treatments in order to maintain its effect. Sometimes, tretinoin and tazarotene can be combined with the procedures listed above to enhance the effects.

Although you may hear more and more about treating aging skin with the procedures and products mentioned above, we all know that the best form of care is through modification of your exposure to the extrinsic “modifiable” risk factors, like sun exposure.

By: Dr Bryce J Cowan BSc MSc MD PhD FRCS(C)

Chemical Peels - Are They Right for You?

With so many beauty products, facial treatments and surgical procedures available these days, it can be overwhelming to choose a treatment that is right for you. First off, when trying any new skincare treatment or procedure, it is always important to do your research, seek out reputable sources and never be afraid to ask questions, after all, it is your face – you only have one, so treat it accordingly. Selecting the right specialist or understanding details of a surgical procedure will be time consuming, be prepared to put in the time necessary to make the best choice. Below are some tips to help you get started.

Choose carefully. The Consumer Guide to Plastic Surgery recommends you:
•    Check educational, training, background credentials and experience to ensure that he or she is well-qualified
•    Ask how many times they have performed this procedure
•    Ask to see before and after photos of patients who have had chemical peels - in some cases offices will give you contact information of previous patients as referrals.

Dermatologists, plastic surgeons, licensed estheticians and registered nurses can all perform chemical peels. However, depending on the type of peel, you might need to see a doctor. Ensure your procedure is both safe and effective.

Schedule a skin consultation. A chemical peel is an aggressive treatment, it’s important that you get an in-depth analysis of your skin beforehand. When at the consultation, make sure the specialist knows your medical history and any prescriptions you may be taking. Be prepared to ask questions, such as what is my skin type? What are my skin concerns? How can chemical peels improve my skin? What kind of peel is best for my skin type?

Become a peel expert. There are three types of chemical peels: superficial, medium and deep. In addition, they increase substantially in cost depending on the peel. The cost ranges from $150 to $300 for superficial peels; $1,000 to $2,000 for medium peels and $2,500 up to $5,000 for deep peels, according to Smart SkinCare:
Superficial: The mildest of chemical peels, superficial peels treat fine lines, discoloration, dryness, roughness and mild acne. Results are subtle and you will need regular maintenance sessions. Estheticians typically perform superficial peels. Common solutions: Alpha hydroxy acids or AHAs (e.g., glycolic acid, lactic acid), salicylic acid

Medium: These peels penetrate deeper into the skin, producing a second-degree burn. Medium peels treat wrinkles, pigmentation problems, sun damage and blemishes. You will need at least a week to recover. You’ll also need several peels to achieve desired results. Common solution: Trichloroacetic acid (TCA)
Deep: These peels target deep wrinkles, dramatic discoloration and skin lesions. Deep peels are the most effective, providing pronounced and long-lasting results. However, they are also riskier with longer recovery time—most people take two weeks off from work. A certified, experienced plastic surgeon must perform these peels. This peel is performed once. Common solution: Phenol

Consider your skin type. Be aware that a chemical peel is not always the best option for your skin type. These are several examples when a chemical peel isn’t appropriate or can be helpful. In most cases, a chemical peel should not be used on dry or sensitive skin. A peel might cause dryness, flakiness, itching and further inflammation. If you have inflammatory acne and deep cysts, you should also consult a dermatologist, as a chemical peel might not be the best treatment for those conditions.

Chemical peels are a good choice if you experience mild to moderate acne or acne scars: The acids in the peel work to both kill active blemishes on the surface and to prevent new blemishes from forming. By accelerating the exfoliation process, a chemical peel delivers clearer, healthier-looking skin.

Become an expert on your chemical peel. Before having the chemical peel, make sure you ask every question possible to ensure you are aware of the entire procedure and its potential complications.
Examples like; what strength is the peel? How many sessions will I need? What are the pros and cons? What kind of discomfort, pain and other reactions can I expect during the procedure? How should my skin react after the chemical peel?

Communication is key in making your chemical peel a safe experience. Clarify you are experiencing normal reactions or seek immediate attention if you think you are not. Remember if something doesn’t feel right, only you can speak up about it.

About two to four weeks prior to your chemical peel, the specialist will ask you to incorporate pre-care products into your daily regimen. These products are designed to thin out the skin’s surface, allowing the peel to penetrate deeper and evenly. Your medical expert might prescribe Retin-A, an AHA product or hydroquinone cream.
When using these new products, you might have to discontinue your old ones. Your specialist will give you specific information about what products to use and avoid.
Depending on the type of peel, your results might be subtle or dramatic. Every skin type reacts a bit differently. Be realistic about the results and fully understand to what degree the peel will improve your skin and whether you will need additional sessions to maintain results.