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)

Treatments for Lines and Wrinkles

As we age, the skin droops and develops wrinkles, lines and furrows. Depending on your skin type, you may find your skin to be pre-disposed to wrinkling. But thanks to diligent research and new advances, there are a number of solutions to combat facial lines.

Causes of facial lines

In addition to aging, facial lines can form because of the following:

* Sun damage (Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the amount of water held by the epidermis. caused mainly by sun damage.) (Read more at Sun Damage)
* Smoking
* Muscle movement / Dynamic lines (People tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek. Crow’s feet around the eyes are due to smiling and activity of the eyelid muscles. Worry lines on the forehead are due to contraction of the muscle when raising the eyebrows)
* Gravity is responsible for folds in the skin

What treatment is available?

See your dermatologist for information about what might work well for you, which could include (Also see treatments for sundamaged skin):

* Topical agents which produce collagen in the skin, Vitamin A acids (Tazarotene, Tretinoin, Adapelene) and Vitamin C or alpha

Hydroxy acids
* Microdermabrasion has a very modest benefit for very fine lines
* Injectionable fillers such as Restylane (Hyaluronic acid)
* Botox for dynamic lines (Check-out www.BotoxFacts.ca)
* Lasers. Traditionally the CO2 and Erbium lasers (ablative) were used to essentially peel off a layer of skin and then allow a new skin to grow in. Results were impressive but the healing time of many weeks and sometimes months of redness has reduced the use of this approach. Patients with darker skin would often end up with darker skin and those with very fair skin sometimes white skin

* Plastic surgery is usually used to improve skin folds rather than fine lines and wrinkles
* The newer non-ablative laser treatments do not have the down time of the older methods nor do they have the degree of improvement. Repeat treatments with lasers that essentially produce a heating of the dermis, which in turn encourages collagen production, Lasers such as the Nd: Yag, V Beam and Smooth Beam may be used.
* The Fraxel laser is a modification of an Erbium laser that just treats multiple small pinpoint areas of skin allowing a quick recovery after a treatment. We will be hearing more of this in the future
* Cosmetic facial surgery

Prevent it before it happens

You can take steps to protect your skin. You’ve heard it before, and it’s worth repeating:

* Avoid excessive time in the sun, and always use a sunscreen of SPF 15 or higher
* Avoid smoking and exposure to second-hand smoke or other pollutants. Smoking increases facial lines and wrinkles and delays skin healing.
* Exercise. It’s good for the skin as well as for your general health.
* Aging skin feels and looks better when moisturizers are applied regularly. These improve the water-holding capacity of the skin. Choose one that feels nice to apply, doesn’t sting or burn or provoke acne
* Use tepid or warm water and a non-soap cleanser to wash your face twice daily
* Drink plenty of water to rehydrate internally. Because moisture content is related to water, not oil or grease, oily-skinned women need to rehydrate as conscientiously as their dry-skinned counterparts
* Eat a balanced diet that includes plenty of fruits and vegetables
* Generally what is healthy for your heart and brain is good for your skin

See your doctor or dermatologist to determine which solutions best suits your experience with facial lines.