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When we want to treat the ageing face, we need to first understand what is causing the face to age. There are a few main aspects to consider. We call it the 4-D’s of ageing:
- Deflation of the face
- Descent of the face
- Deterioration of skin quality (pigmentation, blemishes, wrinkles)
- Dehydration of skin cells
Deflation of the face
As we age, the once youthful face is gradually deflating. The bone structure beneath, the collagen content and even the facial fat are all thinning out. This explains why older people or someone who lost a lot of weight quickly can appear gaunt. Age lines and wrinkles start to appear. People with a higher reserve of collagen and facial fat will be more resistant to this change. But those with very low body fat percentage, for example triathletes, marathon runners, are more susceptible. Think of a balloon that has deflated, as more and more air escapes, the balloon will become limp, eventually collapsing on itself. The answer to this problem? Re-inflate the face with suitable materials, in the right amounts in the right areas, to create a more youthful look. What are some of the proven methods?
- Dermal Fillers
Dermal fillers are gel-like substances that are created to mimic skin’s natural components. As the name implies, dermal fillers are used to “fill” deep grooves and depressions on the face due to ageing. It is gently injected using fine instruments like micro-cannula or fine needles. The most popular filler material is hyaluronic acid. Hyaluronic acid fillers have been in use for more that 20 years, with more than 20 million injections worldwide. Hyaluronic acid is made up of sugar molecules linked together chemically and they naturally break down over time into harmless subunits. Some of the most established brands include Restylane, Juvederm and Teosyal. Modern fillers are usually pre-mixed with lidocaine anaesthetic so that it is much more comfortable to inject into the skin. First, a numbing cream is applied for 30 minutes, before starting the filler injection procedure. It is quite tolerable, although some needle prickling sensation is to be expected. Patients can expect an almost immediate improvement after the injection. There may be very mild swelling and occasional bruising, which can be covered with make-up. The results last between 6 to 18 months, depending on the type and amount of filler used and the location on which it was injected. Common areas of filler injections include the laugh lines, thinning lips, sunken cheeks, temples and forehead.
- Sculptra Collagen Stimulator
Sculptra poly-L lactic acid (PLLA) is an established collagen stimulator. PLLA was first approved by the FDA in 2004 for the treatment of facial fat loss. It is a great option to treat a deflated, aged face. Sculptra is a liquid substance that is injected in the skin to stimulate collagen production. The most commonly treated areas are the hollow temples, sunken cheeks and the forehead. It should not be used in the lips or the nose. It stimulates one’s own collagen and takes about 2 months to see results. When done properly, it gives a very natural, rejuvenated younger face. Just like a filler procedure, expect some facial swelling and occasional bruising. It is important to do daily frequent facial massages for at least 5 days after Sculptra injection. This is to ensure that Sculptra is evenly distributed in the skin for the best results.
Sculptra should be repeated every 2 to 3 months until the desired results are achieved. Thereafter, Sculptra can be done once a year to maintain the results.
Gravity is constantly pulling down on our face. With time, facial sagging and descent becomes more and more apparent. The younger face we used to love, the V-shape that represented vitality and confidence has now become more A-shaped, where the lower face appears broader than the rest of the face. Add to that, gravity has an effect of making us look tired, even sad as the corners of the mouth and eyes are pulled downwards. In some cases, our face appears “fatter” or broader.
In early to moderate cases of sagging, there is no need to do surgery. Many are also unwilling to go under the knife, due to fears of prolonged downtime, the worry about what if the outcome is not ideal and worse, it is a permanent problem we have to live with. This is the reason that non-invasive or minimally invasive treatments have become much more popular in the past decade. We shall explore tried and tested treatments to counter the effects of gravity.
Ulthera or ultherapy is the original high intensity focused ultrasound (HIFU) and still the only USFDA-approved ultrasound treatment for sagging skin in the face, under-chin, neck and decolletage. Using focused ultrasound energy, it goes to a precise depth of skin to stimulate new collagen. This results in a gradual and natural tightening and lifting effect. The accuracy comes from its DeepSee imaging technology, which allows the doctor to visualize the skin treatment depth in real time. This means that the energy can be safely and predictably applied to the deep dermis and SMAS layer, right where the tightening is needed.
Ulthera was approved since 2009 and has been widely used worldwide ever since. Over 1 million treatments have been successfully completed worldwide, with little risks and adverse events. There have been many copycat technology called HIFU to try and emulate Ulthera’s results. So far, there have been no published data that compares these alternatives with Ulthera. Anecdotal evidence suggests that they cannot rival Ulthera’s efficacy, be it in safety, depth of penetration, precision of treatment and results. Most HIFU machines do not have any real-time visualization of the skin, compared with Ulthera. In other words, the other HIFU machines are treating the area “blindly”. Also, it has been shown that the energy output of some imitation devices are not consistent. It is either producing too little energy (no effect), or too much energy (danger of burns or injuries to the skin). Take the guesswork out of the treatment safely and precisely with Ultherapy. This treatment has no downtime and is a great lunchtime procedure to look and feel rejuvenated.
- Thread lift
If you have more facial sag, are more adventurous, or are seeking more than just subtle, gradual improvements to your face sag, you could consider a thread-lift procedure. Thread lifts have been offered in our clinic for more than 10 years. Today, a thread lift is considered a minimally invasive, low downtime procedure to treat mild to moderate face sagging with a dramatic improvement. No wonder some doctors call it a mini face-lift procedure. Individual results may vary.
A thread lift procedure involves a proper assessment of the areas of concern to determine suitability, expected outcomes and goals of the treatment. A thread lift procedure can reverse the signs of sagging and improve the drooping at the jawline (jowls), nasolabial folds and marionette lines.
A thread lift procedure involves applying numbing cream and giving a local anaesthetic injection to specific points on the face. The threads are actually temporary sutures (poly-dioxonone or PDO) specially designed to have a lifting capacity. There usually little tiny hooks, barbs or cones that help to pull skin upwards for the lifting effect. This gives an almost instant improvement to the appearance. These threads are designed to dissolve over the next 2 to 3 months. As the threads break down within the skin, new collagen are actually stimulated to regrow. What the patient experiences is an instant lift followed by an improvement to the collagen and texture in the skin. This new collagen reverses ageing and helps to prevent further ageing. Most patients notice the benefits of smoother, younger tauter skin after a thread lift procedure. A thread lift procedure is usually performed once a year.
There is a downtime of 2 to 3 days with a thread lift. Expect some swelling, redness, tightness of the face. Very rarely, some bruising may occur. Do plan your time and social commitments accordingly. Mild painkillers (panadol) and antibiotics are routinely given after the procedure.
Deterioration of skin
As we age, the quality of our skin’s appearance will change. Ageing leads to a loss of collagen, elastin and fat. This results in fine lines and wrinkles forming. Add photo-damage to the mix and we start to see uneven skin tones, unwanted blemishes appearing. As a result, our skin loses the youthful glow.
- Botulinum Toxin
Botulinum toxin, or more commonly known as Botox, is an established treatment to reduce unwanted wrinkles. Other brand names include Dysport and Xeomin. Wrinkles form when we make facial expressions like frowning, smiling, wrinkling our noses or raising our eyebrows. Botox helps to reduce excessive facial movements, achieving a smoother, wrinkle-less appearance. When done properly, the effect is a refreshed, younger face. The objective is a refreshed appearance, not a frozen one. Results are noticeable after 5 days and it lasts about 3 to 4 months.
Dermal fillers help to fill in the grooves and creases on our face. It is a very popular way to soften nasolabial folds, the marionette lines and even cheek grooves and forehead wrinkles. Fillers are injected after applying numbing cream and can last between 6 to 18 months, depending on the type of fillers used.
Blemishes or unwanted pigments
Pigments form a big concern for many patients. Unwanted pigmentation can refer to blemishes like freckles, solar lentigenes, liver spots, melasma, seborrhoeic keratosis, etc. With age, more and more blemishes appear, mainly due to cumulative photo-damage from the sun and pollution. Pregnancy, menopause, cigarette smoking and stress all contribute to uneven, dull skin tone. Using a good sunscreen is the best defense against photo damage, but make sure to use a high SPF grade sunscreen (we recommend at least SPF 50), apply it evenly and sufficiently and to top up regularly if outdoors for an extended period.
There are oral supplements like Crystal tomato, Heliocare ultra that help to protect the skin from oxidative damage, leading to brighter and more even skin tones.
For pigmentation that have already formed, a combination of laser treatments and pigment lightening agents like Cyspera are commonly used to zap away stubborn pigments and keep them at bay. There are many types of lasers in the market designed to treat pigmentation. The latest generation of lasers are called picosecond lasers. Picosure was the first brand in the market to introduce a picosecond laser to the medical world. The 755nm Picosure laser is great for removing unwanted pigmentation in addition to improving dull skin, open pores, superficial wrinkles and even mild acne scars. Another popular laser is the Dual Yellow laser that is great for melasma and rosacea.
Our skin is like a barrier that prevents water content from escaping from our body. However as we age, the moisture and hydration in skin diminishes, leaving skin appearing more dry, more wrinkled, less supple. One way of replenishing this hydration is to use good products daily to keep skin moisturized. However, creams, serums and lotions can only do so much.
Introducing injectable hydrating skin boosters treatment. As the name implies, this treatment involves injecting the superficial skin with specially designed products to hydrate and repair skin. We combine 4 ingredients to create a cocktail to hydrate and rejuvenate skin. Dubbed Baby-skin 4-in-1, this treatment is performed once every 6 monthly to keep skin hydrated and youthful. Some of the key ingredients include Rejuran salmon DNA extract, hyaluronic acid and botulinum toxin.
We have presented a brief summary of our approach to the ageing face. Depending on your condition, you may benefit from a combination or all of the above treatments. Do contact us if you wish to find out more about how to combat the 4-D’s of ageing.