Treatments for wrinkles and lines over the years have been managed by various moisturisers which have been touted to help these problems. Emollients may in fact be useful. But generally something that tones the skin to eliminate the lines is required.
Retinoic Acid (Retin-A & Retinova), a derivative of Vitamin A has proved useful in more recent times. The skin can be more sensitive in sunlight with this. Therefore greater care in sunlight is required.
Also beneficial are AHAs (such as Glycolic Acids) more through the effect of breaking down old skin cell bonds and allowing more fresh skin cells to appear on the surface. In themselves AHAs tend not to sensitise the skin to sun.
Forms of freely absorbed Vitamin C also seem to help. There are also some newer cosmetic-type products that hide lines with a very fine powder-like effect.
There are changes occurring in the thinking of how to best manage changes that occur in the skin including treatments for wrinkles and lines. A lot of what is mentioned on this page is concerned with provoking a response in the skin that is based more on an inflammatory process.
New methods are emerging that seek to generate a more normal growth-based biological response. We are evaluating some of these now. Those sorts of treatments like those described below in PRP and lower energy laser stimulation seek to utilise these natural properties.
By removing the older layers of skin, allowing newer skin cells to come through, and stimulating the natural dermal collagen layer, medical microdermabrasion will reduce the very finest lines and wrinkles. The number of sessions may vary depending on the depth of the problem and a person's skin type. Many will get a good result after four to six sessions.
The benefit can be maintained with single monthly or so sessions as required. By doing this procedure first, the need for other modalities (as below) can be reduced or eliminated. Sagging along the jaw-line, upper eyelids and other similar areas is also reduced with special applications of this method.
Dysport or Botox (Botulinum A Toxin)
Botulinum toxin A is useful for face lines caused by muscle expression lines in such areas as the upper parts of the face and the chin line below the lower lip. The commonest area is that of the frown lines between the eyes. Also the lateral eye crow's feet and the horizontal lines of the forehead. By coincidence migraines have been relieved for the period of the effect of the treatment as well.
Utilising Dysport (a British version of what is known as Botox in the USA), small volumes of the dilute solution are instilled, blocking the nerve endings that supply the muscles, causing the muscles to relax over usually three to five days and lasting three months or more. In a number of people progressive lengths of time can be achieved with successive treatments.
Dermal (Skin) Fillers
Hyaluronic Acid - Restylane
The fulness of the skin is supported by underlying collagen and hyaluronic acid. Collagen has been used for many years to treat lines, wrinkles, and to enhance lip lines and lip fulness. Produced from a cowhide, pre-testing is necessary to ensure there is no underlying allergy to the product. In more recent years a cultured human collagen from an original foreskin sample has become available. This bypasses the problem of species-related protein allergy.
The function of hyaluronic acid (Restylane), present in a lot of body tissues, was not understood for many years. This long sugar molecule serves to bind water to itself, thereby creating fulness as well as serving other body functions. The structure of hyaluronic acid is common across a lot of species. Allergy testing therefore is not necessary. Allergies to it very rarely happen.
In most applications hyaluronic acid products seem to last twice as long as collagen. Therefore, in most areas, it should last six to twelve months. In areas associated with muscle movement, dermal fillers disappear faster as the muscle action tends to massage it away.
Combining the filler with a Dysport or Botox treatment (in appropriate places) can therefore prolong the filler effect. There is also a denser form available which lasts a little longer.
Calcium Hydroxyapatite - Radiesse
For longer effects a newer filler based on a scaffolding-type effect of calcium hydroxylapatite (Radiesse) has been developed. This is the lattice work used by the body in the formation of bone. When placed about bone it forms new bone tissue. In other tissue areas, though, it produces extra tissue within it from that around it.
It has been used for some years in improving vocal cord function where there has been an impairment. It has also been used at the outlet of the bladder to improve continence.
Due to its nature it has to be placed under the skin structure. This means fine lines are not so easily elevated. But larger ones like the nasolabial fold and other similar areas respond well. It tends to last two to four years or so. Its use in lips is less ideal as it tends to produce some irregular lumpiness.
Radiesse is not a registered medicine and is available to be used under Section 29 of the Medicines Act 1981.
Polyacrylamide Gel - Aquamid
Beyond this is the permanent filler polyacrylamide gel, Aquamid. This was used years before in Russia as a breast augmentation agent. There was no evidence of adverse long term effects from this application. The base for it is actually used in various areas of the world as a water purification agent. Polyacrylamide Gel is not a registered medicine and is available to be used under Section 29 of the Medicines Act 1981.
Again it must be placed under the skin so is less useful in fine line reduction. It does a great job at lip filling though. Due to the fact it is a long-term filler (only needing adding to as the surrounding tissue continues to decrease) people seeking its use need to be sure they want it where it is placed for their full life expectancy.
Aquamid is not a registered medicine and is available to be used under Section 29 of the Medicines Act 1981.
PRP - Platelet Rich Plasma - Therapy
Platelet rich plasma - PRP - supplied from your own blood allows for an autologous - own tissue - treatment to improve fine lines and wrinkles and to recondition the skin. Taking about three sessions and lasting for around two years this is an emerging field you can find more about at our page
specifically about this.
Cosmecanique by the Lift 6
This unique machine, the Lift 6
, developed by LPG has proven useful for treating the face, neck, décolletage and breasts with its cosmecanique technique
. By stimulating the connective tissue in the skin and improving both circulation and lymphatic fluid flow, the appearance of the skin can be enhanced. Fine lines are helped and a degree of lift results.
The apparatus replicates the “Pincement Jacquet-Lery” French technique in a comfortable massaging influence. People see an immediate change in the areas treated, especially when comparing a treated to a non-treated side, part way through the treatment.
The change after the first session wears off overnight. But as further sessions are continued the effect lasts longer. After a usual course of fifteen, the effect will last around six to nine months and can be enhanced or continued by further occasional single treatments.
With our newer endermologie machine - the Cellu M6 Integral S
- these treatments are now incorporated as part of this larger machine we use in our cellulite and non-surgical body-shaping treatments.
In the breast area a slightly different protocol, but utilising the same underlying principle, can increase breast fullness and lift. The breasts appear fuller and more pert. The most dramatic changes occur with the smaller cup sizes. All breasts will experience some degree of benefit.
Non-Ablative Laser Treatments
Xeo Cool Glide Laser - Genesis Treatments
In the past skin vapourising lasers were employed to improve wrinkles (as noted below). This was very effective but there were problems with downtime and risks with infection (and subsequent scarring), loss of normal pigmentation and direct scarring through prolonged healing or deeper heat effects.
In more recent years lasers have been employed at different wavelengths to stimulate the tissues under the skin to produce new collagen synthesis. Both the Cutera Xeo Cool Glide
laser (which we use most commonly) and the Dual Yellow laser
can produce significant effects.
In the Genesis treatment
with the Xeo Cool Glide (1064nm NdYAG laser) a 5mm mid-sized beam
is used, slightly defocused with the head not in contact with the skin, with a lowish energy and a very short and rapidly repeated pulse. This absorbs into the second layer of the skin (the dermis) in the local blood vessels there as well as other tissue chromophores such as those located in the mitochondria of the cells to increase the activity of the fibroblasts – the cells that produce the collagen and elastin.
Over a series of sessions, usually undertaken about three or four weeks apart, fine lines will improve. Usually around five sessions in younger, less severely affected skin will produce changes. In older people around seven are needed. After the third and fourth session pore size decreases. Local changes continue to occur for up to three months after treatments stop. The benefit will continue for months to years after the sessions. Frequently people return for the occasional single session to boost the effect particularly for the skin surface benefits.
All skin colours are suitable for treatment with the Xeo Cool Glide Genesis procedure.
The effects of the Genesis procedure can be enhanced
by other heads on the Xeo Cool Glide platform. The OPS 600, which is an intelligent pulsed light source of 600-850nm, reduces uneven pigmentation and produces its own more superficial skin improvement. The LP 560 using 560-850nm light can help reduce reddened areas too. The Titan head, discussed below, can also add other tissue tightening effects reducing other lines.
Dual Yellow Laser - Photorejuvenation
The Dual Yellow laser can have a similar effect
using its yellow 578nm light and moving rapidly over the area in a scanning fashion. In the earliest applications of this method a non-contact tip was used. More commonly now a contact tip with gel applied to the skin is used in either a computerised controlled head or a smaller tip with free-hand scanning.
There is more associated discomfort with this laser. But local anaesthetic can be employed and the freehand scanning is more comfortable.
Some good changes on fine lines about the eyes have been seen with three sessions of the Dual Yellow. The treated skin must not have a recent tan and more brown skins are not suitable for this.
Light Treatment Skin Tightening
Xeo Cool Glide Titan Treatment
This is a more recent innovation available since about 2003 in some areas that were testing the initial machines and more widely since 2004. At Springdale we began using this technique in 2005. It employs the Titan
head on the Xeo Cool Glide laser platform.
The basis for the treatment is that an infra-red light (1100-1800nm) source in shone on the skin while in contact. This absorbs selectively into water molecules located in most of the skin cells. By pre- and post-cooling the skin as part of the action of the applied treatment head the action is localised in the deeper dermis.
This induces some immediate effect put down to collagen contraction (although there is a very narrow temperature window that achieves this) but probably also affected by increased blood supply and fluid movement. It seems to wear off fairly rapidly overnight in most people and then long-term changes begin with tightening around five weeks and continuing for up to six months after the treatment.
Most people benefit from a couple of treatments usually two months apart. Some people requiring minor benefits will need only a single session. A few people might need a third.
The tightening achieved
is in the order of 1-3mm. But this can be enough to soften or, in some cases, eliminate some superficial lines. Certainly the heavier folds in the nasolabial area can be quite dramatically reduced.
should be quite comfortable. At its most effective range each around seven second pulse should feel just briefly slightly hot (below a feeling of burn).
As mentioned above it can be combined
with other Xeo Cool Glide treatments, either with specific treatments from the NdYAG 1064nm laser head to produce more superficial collagen changes and line reduction, to spot treatments of unwanted blood vessels, or one of the other Intelligent Pulsed Light sources such as the OPS 600 which reduces uneven pigmentation to the LP 560 which does that as well as reducing excess redness.
Plasma Treatment for Tightening and Lines
Plasma Portrait PSR3
To achieve more rapid improvement in lines and skin tightening there has been another recent development. Ablative lasers such as the carbon dioxide (CO2) from the mid 1990s and later the Erbium were employed quite successfully to give quite dramatic results with wrinkle reduction. The problem was that in vapourising the skin a raw wound was left (like an open graze) which took some time to heal. This involved regular dressings being applied and the risk of various infections with the open weepy skin.
In the last couple of years an alternative has arisen – the plasma based Portrait PSR3 machine. As with the more aggressive ablative laser treatments there is some downtime after treatment while the skin recovers. But a single high energy session can produce quite dramatic results.
The changes are noticeable as the skin heals but continue to improve over the year following treatment. The skin effectively acts as a bandage over the treated base, peeling away over three or four days revealing fresh delicate new pink skin below.
Lighter treatments can be used with less downtime and only minor peeling and redness. Normally three or so of these treatments is required and the final result is not usually as dramatic as the single stronger one.
With changes in the company that manufactured this machine, we have not utilised this process for some time and likely will not use it in the future, aiming to use some other modalities. More will be placed on the site as we embrace them.
Other Treatments Used Elsewhere
These have been used for some time to remove lines and wrinkles through resurfacing the skin. Different types are available. In many ways a lot of them are similar in effect to microdermabrasion, but less controllable at the treatment times. More powerful ones run into discomfort problems and sometimes unpredictable outcomes.
Laser resurfacing by either carbon dioxide or the newer erbium laser will achieve a dramatic effect in usually one session (occasionally two with the erbium). More severe wrinkle problems will respond well to this. The cost, recovery time and time until the face settles fully can be a consideration in deciding on this form of treatment.
Radiofrequency tissue tightening with various machines has been used quite effectively in some and not so in others. There tends to be a higher level of discomfort than with the light-based treatment. And its targeting is not as specific.
Surgical facelifts are designed to tighten loose skin. When there are redundant folds of skin present, this is certainly the best approach. They are best done through a qualified plastic surgeon.
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