Skin aging is a complex, gradual and ongoing process. It involves several physiological phenomena that lead to loss of volume, such as decreased collagen in the skin, bone resorption (bone loss) and loss of adipose tissue. There is also slackening of a number of ligaments with age. All of these changes can give the face an undesirable appearance, projecting a look or demeanour that is not consistent with how people feel. Many people say they look tired, severe or less feminine/masculine. Some find their face has become flabby or less defined.
All of these factors must be taken into account when trying to combat skin aging, so that when people look in the mirror, the image they see reflects who they feel like inside.
At the same time, we must also make sure we address the fears of those who are worried about looking frozen, unnatural, weird or no longer recognizing themselves.
For the face to remain truly natural, several types of treatments must often be used in combination. The key to success is to do treatments on a regular basis to ensure long-term maintenance.
What is a wrinkle? It is a small linear crease in the skin that can have different causes. There are several types of wrinkles and they will be treated differently depending on the underlying cause. Wrinkles can be caused by sagging of the tissues (volume loss wrinkles) or by repeated folds in the same place related to movement, speech or laughter (expression wrinkles) or by a loss of tone.
To reduce expression lines, muscle relaxants containing botulinum toxin type A (Xeomin®,Botox® or Dysport®) are typically used and injected into the muscle to make the area look more relaxed.
Expression lines are caused by the repeated contraction of certain facial muscles. For example, someone who raises their eyebrows a lot will develop horizontal wrinkles on the forehead. Someone who frowns a lot when expressing themselves will develop what are called frown lines. These wrinkles, which can sometimes be very deep, form between the eyebrows and give the face a severe look.
Crow’s feet are small wrinkles that occur around the eyes and are seen in people who laugh a lot. Rather than erasing these wrinkles completely, it is preferable to attenuate them while maintaining a natural appearance and avoiding a frozen look.
Smoker’s wrinkles (even in people who have never smoked) are small wrinkles that form around the mouth. Microneedling, ablative radiofrequency and hyaluronic acid injections are very useful for correcting these small wrinkles while maintaining a natural appearance.
For volume loss wrinkles, such as nasolabial folds or marionette lines, it is essential to restore volume in strategic places to rebalance the face, restructure it and restore definition. Treatments of choice are hyaluronic acid injections (Juvéderm®, Restylane®, Belotero®) and collagen biostimulators.
Several technologies are effective for improving loss of tone. These include intense pulsed light, which provokes the phenomenon of photorejuvenation and collagen production, microneedling to stimulate collagen production, radiofrequency (ablative or nonablative) and injection of growth factors, such as fresh platelet-rich plasma. Injectable collagen biostimulators containing poly-L-lactic acid (Sculptra®) or calcium hydroxylapatite (Radiesse®) can also be used.