Intrinsic, or innate aging, is a naturally occurring process that results from slow, but progressive and irreversible tissue degeneration. Based on unique genetic factors, intrinsic aging affects everyone at different rates. Clinically, fine wrinkling of the skin, loss of skin tone, skin laxity, and loss of subcutaneous fat occur. Loss of underlying fat pads and bone re-absorption leads to development of hollowed areas near the eyes and cheeks.
Of the extrinsic factors, ultraviolet (UV) and infrared (IR) radiation from the sun, so-called photoaging, environmental pollutants and wind play a crucial role. Clinically, photoaging is characterized by coarse wrinkling and furrowing of the skin, elastosis, and a variety of benign, pre-malignant and malignant neoplasms. Photo-damaged skin shows a 20% decrease in total collagen and decreased cellular content compared to sun-protected skin.
Moreover, pigmentary alterations, red superficial blood vessels (telangiectasias) and brown spots contribute to an aged appearance of the skin by creating shadows and contrast on the face.
To minimize premature aging of the skin:
- Protect your skin from sun exposure
- If you are a smoker – quit! You may see improvement in your skin after quitting, even if you have smoked for many years.
Your skin should be examined regularly for precancerous and cancerous lesions at least once a year. Make sure to perform skin self-exams monthly.
The natural aging process can be divided into photoaging and structural aging. Structural aging has two components – gravitational and volumetric. As a result of structural aging, shape and facial proportions change.
Age associated structural changes include:
- Dermal thinning and loss of elasticity
- Photoaging and exposure to environmental pollutants are associated with reduction in collagen and elastin leading to clinically visible as fine lines and wrinkles
- Therapy Options: sun protection, topical retinoids, chemical peel, microdermabrasion, intense pulsed light (IPL), photodynamic therapy (PDT), non-ablative and ablative lasers
- Gravitational aging
- Leads to drooping of the skin
- Common manifestations include rhytids, grooves, wrinkles, and jowls (“sags and bags”)
- Therapy Options: BOTOX, Dysport, Xeomin, Jeuveau, fillers, neck and jowl liposuction, contour thread lift, S-lift, blepharoplasty, facial implants, brow-lift, CO2 and erbium: YAG laser resurfacing, radiofrequency
- Volumetric aging
- Leads to development of deep hollows and furrows and thinning of the face
- Loss and redistribution of fat
- Loss of temporal fat resulting in loss of natural convexity
- Loss of lateral cheek (malar, zygomatic) fat leading to sagging and soft tissue loss in the mid face
- Skeletal and bone remodeling
- Decreased brow support leading to sagging eyebrows
- Increased orbit size
- Sunken maxilla
- Therapy Options: fillers, autologous fat transfer, facial implants
Soft tissue injections can be used in many ways to address your individual concerns. Areas of possible augmentation include:
- Lateral eyebrows to provide adequate brow support, “brow lift” and shaping
- Periorbital volumizing diminishes appearance of infraorbital hollows, under-eye dark circles
- Nose – shape and structural irregularities can be address by non-surgical filler rhinoplasty
- Nasolabial fold – facial “parentheses”, the lines that run from the nose to the corner of the mouth
- Chin – shape and structural irregularities can be addressed by non-surgical filler chin implant
- Lips – soft tissue fillers are used to fill in and augment thin lips. Improve border and volume.
- “Marionette lines” – sad, downward expression that appears at the corners of the mouth with advanced age
- Lift up jowls or plump up volume along the jawline where definition has been lost.
- Acne and depressed scars
- Static wrinkles – wrinkles at rest, caused by aging, overexposure to the sun, environmental exposures and/or cigarette smoking
While it is not a soft tissue filler, botulinum derivatives BOTOX, Dysport, Xeomin, and Jeuveau are very popular injectable treatments that work synergistically with fillers for wrinkle treatment and overall facial rejuvenation.
BOTOX, Dysport, Xeomin, Jeuveau are meant for “dynamic” wrinkles that are caused by repeated muscle movements and increase the effects of fillers that actually plump up wrinkles and facial depressions. Soft tissue filler and BOTOX®/Dysport, Xeomin, Jeuveau injections can be performed on the same day, during a single session.
There are a variety of treatments available to improve the appearance of damaged skin:
- Dermal fillers, or soft-tissue fillers, can be injected into the skin to fill areas that look hollowed or wrinkled such as nasolabial folds, marionette lines, under eye dark circles.
- Botox, Dysport, Xeomin, Jeuveau –a purified form of botulinum toxin, is injected into targeted facial muscles to prevent and correct wrinkles related to certain repeated facial expressions (such as squinting, smiling or frowning).
- Chemical peels are chemical solutions that, when applied to skin, remove damaged outer layers, leaving smoother contours and an overall improved appearance. Chemical peels have many dermatological uses, including the treatment of wrinkles, brown age spots and scars.
- Intense pulsed light (IPL) photofacial is effective in removing age spots, freckles, fine wrinkles, broken capillaries, telangiectasias (red, purple or blue small veins on the face), hemangiomas, sun damage and some flat birthmarks. IPL might also be useful in reducing facial flushing and redness.
- Photodynamic therapy (PDT) with Levulan® is a two-step FDA-approved procedure for the treatment of precancerous actinic keratoses and superficial basal cell skin cancer. Off-label uses of PDT include treatment of acne, rosacea, sebaceous hyperplasia and skin rejuvenation.
- Laser resurfacing effectively removes the epidermis and a portion of the dermis, thereby removing unwanted epidermal changes and initiating regeneration of new epidermis, collagen, and elastic tissue. In addition, heat deposition offers the additional benefit of tissue tightening and collagen shrinkage. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, age spots, seborrheic and actinic keratoses as well as tightening the skin and improving overall appearance.
- Liposuction is a way to reduce visible effects of aging by removing unwanted fat deposits that don’t respond to diet or exercise. Common target areas include the face, chin, neck, hips, and buttocks.
- Dermabrasion is a common treatment in which the top layer of skin is abraded so that a new, smoother layer grows in its place. It’s used for many skin conditions, including acne and acne scarring, skin cancer, and photoaging.
- Microdermabrasion is a minimally invasive, superficial resurfacing procedure that gently scrapes away the most superficial damaged and aged layers of the skin to trigger the growth of a new healthy epidermis.
- Topical retinoids have been shown to reduce fine wrinkles, uneven pigmentation and other signs of chronic sun damage.
- Unwanted facial and body hair can be removed through laser hair removal.
- “Cosmeceutical” are products containing biologically active agents designed to reduce the signs of aging, such as alpha-hydroxy acids, anti-inflammatory agents and/or antioxidants.
- Topical moisturizers