What happens during the ageing process?
The skin becomes thinner with loss of ground substance, collagen, elastin fibres and, occasionally, fat. This is accompanied by uneven accumulation of pigments. The result is deterioration of skin texture and colour, wrinkles, skin laxity and loss of volume.
How do you formulate a rejuvenation regime?
Every patient requires a personalised regime.
I identify the most significant problems and the ones that bother the patient most. I plan the regime based on the patient’s work schedule, tolerance for downtime, pain threshold, risk adversity and financial constraints.
What are the simpler rejuvenation techniques?
For improvement of skin texture, pore size, pigmentation and fine wrinkles, I recommend intense pulsed light (IPL) or broadband light (BBL). This treatment is well tolerated and has no down time. Clinical results are usually seen within two to three treatments up to one month apart. Some patients report results as early as one week after treatment.
Botulinum toxin injection is the standard treatment for wrinkles which are worsened by facial animation. It can improve crow’s feet, frown lines and forehead wrinkles and its effects usually last for three to four months. Clinical judgement is needed to alleviate wrinkles without causing an unnatural mask-like appearance.
Filler replaces volume to correct deep facial folds and volumise the cheeks for a more youthful appearance. For non-surgical augmentation of the nose, fillers can be a temporary alternative. Most fillers are composed of hyaluronic acid which lasts for about six months. Long-lasting filler materials are associated with side-effects such as infection and granuloma formation.
Botox and fillers complement each other and some patients require both.
Several non-invasive therapies are available to tighten the skin moderately. These include the use of infrared wave therapy (Sciton SkinTyte®), radiofrequency (Thermage®), and focused ultrasound (Ultherapy®). Post-procedure oedema and erythema commonly resolve within a few days, but clinical results may not be as dramatic as ablative laser procedure.
Microlaser peel (resurfacing) can further improve superficial skin texture, and the patient can put on make-up about three to five days after the procedure.
What of moderately complex techniques before surgery?
Profractional laser is used to achieve further skin tightening. This ablates narrow channels into the skin, and is used to treat atrophic acne scars. The healing process is faster and patients can return to work in a few days.
Thread lift provides added skin lifting to the cheeks and temporal area. Several barbed threads made of absorbable material are inserted skin-deep and stabilised by suturing to the temporal area. The initial appearance may appear over-corrected but normally improves over a few weeks to months. The effects can last for one to two years. Fat injection (grafting) has become popular for volume replacement. Fat tissue contains stem cells with rejuvenating properties which are harvested from the abdomen or thighs and processed before being injected. Post-procedure swelling and bruising last for a few weeks, and the final result is firmer skin with increased volume and improvement in wrinkles.
How do you devise a surgical plan for facial rejuvenation?
Ageing affects each part of the face at different speeds and times and this must be understood in the context of the desire for facial rejuvenation.