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Posted March 10, 2015 in Facial Rejuventation

Rejuvenation is a medical discipline focused on the practical reversal of the aging process. Man’s perpetual desire to counter this aging process has been engrained in our DNA for millennia. More than 3000 years ago, Queen Nefertiti was arguably one of the most powerful and mysterious women in ancient Egypt and to this day she remains a global icon of feminine beauty. From brow rejuvenation to nose reconstruction, the modern interpretation and methods we use to this day stem from such times.

Facial aging is a complex process. Despite recent advances in science, we are still unable to significantly inhibit or reverse the aging process on a molecular level. Hundreds of treatments have come and gone. Aestheticians have described new techniques and many of these practices have been discontinued due to unwanted side effects.

The pharmaceutical sector is a multibillion-dollar industry, and thousands of chemicals and compounds have been studied in the hope that we find the miracle anti-aging pill. The molecular structure of collagen has eluded scientists for decades.  More than 20 years ago collagen injections of porcine (pig) and bovine (cow) origin were extremely popular. Their use in 2015 is practically obsolete due to the risk of allergic reactions, infections and permanent granuloma formation (firm hard nodules that require surgical removal). Despite this, we have seen a resurgence of interest in collagen and it’s surrounding structures in the past decade. One of the ‘hottest’ structures studied and used in modern aesthetics is hyaluronic acid. Almost every cosmeceutical company now has this ‘structure’ in their range of products. Hyaluronic acid or HA is essentially the ‘goo’ that binds collagen molecules together; a structure that scientists have successfully synthesized from bacteria. HA is the number one choice of filler worldwide and is second to Botulinum toxin injections as the most popular forms of non-surgical procedures in the 21st century. It has remarkable filling capacity, it helps to mask deep lines and wrinkles but is also responsible for hundreds of overly done celebrities whose images are circulating on social and media platforms.

We see far fewer complications with hyaluronic acid based fillers than we used to with more permanent type collagen based fillers. The single reason for this is the body’s ability to break down HA and the fact that there is almost a zero risk of developing an allergic reaction to HA. Despite this, some patients do develop reactions to HA and unfortunately many of these patients require surgical intervention.

The use of HA based fillers should be used with caution. They should be injected by a professional, and should be used conservatively.

Botulinum toxin was a remarkable discovery and is still successfully used in the treatment of spasticity in cerebral palsy patients. By manipulating the Botulinum toxin in the laboratory, scientists discovered a way to temporarily paralyze muscles and relieve painful spasms. The aesthetic industry uses the toxin in very much the same way. By paralyzing muscles of the face, the skin overlying it tends to relax and wrinkles are diminished. The problem lies in its long-term use. Muscles that are injected with toxin tend to atrophy. The repeated use of toxin injections over a long period of time can have unpredictable consequences. They should be used with caution and injected by a professional that has a true understanding of what they intend to achieve by injecting the toxin.

Research on an even “smaller” level will probably find the answer to reversing the aging process.  Genetic manipulation of specific DNA structures that are responsible for aging will be the focus of attention. Unfortunately any manipulation of our DNA is subject to ethical scrutiny and potential disastrous outcomes and I don’t think we will find a safe, reliable answer in the foreseeable future.

When it comes to anti-aging techniques in the 21st century we must be cognizant of the basics that have been tried and tested for many years.  I have already alluded to the fact that we may not yet have the answer to ‘specific’ anti-aging. We do, however, have a very good understanding of why we age and we often tend to neglect the basics. The field of preventative medicine is an integral part of any specialty, from cardiology to gastroenterology. Screening protocols and preventive strategies to evade disease are commonplace in modern medicine. Instead of focusing on curable anti-aging strategies, why not focus on preventative strategies in the field of Aesthetics? Prevention is always better than cure.

The single most important cause of facial aging is solar radiation. Solar radiation is responsible for the generation of harmful, ‘aging’ free radicals in our skin. For years we have known this; it has become general knowledge even in primary schools. Children were never advised to wear hats in post curricular outdoor activities in schools in the 70’s. It is now compulsory in several schools.  The negative changes that occur on the molecular and histological level in the skin are profound, well documented and well understood. It is this intellectual knowledge alone that has seen a shift in the timing of face-lift surgery requests in plastic surgery over the past few decades in the well-informed patient.  The specific skin changes and disastrous, damaging consequences are far beyond the scope of this article. Stress, poor nutrition, lack of exercise and smoking are extremely important factors very often overlooked and are all well established causes of free radical generation in our skin. The end result is inelastic skin without enough collagen to provide structural support.

UV blockers in the form of creams are well established and should be recommend by every single aesthetician and should be the first line of defence in any anti-aging protocol. Recent advances in our understanding of radiation damage to the skin include infrared radiation, which forms part of the solar spectrum. These other forms of radiation are successfully blocked with anti-oxidant serums that also help to neutralise free radicals generated in the skin. Traditional sun blocks alone only prevent damage from UV radiation. I routinely prescribe a sunblock and an anti-oxidant serum to every single patient requesting facial rejuvenation.  Vitamin C, as an example, is a well-established anti-oxidant, but is completely useless and unstable if not formulated and stored correctly.

Well-established features of the ageing skin are diminished levels of collagen and its surrounding structures in the deep layers of the skin.  A healthy skin contains significant levels of collagen, elastin, hyaluronic acid and lots of essential ‘goo stuff’ that help to provide the skin with its ‘youthfulness’ and integrity.

“Micro-trauma” when applied or delivered to the skin in the form of a chemical, a needle, a laser or a cosmeceutical is healthy, non-scarring and rejuvenating when prescribed and administered by an aesthetician correctly. They all result in the production of collagen and its surrounding constituents. The term “neocollagenesis” means the production of new collagen in the skin. Anything that creates micro-trauma to the skin results in neocollagenesis. Micro needling, microdermabrasion, laser therapy and chemical peels all result in neocollagenesis. Yet their method of action is different. The choice of method depends solely on down time. Certain treatments take longer to heal, whilst some require more sessions. Treatments need to be tailored to the specific individual, their requirements and their lifestyle. I prefer to use a combination of therapies in order to achieve the end result, always keeping in mind the importance of a sunblock and an anti-oxidant serum.

It will take many years before we truly establish safe strategies that are truly anti-aging by definition. In the mean time, we should focus on educating our patients on modalities that work, that are safe and keep the sag away for now….

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