Wrinkles & Sun Damage Treatment
Age and sun exposure are the two main factors in the appearance of lines and wrinkles, pigmentary changes and change in facial shape and appearance. Wrinkles appear with ageing and may be exacerbated by loss of facial fat and over-active facial muscles. Filler injections and muscle relaxing injections may be used alone or together to relax smile or frown lines and fill in the residual wrinkles. Lines around the mouth are usually caused by loss of lip volume due to ageing, and modest replacement with Hyaluronic Acid fillers can restore lost volume and fill out wrinkles.
Hyaluronic acid filler injections
The first filler to appear in the 1980's was collagen. This was unsatisfactory due to its short lifespan (often less than three months) and rate of allergic reaction. The hyaluronic acid products revolutionised filling. They are natural tissue gels present in all living tissue. They are manufactured using a natural bacterial culture (similar to that used to manufacture foods such as yoghurt and cheese). These products are used in the treatment of fine lines around the eyes, mouth and for restoration of lost lip volume. Treatment needs to be repeated at six to nine monthly intervals.
Bulk filling refers to the replacement of facial fat loss within the treatment of deep shadow areas. Initially fat transfer was used, however this is a complex procedure and many of the patients who need it do not have the abdominal or hip fullness necessary to provide adequate amounts. The other problem with fat transfer is its unpredictable duration of effect.
Hyaluronic base fillers are the most practical solution in a procedure that we call "megafilling". This is usually repeated on an annual basis. Laser Dermatology makes use of multiple different hyaluronic fillers based on individual requirements.
Some subliminal signs of ageing which respond well to bulk-filling are:
- Naso-labial creases. The naso-labial fold runs from the outer corner of the mouth to the nose. This is usually the first sign of facial ageing.
- Under-eye shadow ("Tear Trough") and vertical mid cheek shadowing (nasojugal). Due to loss of facial fat usually caused by ageing but sometimes seen in lean, fit younger people.
- Backs of hands - loss of fat can be filled with HLA. "Age spots" can be removed with Q-switched YAG laser.
Botulinum toxin injection
This product was first used by eye specialists for the treatment of eyelid spasm. The cosmetic dose is only enough to induce mild relaxation of over-active muscles. Its effects wear off over six to nine months. In larger doses this medication is now being used to help children with spastic cerebral palsy to relax their limbs and allow them to learn to walk.
Fine generalised sun damage wrinkles
Facial wrinkles caused by sundamage can be improved but not eliminated. The new Fraxel re:store® dual laser can soften these signs of ageing with minimal "down time". The Fraxel re:pair® ablative laser is excellent for severe sundamage and wrinkling but does require a minimum of one week recuperation time. Laser Dermatology has the only Fraxel re:pair® laser in Victoria.
Ageing and sun damage to the chest and neck
Redness on the neck and chest is caused by sun damage and is known as poikiloderma of Civatte. It produces a characteristic horseshoe shape on the neck caused by sparing under the chin which is in shadow and protected from sun damage. On the chest it is usually confined to the area above clothing necklines.
This problem is treated using a combination of laser treatments using the Candela Vbeam Perfecta™ laser and the Ellipse Flex™ IPL. The skin at this site is very delicate and there can be problems with white marks if laser treatment is carried out too aggressively. It is therefore important to choose experienced laser operators who will treat using multiple low power sessions and encourage patience regarding the outcome.
Age spots and sunburn freckles
It is important to note that at Laser Dermatology, all pigmented lesions are assessed by a qualified dermatologist before any type of removal is considered.
The laser treatments of choice for these benign pigmentary changes are the RevLite® SI Q-Switched Nd:YAG laser and the Sinon™ Ruby laser. The same lasers used for laser tattoo removal and laser removal treatment of brown birthmarks are also very helpful in the removal of ageing brown marks. Usually only one laser treatment is necessary. More diffuse sun damage pigmentary change will respond to treatment with the Fraxel re:store® Dual laser.
Glycolic Acid peeling system
What should I know about Glycolic Acid peeling system?
A key factor that can affect the appearance of your skin is over-exposure to the sun. Often these changes are mild and may respond to a combination of safe alpha hydroxy acid peels in combination with a dermatologist recommended daily skin care regime. This gentle method of treatment may be suitable for surface pigmentation, fine textural change, "dull" complexion and oily or acne prone skin.
Laser Dermatology uses Neostrata ™ peel products that contain glycolic acid, an alpha- hydroxy acid which, in nature, is found in sugar cane. Rationale ™ skin care products including niacinamide serum is suggested for daily use. More information on Rationale ™ skin care products is available from the nursing staff.
This peel will be prescribed by a dermatologist and performed by a registered nurse. It may be used alone or in conjunction with other therapies. It is especially designed with products formulated to provide the best results for your skin. This process begins with the removal of the damaged layer of skin, which lies over the undamaged skin.
What is Glycolic Acid?
Glycolic acid is one of the alpha hydroxy acids (AHA's) a group of naturally occurring substances often referred to as "fruit acids" because they are found naturally in various fruits and other foods. In its natural state, glycolic acid is found in sugar cane juice.
Numerous clinical publications have shown the benefits of AHA's in improving skin appearance. Improvement may be achieved in the appearance of mild acne, oily/problem skin and surface pigmentation and fine textural change due to sun damage and ageing.
Many skin problems are caused by, or associated with, excessive build up of dead skin cells that make the skin thick and dull. AHA's help loosen and remove the layers of dead skin cells that accumulate on the surface of the skin. This produces an initial thinning of the skin and an ongoing improvement in skin appearance and texture.
What is a Glycolic Acid Peel?
A glycolic acid peel is a gentle process whereby a high concentration of glycolic acid is applied to the skin. Treatment is commenced with lower concentrations of peel solution; with stronger peel solution applied at subsequent treatments up to a maximum of 70%. This removes the dead outermost layer of the skin to reveal a softer, smoother and clearer skin underneath. Essentially the glycolic acid peel process is a controlled removal of the surface skin cells to reveal a better looking skin.
How will I look or feel immediately after the peel?
The majority of patients develop a slight redness following the peels. This usually subsides after a few hours. Usually there is no visible shedding of the skin, however occasionally some people react strongly. Because of the mild reaction, these peels have become known as "mild peels".
What is the timing for the additional peels?
Patients usually have 6 - 12 treatments performed at weekly intervals, and may go on to a maintenance treatment of fortnightly peels if recommended. The glycolic acid peeling regime was created to allow flexibility in the timing of the peels, and for you to proceed at a comfortable rate of skin improvements. Some problems i.e. skin sallowness, roughness or acne start to improve immediately, while fine wrinkles, acne and pigmentation improve gradually.
Is there any reason I shouldn't have a peel?
The following conditions may contra-indicate glycolic acid peels. Please tell your dermatologist and nurse if you have any of the following:-
- Seborrhoeic dermatitis
- Collagen disease or auto-immune disorders
- History of cold sores ( Herpes Simplex)
- Hypertrophic or keloid scarring
- Roaccutane in the last 6 months
It is important to note that not all problems will respond to gentle peels. Your dermatologist will recommend the most appropriate treatment for your specific problem. This may require laser or light therapy (IPL) treatment to achieve the best outcome.
Minimally invasive skin tightening procedures
The surgical facelift performed by a qualified Plastic Surgeon remains the gold standard for predictable long lasting results. This is, however, an expensive procedure with significant recovery times and many patients look for alternatives. Modern technology has given us some new, less invasive procedures; however the results are modest, not as long term and it is important that one has realistic expectations.
Loose skin and fat pads under the chin can be another manifestation of ageing. This problem will respond on many occasions to minimally invasive dissection and liposuction using a fine cannula. The procedure is done under local anaesthesia and does not require hospitalisation.