Reverse the Clock: A Guide to Aesthetic Treatments for Anti-Aging
- Dr. Ho Shuyan
- Mar 19, 2023
- 8 min read
Time flies. Getting into your 60s is unavoidable, and aging is unavoidable. As you approach 4th decades of life, you might start to notice signs of aging, such as:
- Fine lines and wrinkles-> due to repeated facial movements and expression. As skin ages, it loses collagen and elastic fibres, leading to loss of flexibility and elasticity.
- Dullness of skin-> due to buildup of dead skin cells
- Uneven skin tone and hyperpigmentation-> caused by hyperactivation of melanocytes (pigment-forming cells), alteration in the distribution of pigment and turnover
- Dry skin -> due to decreased amount of natural moisturizing factors, glycosaminoglycan and impaired skin barrier causing water loss.
- Rough skin texture-> caused by dryness and buildup of dead skin cells
- Visible pores-> due to reduced skin elasticity around pores
- Sunken eyes-> due to fat tissue reduction
- Dark circles-> as you age, skin below your eyes loosen and thins out, making colour of blood vessels underneath more visible. Sunken eyes also result in dark circles due to shadow.
- Hollowness of cheeks, temper, forehead-> due to superficial fat pads loss
- Face sagging-> due to drooping of deep fat pads, alteration of supporting ligaments and loose skin.
However, why do some people age like fine wine, but you don’t?
There are multiple factors that speed up aging, including:
Sleep deprivation
Ever notice why people who have sleeping disorders, work night shift, and oncalls like doctors *sigh * tend to age faster? It is because inadequate sleep can accelerate aging process. Here is why:
During the first three hours of sleep, growth hormones called somatotropin is being produced, and this hormone helps to repair damaged skin cells. Another hormone, namely melatonin increases during the next two hours of sleep. It helps to protect skin from damaging free radicals that cause aging. During the final stage of sleep, cortisol, which is a stress hormone, along with skin temperature decrease. These cause the muscles to relax and collagen production to increase. In other words, when you do not get enough sleep, the damaged skin cells do not get a chance to repair, thus leading to signs of aging.
Blood vessels dilate when you do not get enough sleep. The colour of dilated blood vessels is able to show through the very thin skin of your undereyes, appearing as dark eye circles.
Stress
Stress raises the level of cortisol, leading to collagen and elastin breakdown and forming wrinkles. So, whoever reading this now, smile and relax :D
Lack of Exercise
Exercise improves blood circulation which delivers oxygen and nutrients to body’s organs including skin. Exercise also burns fat and tones up muscles, giving you a better body figure and less cellulites.
Alcohol
Heavy alcohol drinkers age faster because alcohol directly affects DNA. Studies found that heavy alcohol drinkers have shorter telomeres- a part of chromosomes linked to aging. Also, alcohol being a diuretic dehydrates you. Dehydration makes your skin dry and saggy, and wrinkles also appear to be more pronounced.
Smoking
Tobacco smoke contains reactive oxygen species, which increase matrix metalloproteinase level, leading to break down of collagen. Nicotine also constricts your blood vessels, reducing blood flow to your skin.
Unhealthy Diet
Processed food can speed up aging of your cells due to the high amount of saturated fats and trans fats that promotes inflammation. Same goes to high-sugar diet that cause inflammation and accelerates the breakdown of cells.
Sun Exposure
Ultraviolet rays from sunlight breakdown collagen, elastin and hyaluronic acid in our skin, causing premature aging. It also causes melanin overproduction leading to hyperpigmentation. This is why sunscreen is extremely important. If you are too lazy to use other skincare products, at least use sunscreen!! Most people think that sunscreen is only needed when going outdoors, but this is incorrect.
UV rays can actually pass through windows. Sunscreen can combat sunburns caused by UVB ray, and also UVA ray that has longer wavelength and is responsible for skin aging by seeping into your skin, breaking down collagen. Blue light emitted by indoor electronic devices can also cause skin damage.
*A myth about aging: People with oily skin appear to age more slowly.
- Skin aging is not related to the amount of sebum (oil). Instead, the more quality collagen and elastin you have within your skin, the healthier and younger your skin looks. So, for antiaging, look for a treatment that can stimulate collagen and elastin.
Back to our main topic, there are tons of skin care available in the market that target aging, but do they work??
Unfortunately, in the 6th decade and beyond, skin care will not reverse aging, but only helps to PRESERVE your skin. Furthermore, due to aging, there will be fat loss, bone resorption and weakened ligaments causing hollowness and sagging that cannot be resolved by skin care. This is when aesthetic treatments come into play to REVERSE signs of aging.
WHAT CAN BE DONE?
Ultherapy
Ultherapy is approved by FDA as a safe and effective non invasive aesthetic procedure that lifts the neck, chin and brow, and improve lines and wrinkles. It utilizes microfocused ultrasound to target layers of tissues, and stimulate new collagen formation.
During treatment, ultrasound gel and probe will be placed on your skin and direct visualization of the layers through ultrasound imaging ensures heat is delivered to areas that benefit you the most.
So, for people who are afraid of needles or scalpels, this is the choice for a firming and lifting. BUT, of course, the result won’t be as dramatic as surgical face lift. After ultherapy, you will see improvement gradually as collagen continues to form, and best result can be seen in 3 to 6 months. Result can last 1 year or more and treatment can then be repeated.
Thread lift
Thread lift is a minimally invasive aesthetic procedure for face lifting. It involves insertion of medical grade sutures to hold onto facial tissues and pull them taut. It gives immediate lifting effect, and further improvement of facial sagging can be seen when the threads inserted stimulate collagen production in your skin.
There are different types of thread and the duration for the threads to break down differs depending on the types. But even after the thread has dissolved, collagen stimulating effect continues. Again, thread lift cannot replace facelift surgery given its less dramatic and sustainable results, but it is a more suitable choice for people who cannot take downtime and not fit for general anaesthesia due to medical illness.
Dermal fillers
As you age, there is redistribution of facial fat. You lose deep fat, and superficial fat becomes droopy. That’s why you get hollowness in certain parts of your face while some areas become saggy.
Dermal fillers can be used to replace volume loss, bone loss and to support overlying skin. Certain types of dermal fillers can help to stimulate collagen, E.g. Radiesse, Sculptra, Ellanse, hence able to improve your skin quality and youthfulness on top of volumisation. Static wrinkles can also be improved by dermal fillers.
Botulinum toxin (a.k.a botox)
Botox works by temporarily relaxing underlying muscles that contract and causes wrinkles. As a result, dynamic wrinkles no longer occur. Effect of botox last about 3 to 4 months, so treatment can be repeated after reoccurrence of wrinkles.
FYI: Some brands of botulinum toxin can lead to resistance, in other words, not responding or decreased response to botox after a few treatments due to development of antibodies. It is theorized that antibodies developed because of “complexing proteins” present. Xeomin, which is one of the brands marketed, DOES NOT have this complexing proteins, therefore has LESS RISK of formation of antibodies and resistance.
Laser
Non ablative laser like Q-switched NdYAG 1064nm when used in low fluence for several sessions can improve hyperpigmentation. 532nm wavelength can treat hyperpigmentation in the epidermal layer, for instance, freckles, solar lentigo, age spots and seborrheic keratosis caused by sun exposure and aging.
Skin resurfacing by ablative laser like CO2 laser and Erbium YAG laser can help improving conditions like wrinkles, sun spots, loose skin and scars. Ablative lasers remove the top layer of your skin and part of the second layer of your skin. After this controlled injury, your body responds by making new, healthier skin with less wrinkles and dark spots. This can also be achieved by fractional lasers that delivers laser beam to thousands of microscopic columns with lesser downtime.
Ablative lasers are less popular among people with darker skin tone because it tends to leave hyperpigmentation for a longer period of time, which is known as postinflammatory hyperpigmentation, or even hypopigmentation. This happens because people with darker skin tone have more melanosomes, and are larger in size. Lasers may remove too much melanin, causing hypopigmentation. Other possibility is that after injury, your skin produces extra melanin, and melanin may deposit abnormally, resulting in hyperpigmentation.
Sublative radiofrequency
Using a hand piece placed on the skin, each pulse of the treatment delivers radiofrequency via grid of spots similarly to fractional laser. The radiofrequency heats the skin enough to trigger healing response.
The spots surrounding the treated area accelerates wound healing, thereby producing collagen and elastin. Wrinkles, superficial skin pigmentation are reduced and skin texture improves. It is safe and effective with less risk of postinflammatory hyperpigmentation for all skin types and colours as it minimally affects skin’s surface layer. Number of treatment session varies depending on severity and condition, but minimally 3 treatments are needed for better result.
Chemical peel
Chemical peeling involves application of chemical agent that results in exfoliation of skin followed by regrowth of new skin leading to skin rejuvenation. Different depths of peeling can improve different signs of aging including pigmentation, fine lines, wrinkles and large pores. Good things never come for free. Chemical peel does have downtime for about a week. You will experience redness, tightness and some swelling immediately after peel, dryness on the 2nd day and peeling on subsequent day, lasting for around a week. Similarly to ablative laser, there is risk of postinflammatory hyperpigmentation or hypopigmentation, especially in people with dark skin tone.
*For ablative laser and chemical peel in darker skin tone, skin preparation starting 6 weeks before procedure and after procedure care are required to minimize risk of postinflammatory hyperpigmentation.
Microneedling+ PRP ( platelet rich plasma)
Microneedling involves using device that has multiple tiny sterile needles to make punctures in the skin. It creates controlled injury to the skin, thereby triggering body natural healing response and induce collagen production. Microneedling is beneficial to multiple aging conditions, such as fine lines, hyperpigmentation, and enlarged pores.
Combination of microneedling with PRP, also known as Vampire Facial has become a popular treatment for skin rejuvenation. Before treatment, your blood will be taken for centrifugation to produce concentration of platelets above normal value, which is the PRP. What makes PRP different from normal platelet is that PRP contains multiple growth factors and these growth factors are able to augment tissue repair and healing and stimulate collagen formation. Hence, there will be improvement in terms of elasticity, skin tone, complexion, pore size, hydration, skin texture and firmness. PRP together with the action of microneedling from dermapen give even better result.
Growing popularity of microneedling has caused an exponential rise in home DIY device, but professionals use more advanced microneedling devices and longer needles for more noticeable results. If falls on amateur hands, long needles can be dangerous. Microneedling at home also has higher risk of infection due to the lack of sterility and proper care.
Other than its benefits for skin, PRP injection can also treat hair loss. It is clinically proven to increase hair count, hair thickness and growth phase of hair cycle.
Microdermabrasion
In elderly, due to slower skin cycle, there is accumulation of stratum corneum (the uppermost layer of your skin), resulting in thick, dull and irregular skin surface.
Microdermabrasion produces superficial ablation that removes stratum corneum. Subsequently, new layers of skin with improved complexion and texture replace within 1 to 2 weeks. As it only removes the top layer of your skin, it is not effective for deep wrinkles.
If your concern is fine wrinkles, superficial pigmentation, enlarged pores, dry skin, and wants skin rejuvenation, then you can consider microdermabrasion.
The above mentioned are some of the treatment options available for signs of aging. Combination therapy often yield better result. For example, combining ultherapy with fillers or ultherapy with thread lift, thread lift with fillers, fillers with botox, laser toning with microdermabrasion and many more. Doctors will carefully assess your face before deciding a treatment plan that suits you.
There is always misconception that we cannot do anything about how we age as it is a natural process. Yes, aging is a natural process, BUT we are responsible for how well we age. Although genetic, lifestyle and environment factors play a huge part in aging, good skin care routine, especially sunblock starting from early age are important, and aesthetic procedures will be the icing on the cake. Aesthetic procedures can be a maintenance, and also a treatment when you finally have signs of aging that never go away with skin care alone. Everyone deserves to be beautiful, regardless of your age. So there is nothing to be ashamed of.
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