The Nitty Gritty 😬 on Wrinkles 🙈 All Women 👩 Should Know 💭 ...

I'm here to tell you what every woman should know about wrinkles. Dr Alhallak says wrinkles are one of the most noticeable features of photoaged skin. Wrinkles are associated with a weak cellular epidermis and have reduced structural proteins in the dermal extracellular matrix (ECM) such as collagen and elastin that give skin its firmness and elasticity. Synthesis of ECM components slows naturally with age, and ultraviolet (UV) light stimulates degradative enzymes that weaken and accelerate protein breakdown. Sweat and oil glands start to lose functionality, and fewer ECM glycosaminoglycans, which reduces skin hydration. In certain cases of advanced photoaging, skin can have solar elastosis changes with tangled masses of damaged elastin protein in the dermis. So, it's time to acquaint yourself with what every woman should know about wrinkles.

1. Can We Prevent Wrinkles?

Yes. There are several factors that expedite the formation of wrinkles. The most vicious factor is UV light. The extended exposure to sunlight with our proper protection is considered the skin enemy number one. The results are loss of skin quality, wrinkle formation, and pigmentation. Wearing good quality sunblock is usually sufficient to protect your skin. Another important factor is hydration; it is important to keep you face hydrated all the time by using a quality skin moisturizer and consistently peeling the dead layer of your skin. Skin peeling could be chemical (Jessner peel) mechanical (silk peel microdermabrasion), or laser (carbon peel). Vitamin C products have shown efficacy in delaying skin aging and wrinkle formation. Other products contain the amino acid, polypeptides, and protein that help skin rejuvenation and skin tightening. Knowing how to prevent them is definitely what every woman should know about wrinkles.

2. Who Suffers from Wrinkles the Most?

When the degree of skin aging was compared between races, such as Asians and whites, it was reported that pigmentation occurred more often and wrinkling occurred less often in Asians than in whites. It is increasingly obvious that the rate of skin aging progression differs between races, as exemplified by a study comparing the onset of wrinkles between Chinese and French subjects. The report showed that the Chinese subjects started wrinkling approximately 10 years later than the French subjects.

3. What is the Most Effective Treatment for Wrinkle Removal and Skin Tightening?

The goal of any wrinkle removal and skin tightening treatment is to reverse time and the mechanism behind wrinkle removal. In other words, to help the skin to have thicker epidermis, increasing the structural proteins by inducing the fibroblast to produce more collagen and elastin to increase and restore the skin firmness and elasticity. This can be done by providing the skin with the required nutrients and creating a micro wounding environment. After stress from creating the micro wounding environment, the skin will start to recover naturally and will build a new extracellular matrix through new coils of collagen and elastin. To our knowledge, these are the most effective and frequently used skin tightening and wrinkle removal therapies.

4. Fractional Ablative Laser (CO2 Laser and Erbium YAG Laser)

Ablative lasers used for skin resurfacing remove epidermal and dermal tissue. The healing process begins after treatment and stimulates synthesis of collagen and other ECM components. They use water as a chromophore. Immediate improvement in wrinkles is seen post-procedure due to thermally induced collagen denaturation and shrinkage, and delayed improvements subsequently occur due to fibroblast proliferation and synthesis of new collagen, referred to as dermal collagen remodeling. In addition to wrinkle reduction, collagen remodeling works to improve atrophic scars, hypertrophic scars, pore size, rough skin texture, and skin laxity.

Furthermore, benign epidermal pigmented lesions are also removed with ablative lasers. Pigment removal is nonspecific and results from vaporization of tissue containing epidermal pigment. This is the most aggressive treatment that anybody can get, the results are usually great but it has lots of disadvantages - mainly the downtime (could be as long as three weeks) and the high risk of infections and post-inflammatory pigmentation PIH. We usually do not recommend this type of aggressive treatment due to the risk associated.

5. Fractional Non-ablative Laser (Fraxel Dual)

Nonablative skin resurfacing lasers offer a gentle means of improving skin texture and wrinkles with minimal downtime. They are versatile and can be combined with other lasers for treatment of pigmentation and vascularities, as well as other minimally invasive procedures such as botulinum toxin and dermal fillers. Devices used for nonablative resurfacing are a heterogeneous group of technologies but are all similar in that they induce dermal collagen remodeling with collagen synthesis while keeping the epidermis intact. Wrinkle reduction results are modest compared to ablative lasers, however, nonablative lasers are a good option for patients seeking gradual cosmetic improvements who want minimal or no disruption to daily activities.

Common terms used for wrinkle reduction with nonablative lasers include nonablative resurfacing, nonablative laser resurfacing, skin toning, and noninvasive laser rejuvenation. With recent advances in fractional devices that deliver higher energies and have deeper cutaneous penetration, nonablative lasers have become one of the primary modalities used for rejuvenation of the photodamaged skin.

The advantages of nonablative lasers are that they maintain an intact stratum corneum while causing mild thermal injury to the dermis. A wound healing response ensues after treatment, resulting in collagen shrinkage and fibroblast activation with the synthesis of new collagen and other ECM components referred to as dermal collagen remodeling. Expanding the ECM thickens the dermis and smooths the skin, resulting in the clinical reduction of wrinkles. In addition to wrinkle reduction, collagen remodeling effects with nonablative lasers also include improvement in atrophic scars, hypertrophic scars, pore size, striae, and rough skin texture.

6. Microneedling

The newer form of microneedling combine the mechanical wounding with radio-frequency technology. The insulated needles penetrate as deep as 3 mm into the skin and release a radio-frequency current. Due to the high resistance of the tissue, the radio frequency turns into heat and creates a coagulation point. There is no risk of having PIH after the treatment or restriction on sun exposure, but the treatment is more painful and has more blood exposure. We love using this specific treatment for scars and stretch marks.

7. Platelet-rich Plasma (PRP) and Vampire Facial

I would love to think of this treatment as a maintenance rather than an initial treatment. It has shown that using plasma injection directly after laser or microneedling will result in shorter downtime and higher treatment efficacy.

Microdermabrasion and chemical peeling are less effective and are used as maintenance.

8. High Intensity Focused Ultrasound (HIFU) Ulthera

Without damaging the skin surface, Ulthera delivers intense ultrasound energy (HIFU: High Intensity Focused Ultrasound) to the muscle fascia to tighten the sagged muscles. It is a device to guarantee instant lifting. With its specially designed cartridge for the body, it produces focal thermal coagulation points to destroy fat cells and helps body slimming, Ulthera is a non-invasive and non-surgical device to offer safe and effective treatments.

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