We all recognise facial lines and wrinkles when we see them and it is certainly true to say that we all have them or get them! The older we get, the more we have and the deeper they become. Lovely young skin is certainly attractive but even youngsters don’t have perfectly smooth skin, even they have lines, usually present around the eyes and mouth.
Different faces have different line patterns and different line quantities. All this adds to the interest and the character of a face. As we get older, lines increase in number and depth, furrows develop and wrinkles appear. This differentiation between lines, wrinkles, and furrows helps me understand the root cause of a facial crease and develop treatment strategies. ??
The way and rate we age is significantly affected by inherited factors from your parent’s and family but environmental factors also have a very strong influence. Smoking, sunshine and general health having the greatest bearing. Lines, wrinkles and furrows are all external features of ageing changes taking place not only in the skin but also within the facial soft tissues and to some degree also the facial skeleton.
As skin ages it thins and looses its elastic qualities, so it becomes less able to stretch, rebound and contour itself, over facial undulations and around facial movements. This means that folds in your skin appearing during facial expressions intensify and no longer smooth out on resting, becoming permanent fine wrinkles at first. These become deeper with time and are known as mimetic lines. A crazy-paving type of wrinkling and crêpiness can also develop at rest as the ageing process increases. This sort of appearance can often occur even in those areas not so much involved in facial movement and can usually be attributed to sun exposure.
Relentless gravitational forces also have a long-term effect, dragging down the soft tissues and causing furrows at and around certain points where tissues are tethered deeply. Furrows are seen at the junction between the eyelids and the cheek and then also between the cheek and the nose, mouth and chin. Facial muscles work hard to maintain the tissues in their original position becoming bigger and stronger, responding like all muscles do when worked hard. This in itself increases the tone of muscle and worsens those mimetic lines!
There is no one-root cause of wrinkles and no one anti-wrinkle treatment that can eradicate all the different types. Diagnosing the root cause is important in deciding a treatment plan.
Muscle inhibitors, such as Botox, Vistabel and Dysport (Botulinum Toxin A), are excellent at treating mimetic lines and work by a controlled partial paralysis of facial muscles.
Filler injections or dermal fillers can be used to plump out the skin or the immediate subcutaneous tissues to improve static lines and furrows. The hyaluronic acids (Juvederm, Restylane, Teosyal) have been used for quite some time now and have been shown to be safe and good in experienced hands. The longer lasting fillers such as Radiesse and Sculptra I prefer to use in the deeper planes where they can add volume to assist in reshaping or filling out furrows.
Skin re-surfacing or rejuvenation may be required to complete the result. Traditional resurfacing with chemical peeling or laser skin resurfacing removes the top layer of skin to allow healing from below this takes time and has a higher complication rate than fractional laser resurfacing that has pretty much taken over from the traditional techniques.
Addressing the furrows caused by descended fat pads or treating excess skin laxity becomes more difficult as it becomes more severe. Previously surgery was the only realistic solution but some recent very exciting technologies are starting to offer effective alternatives without any downtime. Ulthera the first and only device ever to receive FDA approval for non-surgical face lifting. Some good radiofrequency devices Pelleve Thermage and Accent), have FDA approval for skin tightening.
Surgery remains the most effective and reliable treatment for moderate to severe facial ageing. Brow lifts, blepharoplasty, mid-face lifts face and neck lifts are very popular. I have traveled extensively to learn, develop and refine procedures that are mostly done through minimal incisions hidden in the least obvious places and allow my patients to get back to work and socialize within the shortest possible time.