BOLANDCELL emphasizes the importance of acquiring in-depth basic science knowledge, applied biotechnological tissue culture background, skin histochemistry, including application of proteomics when considering treatment of facial wrinkles. Now you read of some of the latest equipment available during 2007.
When an anatomist examines a human cadaver in a dissection hall, one of the most outstanding features is wrinkling of the face. This affects both genders. Clearly, genetic and environmental factors are operating. And also abuse of tobacco, sunlight (sun-worshippers) and alcohol. Besides the rhytids, marionette lines around the mouth, the crow feet at the angle of the closed eye, we become aware of the lines of Langer. Reversible? Not at this stage. But then one would have to start much younger, avoid the sun, wear sun protectants, stop smoking, apply moisturizing creams and probably have to undergo laser treatment and perhaps biological treatment with cells. Many of the fair gender prefer to age more gracefully. They believe the lines give them character. They would never consider Botox or a filler, not to talk about a facial or peel. They would also not visit a SPA. The modern corporate feminist does, because she can look a lot younger and many of them want to turn back the clock. She knows that her appearance is important especially if she can look more youthful, especially when she walks into the boardroom. She needs to look radiant. She also likes a comment and to hear that she has a youthful appearance. And so did Jane Fonda, Marilyn Munro, Anneline Kriel, Margaret Gardener and Penny Colline of South Africa . The darling of the nation at that time.
Ben Franklin, is on record, "In this world nothing is more certain than death, taxes and wrinkles". Wrinkles and lines affecting the face are a depressing component of aging (Du Toit et al: Specialist Medicine, 5:38-45, 2005). But there is no magic bullet for the treatment of facial wrinkles! A combination of modalities is needed, including cosmoceuticals.
It is useful for you to have a diagnostic test regarding your face before undergoing treatment. This could mean a quick and simple skin collagen test. This will allow you to make an informed decision if you want laser, IPL, specialised creams, cells, collagen and botulinum.
From a biotechnological and antiaging treatment point of view a detailed knowledge of the skin morphology is essential. Apart from an in-depth understanding of skin anatomy, the reader must also appreciate the importance of Langer's lines. Importantly, the skin varies in thickness( Marieb 2004). The two characteristic regions of the skin are the epidermis and dermis. Important zones to consider if you are an aesthetic care-giver:
- Hypodermis ( superficial fascia) important anchoring function and storage of fat ( Marieb 2004).
Important cells of the epidermis include :
- Keratinocytes( produce keratin)
- Melanocytes( produce melanin)
- Merkel cells ( sensory receptors)
- Langerhan's cells ( macrophages related to the immune system)
Layers of the epidermis include : stratum basale,spinosum,granulosum,lucidum and corneum. The stratum lucidum is absent in thin skin areas. Collagen, elastin and reticular fibers are found in the dermis. In the dermis are also nerves, blood vessels and lymphatics. For aesthetic purposes, the dermis consists of the papillary and reticular layers. Mechanoreceptors such as Meissner's corpuscles, (touch receptors) are prominent. Carotene accumulates in the stratum corneum. Sweat glands are divided into eccrine and apocrine glands. The sebaceous glands ( oil glands) secrete sebum.
Characteristics of photo aged skin : How to spot them.
- Reduced ECM, reduced strength and enhanced sagging. ( U-V light induced. B is supposed to be responsible for wrinkling and aging. DNA and folic acid is damaged)
- Thinner and translucent
- Deep wrinkles
- Dry rough skin
- Telangiectasis ( cheeks,nose,ears)
- Liver spots ( solar lentiges)
- White macules on lower legs and arms)
Remember the terms : Some are precancerous and caused by exposure to sun-light
- Solar keratosis
- Seborrheic keratosis
- Sqaumous skin cancer
- Malignant melanoma ( resources: www. Merck com, www.Mayoclinic.com )
- Fine and deep set wrinkles: due to dysfunctional fibroblasts. Collagen and elastin fibre breakdown results in skin sagging. Dysfunctional fibroblasts are less active and produce less ground substance in the ECM. There is also a thinning of GAG and ECM. There is no magical treatment that does it all! Try and stimulate collagen and elastin production.
BEFORE TREATING THE PERSON, HAVE SOME SKIN CLASSIFICATION AT YOUR DISPOSAL; GLOGAU WRINKLE SCALE:
- Mild changes
- Moderate changes
- Advanced changes
- Severe changes
- Alternative classification: Fitzpatrick: I, II, III.
HISTOPATHOLOGY OF SUN-DAMAGED AND AGING SKIN ( AFTER BAKER ET AL )
- Structural skin damage
- Degenerative changes affect both the epidermis and dermis
- Actinic damage
- Basophilic degeneration of collagen and elastic fibers
- Increase in ground substance in the form of mucopolysaccarides present within the dermis
- Damaged elastic fibers
- Collagen disappears proportionately
- Viscoelastic properties degraded
- Sparsity of vessels and which are dilated
- Presence of telangiectasis
- Perivascular infiltration of lymphocytes, histiocytes, and mast cells.
- Epidermis is thickened ( many cells have pyknotic nuclei, display cellular array, with loss of vertical polarity).
- Basement membrane is ragged, thickened and blurred.
- Increase in the number of melanocytes; uneven distribution of melanin.
- Presence of senile lentigo
TECHNIQUES TO REJUVENATE THE FACE, INCLUDING PHOTO( LIGHT)DYNAMIC THERAPY ( IN NO SPECIAL ORDER )
- Botox injections ( very popular and generally safe): needs repeating and re-injection at 4 monthly intervals
- Facial peels
- Laser treatment ( FRAXEL, SYNERGON ( ELOS TECHNOLOGY )
- IPL treatment, infra red treatment
- Face lifts
- Barb treatment 9 plastic surgeon): effective
- Biological wrinkle treatment with autologous cultured fibroblasts
- Application of rejuvenation creams ( more than 200 on the market)
- Fat injections
- Fillers ( Restalyne and others)
- Skin tightening with the application of the Synergon E-Max: including acne treatment in select patients
- ( cellulite management on other areas: Ultrashape or Velasmooth )
- Whisper laser peel ( Radiancy)
- Skin needling: Environ Roll-Cite®
- Autologous cellular regeneration with growth factors
- LED red light therapy ( stimulates collagen production)
- Rhytec Portrait® Plasma skin regeneration system ( nitrogen plasma energy: generates new collagen. For wrinkles, skin tone, texture and skin laxity ( see: www.bodynew.com )
- Balanced diet: fresh vegetables, fruit and plenty of clean water
- Ibebenone: Elizabeth Arden ( Allergan®): Prevage is an anti-aging treatment and contains 0.5% Idebenone. This is an effective anti-oxidant. PrevageT tests indicates improvement of skin tone, firmness, lines and wrinkles are reduced making the skin look brighter. Also contains Green Tea Extract, another powerful anti-oxidant. Cost are R 1200 for 50 ml in South Africa .
- For Salons: Venus Technologies : " New-Life". B.E.A.M- Bio Electrical Acceleration Management ( circumferential reduction, body contouring, wrinkle smoothing, face lifting, acne clearance, muscle shaping and lifting, skin tightening, accupoint massage, lymphatic drainage).
FACIAL CHANGES THAT AFFECT MOST WOMAN ( RESOURCE: WOMAN & HOME 2005): THESE CAN BE CORRECTED BY PLASTIC SURGERY
- Droopy eyelids and bags under the eyes
- Craggy neckline
- Protruding nose
- Lines around the mouth and eyes
LOCAL ANTI-AGING CREAMS: VISIT YOUR LOCAL STORE
- Loréal: wrinkle De-Crease
- Olay Regenerist
- Nivea Visage Anti-wrinkle cream ( see www.NIVEA .com)
- Loréal ( Paris) Revitalift ( pro-retinol A encapsulated in nanaosomes)
- Elizabeth Arden: Ceramide Plump PerfectT
- Clinique Superdefense ( triple action moisturiser)
- Garnier Skin Naturals ( Ultralift)
- Ingram's Skin Renew