Ageing brings many wonderful things: Wisdom, experience, a bigger bank account. All good. But truth be told, it adds less desirable things like perpetual dullness, deepening wrinkles and the dreaded sag, too. Fortunately, advances in medical science now allows us to replenish part of what time has eroded away to pare years off the face and restore a naturally refreshed look that just looks like a life well-lived – naturally.
WHAT FATHER TIME TAKES AWAY FROM MOTHER NATURE
The shortest answer: With time depredation, all components of the skin get progressively depleted and deteriorate in function.
The skin’s outermost layer, the epidermis, normally forms a protective physical barrier. The dermis, or middle layer, contains collagen, hyaluronic acid and elastin, which provide strength, firmness and elasticity. It also contains blood vessels, fibroblast (collagen) cells, immune cells, nerves and glands that produce sweat and oil. The deepest layer consists of connective tissue and fat.
Collagen fibres, the major backbone of the dermis, is damaged and loses it’s tight weave, and the elastin fibres lose their zing. The fibroblasts that produce collagen and elastin are prone to UV radiation damage. Also, levels of hyaluronic acid (a.k.a glycosaminoglycans, which are moisture-binding molecules) drop, and this decrease in water means that the skin becomes dull, dry and loses some of its supple plumpness. In prematurely photoaged skin, the GAGs may be associated with abnormal elastotic material and thus be unable to function effectively too.
Certain pockets of fat (most prominently near the undereye and mid face) that pads and stretches out the overlying skin get slowly deflated as well over the years, while others (like the jowl fat) clings on for dear life and even accumulates with age, finally succumbing to gravity’s pull to result in a saggy, ill-defined jawline. Beyond skin, it’s been well-documented through imaging studies that even the underlying bony support structure wastes away with age, too.
Thinner, wrinkly, saggy, less vibrant skin is what you expect as you get older, but fortunately, you can control how fast these changes happen. SKIN decodes the 4 major “facial additives” in the beauty market today to preserve your youthfulness for longer.
YOUTH “ADDITIVE” #1: HYALURONIC ACID
Beauty editors and anti-ageing aficionados are having a serious love affair with hyaluronic acid, or simply “HA” to true beauty junkies. This naturally-occurring polysaccharide or large complex sugar (yes, it’s not a fruit acid!) found in the human body acts as a cushioning and lubrication agent for our joints, skin and eyes. It’s particularly important to skin appearance since about 50 percent of the body’s supply is located in the cutaneous tissues, where the viscous jelly-like substance maintains skin’s inner hydrobalance (HA is said to retain more than 1,000 times their weight in water!), keeping our dermis plump, radiant, cushiony soft and supple…well, at least until our skin’s stores get depleted over time.
Replenishing skin’s HA directly through injectables not only restores deep hydration, but also bathes cells in life-giving water to optimise cellular function. There is also evidence that microinjection of HA stimulates fibroblastic collagen production.
Bathe Your Skin in the Fountain of Youth: Nowadays, HA is found everywhere – not only as injectable fillers, but also in topical serums, lotions, masks, and even makeup touting anti-ageing benefits. While HA in topical skincare does act as a humectant to draw moisture to the skin’s surface and make fine lines less obvious transiently, but if we’re talking abut replacing HA in the dermis you’ve lost, then you’re out of luck, ‘cos the HA molecule is TOO big to pass through the epidermis without the help of a needle.
Perfect For: Skin-identical HA products, such as Restylane, Juvederm or Belotero, are by far the most popular anti-ageing skin microinjections. Besides inspiring thousands of skincare products that attempt to mimic its complexion-bettering benefits, a whole (dazzling) array of injectable products are continuously being churned out to fulfill the various needs of the ageing skin. From traditional volume restoration for the face to counter age-related loss of supportive fat pads and bone, reduce laugh lines and lift the overlying skin; to the newer generation sculptural fillers that enhances the sharp definition of nose, cheekbones and chin; or soft fillers to shape a pillowy and kissable Kardashian pout, there is one HA filler to answer your every beauty wish. Results are instantaneous and tend to improve over a few weeks as the HA integrates fully with your skin.
A more recent HA craze comes in the form of skin boosters – an ultra-fine, uber-fluid group of HA injectables that aims to give skin a mega hydration and collagen-building boost to ramp up your radiance, soften stubborn wrinkles and brighten resistant dark circles over a course of 3-4 repeated treatments, without packing on unwanted volume or freezing out natural facial expressions.
Read More: What You Always Wanted to Know About Lip Fillers
Since quality HA injectables are synthesized to be like our skin’s own, no routine allergy testing is required before treatment, as compared to older products such as collagen injections (which were derived from animal sources). This convenience and safety has allowed HA to take over collagen as the beauty additive of choice for restoring lost volume and plumping lines.
Caveat: Adding a sponge to your skin can deliver the hydration and plumping benefits you have always dreamed about, but it can be the cause of problems you might possibly face. Excessive water retention – especially in the ultra-thin under eye region, in those with marked skin laxity, or with overzealous injection – can cause areas of localised swelling, bumps or puffiness. Fortunately, if you’re not happy with how it looks for any reason, an enzyme called hyaluronidase can disperse the HA before it gets naturally metabolised by the body like our skin’s own.
HA injectables may last between 6 to 18 months, depending on the type of product used (robust and long-lasting sculptural fillers v.s. ultra-soft and shorter lasting skin boosters), the area of treatment (super mobile areas like laugh lines and the unforgiving undereye area where only a small amount can be injected each time) and how well you care for your skin.
YOUTH “ADDITIVE” #2: COLLAGEN
Collagen fibres form the structural backbone of our skin to supply the firmness and tautness we (used to) know of young skin. After the age of 20, one percent less of collagen is produced in the dermis each year. As a result, the skin becomes thinner and more fragile with age. Environmental damage (UV and pollution) and lifestyle sins (think: smoking, stress, insufficient rest) greatly exaggerate this loss to accelerate the intrinsic ageing process, giving rise to premature lines, laxity and loss of radiance.
Enter: The collagen stimulator. Made of a fine suspension of poly-L-lactic acid, the collagen stimulator works like “seeds of youth” when sowed within the deep dermis via microinjections to regrow new collagen fibres and rebuild a strong supportive lattice. Poly-L-lactic acid is biocompatible and biodegradable (i.e. it’s naturally resorbed as it works), and has been used safely and successfully for decades in dissolvable stitches and as a facial injectable since 1999 in over 30 countries.
Enticing as it may sound, oral collagen supplements cannot zoom into your face to replace skin’s lost collagen. For one, these collagen supplements are made from marine sources, which is different in structure to human collagen. Moreover, collagen protein gets digested into basic amino acids like any other food protein when ingested. The only way to bump up your collagen stores is to stimulate your skin cells to spin your own.
Perfect For: Rebuilding the tone and strength of wrinkled, slackened skin and improving skin reflectance for a more radiant, refined complexion, while restoring the firm plumpness in larger areas of skin generally and gently without concerns about over-puffiness due to water retention. These properties make Dream Sculpture an excellent choice to enhance skin’s natural resilience against the laugh lines and marionette lines radiating from the mouth like radio-waves announcing your age, and wind back the clock in hollowed cheeks and weakened jawlines - with lasting results of about 2 years.
Read More: I’m Dreaming of a More Beautiful Tomorrow
Caveat: As opposed to hyaluronic fillers, the skin plumping results from a stimulator occurs gradually over a few months for each treatment as collagen regeneration takes place, and requires a series of 3 or more treatments to progressively build up for those with more marked collagen loss or fat atrophy.
Formation of small bumps under the skin that’s noticeable on pressing the area was an uncommon, yet feared, issue that can arise weeks and months after collagen stimulators. Although this complication is now uncommon with proper preparation of the product, better injection techniques and post-treatment skin massage (to ensure even spreading of the collagen stimulator within the skin), this treatment is still not recommended for the delicate undereye area or lips, where hyaluronic acid products are FDA-approved for use. It might not be the best choice for those who are very prone to to keloid formation or hypertrophic scarring as well.
Disadvantage or Quiet Advantage?: Gradual improvements in skin texture, tone and radiance, along with subtle revolumisation over 3 treatments of poly-L-lactic acid (a collagen stimulator) microinjections for a difference everyone would notice, but no one could tell.
YOUTH “ADDITIVE” #3: FAT
One of the key features of a youthful face is the full, soft and well-defined contours. Fat grafting is a star-fuelled trend de jour to achieve that adorably youthful heart-shaped face typified by Korean celebrities – a doll-like hybrid with the rounded fullness of a child in the upper and middle thirds, tapering into a sharply sculpted V-shaped jawline (the “V-Line”) of a supermodel, and completed by big, soulful eyes and a delicate barbie nose.
If you have secretly wished that some of your generous childbearing hips could be magically transferred to your bosoms or cheeks, this is the answer to your prayers. Fat grafting involves removing unwanted fat from one’s own abdomen or thighs through a mini-liposuction procedure to inject into certain regions of the face that has insufficient fat or has deflated with age.
Research on facial attractiveness has pointed out that the presence of childlike facial features increases attractiveness: Large curved forehead; Facial elements (eyes, nose, mouth) located relatively low; Large, round eyes; Small nose; Full cheeks; Small chin. In a German study, less than 10% of subjects rated the original picture of the adult woman as most attractive. More than 50% chose the computer-manipulated pictures with high levels of childlike characteristics, and almost 30% found the picture with 20% childlike features as most attractive.
Perfect For: Autologous fat is probably the softest and most well-tolerated filler, since fat is what naturally pad our faces. Being a living tissue, the fat graft’s volumising and contouring results can last for years or be even almost permanent (until the fat gradually succumbs and shrinks with age again).
Adding fat back to the face may also help the skin texture and tone through what is thought to be a stem cell response that the skin undergoes over areas of transplanted fat. This phenomenon is only speculated, but is thought to be evident towards a year following fat grafting.
Famous baby faces that dazzled on screen or runway through the different eras include Brigitte Bardot, Kate Moss and Lindsey Wixon. Moving East, the baby face rules. Since ancient times, a full heart-shaped face is preferred as traditionally it signifies better nutrition, wealth and hence, good fortune.
Caveat: Harvesting fat from your thighs for injection into the face requires a minor surgical procedure, which translates to some recovery time for both the donor and recipient sites.
And while autologous fat is the longest lasting injectable filler material available, it is also the least predictable. Since long term survival of fat grafts depends on the injected fat being revascularized by the in-growth of nourishing capillaries, loss of the fat graft during the re-homing process may occur if this fails to happen. Refinements in fat grafting techniques – such as gentle hand-harvesting method, Lipokit purification process to isolate only the pure fat tissue for injection, and micro-droplet injection technique – have greatly improved fat survival rate, compared with older techniques that could compromise fat cell uptake and longevity. Those who require larger volumes of fat to plump up their faces may require more than 1 treatment, as an overly large amount of fat injected in a single session might not take up successfully.
Keep in mind that like fat in the thighs and tummy, the transplanted fat can balloon with weight gain or shrink with major weight loss as well, so maintaining a steady healthy weight would keep your new baby face suitably plump and in the optimal youthful heart shape.
Read More: How to Lose Fat in the Right Places
YOUTH “ADDITIVE” #4: STEM CELLS
Ever since doctors performed the first stem cell transplant in the late 1950s, the so-called blank-slate cells have held a promise that seems almost too good to be true: human body cells that can heal and perhaps cure what ails us. In the intervening decades, stem cell transplant research have been carried out on cancer patients, and are being hailed as a potential cure for Parkinson’s disease, paralysis, and, in a new twist, ageing skin.
Perfect For: LaViv (azficel-T) is a FDA-approved cosmetic cell-based skin rejuvenation procedure. It is used to treat wrinkles in the nasolabial ‘laugh lines’, and has been also used to improve acne scars. To harvest the your own collagen-building fibroblast cells, a skin sample obtained from the back of your ear is taken under local anaesthetic. This is processed in the Fibrocell Science lab (the makers of LaViv) to multiply your own fibroblasts by millions. After approximately 3 months of growing your cells and placing them under stringent QC, your personalised elixir of youth is ready for use. A series of 3 injections, scheduled 3-6 weeks apart, is recommended for meaningful visible results.
The duration of results is not as clear as hyaluronic acid filler – some claim to notice benefits even after 1 year, but its efficacy beyond 6 months has not been established clinically. Any of your unused cultured cells are cryopreserved at the lab and can be called back into action at any time. But if you miss your appointment, the live cells that have been Fed-Exed to doctor’s office from the lab would expire and have to be thrown out.
Before and 6 months after LaViv treatment in the laugh lines.
Caveat: A point to note is that most of the “Stem Cell Facelifts” in the market are actually autologous fat grafting (see above), and sometimes even platelet-rich plasma injections. While fat grafting has a definite place in the world of facial rejuvenation due to its lipofilling effect, calling it a stem cell treatment would be false advertising since sophisticated cell-sorting techniques are usually not used to isolate and ensure the quality of stem cells. Although research on fat-derived stem cells show promise for use in regenerative medicine (e.g. in heart disease), few focus on cosmetic treatments as well. Platelet-rich plasma (PRP, also known as the Vampire Facelift), on the other hand, is believed to heal sports injuries and rejuvenate aged skin and balding scalps by re-injecting a soup of platelets and growth factors obtained by concentrating the person’s blood plasma through centrifugation into the targeted area – and is not stem cell therapy.
Read More: Turn Back the Clock: Vampire Facelift V.S. Nefertiti Facelift
Stem cells’ promise could also be their peril. These cells’ ability to spark cell growth could potentially make a person’s skin cells more prone to behave like cancer cells, causing them to grow uncontrollably. There are risks that no one can predict. For instance, there was a report of 1 woman who developed bone fragments in her eyelids and surrounding her eyes after receiving a “stem cell filler”; the combination of ingredients coaxed the cells to turn into bone. It’s unclear what other risks might be, but obviously scientists still have a lot to learn about how these cells behave. As such, stem cell cosmetic injections are still not approved by the authorities in Singapore.
-By Claudia Lin
The post Facial Additives: An Insider’s Guide to Preserving Your Beauty appeared first on The SKIN Magazine.