The area around the eyes is one of the first to show signs of ageing. Lines and wrinkles appear at the sides (crows feet), skin above and below begins to lose elasticity and sag, and even the bone surrounding the eye recedes, causing a hollowed appearance. Loss of volume below the eye can lead to the formation of dark circles underneath.
However, there are various methods we use to counteract these changes. Anti-wrinkle injections can reduce muscle activity and wrinkling around the eye. Dermal fillers can be used to lift the tissues around the eye and add volume where it has been lost. Laser and Platelet Rich Plasma are also employed to improve the skin quality and reduce under eye darkness. Rejuvenating skin creams can also help maintain skin quality and elasticity.
As with most areas of cosmetic medicine, a multimodal approach is required to attain maximum benefit.
On Tuesday night we attended a talk by Dr Francisco de Melo, a Portuguese plastic surgeon practicing in Dubai. Ellanse is a dermal filler that has been on the market here for about a year. Most currently used fillers are hyaluronic acid polymers and act by occupying space in the tissues. In this way we can restore lost volume, enhance lips, etc. Ellanse has a different mode of action. It contains Polycaprolactone microspheres and has a ‘biostimulatory’ action. It induces a slight inflammatory response that results in collagenesis – the increased production of collagen in tissues. Studies have shown volume increases around 1.5 times that originally injected.
Ellanse comes in S, M, L and E, that last for 1, 2, 3 and 4 years respectively. Dr de Melo showed how he has used Ellanse for cheeks, temples, nasolabial folds, marionette lines and pre-jowl sulci. It is not suitable for lips. It looks like being a very useful addition to our range of volumising products.
We are getting into the cooler months and interest in vein treatment is rising. Many patients are aware that compression stockings need to be worn after most procedures to veins, and this can be uncomfortable in the middle of summer.
Whether the problem is large varicose veins or small spider vessels we have a solution. If there is a combination it is important to treat the large veins first. If spider and reticular vessels are being fed by larger varicosities their removal will be less effective. If larger veins are suspected we will do an ultrasound examination of the area to determine if these are incompetent. If this is the case we will recommend these be treated first. Once the large varicosities are eliminated the small veins can be addressed at a later date.
On Saturday I attended what was essentially a re-launch of Sculptra. Sculptra is a facial filler that exerts its effect differently to conventional fillers which mainly just replace volume. The action of Sculptra is to stimulate collagen production. Although there is some initial volume enhancement, the water that goes with the product is soon absorbed and the initial effect lost. Because collagen in the tissues takes time to build up, so the end result takes time to achieve. Add to this the need for Sculptra to be administered over 3 or 4 sessions a few weeks apart, one has to have some faith in the product and clinician. This is not an overnight fix, but certainly would seem to have a place in certain patients and situations.
The address was given by Dr Danny Vleggaar, a very experienced Swiss cosmetic physician. His demonstration of injection technique was useful, but even more interesting was his discussion of facial ageing. The face doesn’t age just because skin gets saggy and wrinkly. Changes occur at all levels – cutaneous tissues, fat, muscle and probably most importantly bony involution. Dr Vleggaar had some good photos and animations of live patients and cadaver dissections to demonstrate this.
It again highlights the need for us clinicians to educate our patients in this regard. Mitigating the effects of ageing can’t be achieved through toxins and skin care alone. It is vital to also address some of the volume changes that occur constantly after the age of about 25. At this stage we can only do this through the careful placement of fillers.
At Sydney Cosmetic Medical Centres we have a range of products to help achieve this.
Light based treatments (laser and IPL) allow us to target pigmented lesions in the skin and remove them. The light is absorbed by melanin, heats up and is destroyed. We have been getting great results with our Palomar Icon MaxG system with unwanted freckles, age spots, etc.
Botulinum Toxin is one of the best known products in cosmetic medicine. In Australia we have two formulations, and soon to be a third.
Most people know that it is used to reduce wrinkles. It does this by paralysing the muscle it is injected into. It is especially useful in the upper face, where the muscles of facial expression (frowning, smiling, raising the eyebrows, etc) act over many years to cause wrinkles.
A very fine needle is used so the discomfort is minimal. The amount used depends on the patients age, number and size of wrinkles and individual preferences. Men generally require more than women.
The effect wears off after 3 or 4 months, as the muscles regain function. We’ve found over time though that those who have had regular treatments for a few years need it less often.
The whole procedure takes less than 30 minutes, including the inititial consultation. We currently have appointments available with little waiting time.
Tonight we attended the launch of Oxygenetix, a new line of makeup designed for post procedure patients. They have a moisturiser and foundation that allow oxygen to penetrate, and the claim is this enhances healing. Certainly in our practice it would seem to be a useful option for those who have just had laser and IPL work on their face. These products can be used immediately to soothe, reduce and camouflage the redness and inflammation that often occurs after light based procedures.
Part of the growing trend toward less invasive cosmetic treatments has been the rise of fractional resurfacing. Also known as a ‘non-surgical facelift’, a laser is used to stimulate regeneration of skin tissue. At Sydney Cosmetic Medical Centres we prefer the ‘non-ablative’ technique, which results in less inflammation and down time for the patient. The treatment is performed in 4 or 5 sessions spread over several weeks, with optimum results seen after a few months. We’ve had excellent results with textural issues, fine lines, large pores and pigmentation, many of the signs of ageing facial skin.