The Anatomy Of Wrinklesby Dr Vivian Oputa on April 3, 2012
Wrinkles are commonly referred to as signs of wisdom and experience. This may sound respectable but most people would rather do without them. Skin ages all over the body but is more pronounced in sun exposed areas like the face, neck, forearms and back of the hands. Sun damage or Photoaging leads to skin dryness, roughness, sagginess, wrinkles and skin growths popularly referred to as liver spots. Other factors that promote wrinkling include smoking, heredity, low oestrogen hormone levels and skin type (people with light coloured skin are more prone to sun damage). Ultraviolet (UV) rays from the sun injure the epidermis and dermis, weakening their supporting structures and with age, the epidermis and the connective tissue weaken.
There are two categories of wrinkles: fine surface lines and deeply set furrows. They differ in structure and origin and respond to different types of therapy. Fine surface wrinkles are as a result of the breakdown of collagen and elastin fibres due to aging and sun damage. Deeply set furrows are caused by the build up of muscles beneath the skins surface over time as a result of repeated facial expressions in pretty much the same way muscle is built through exercise. These deep furrows can show permanently or come about when facial expressions are made like "crows feet" showing up when a person smiles. These categories of wrinkles respond to different therapies.
It's not uncommon to find skin blotchiness, dullness and discolouration associated with aging, sun damaged skin. The skin rejuvenation process should be aimed at tackling all these problems in addition to dealing with wrinkles. Preventative and restorative measures should be taken in the fight against wrinkles. Preventative measures include avoiding excessive sun exposure and smoking as these create highly reactive molecules called free radicals that damage skin cells. Sun protection is a must in every skin care regimen with the use of a sunscreen with a minimum sun protection factor (SPF) of 30. Use of collagen boosting products and supplements are both restorative and preventative.
Smokers usually develop lines around their lips caused by repeated puckering while inhaling. Like sun exposure, smoking breaks down collagen and elastin, accelerating the rate at which the skin sags and wrinkles.
The skin is made up of three layers. The epidermis is the outer protective layer made up of rows of cells that are stacked like bricks in a wall. The basement layer of the epidermis contains the pigment producing cells known as melanocytes that determine skin colour. The dermis, the middle layer, consists of connective tissue, capillaries, nerves, hair bulbs, oil and sweat glands, and collagen producing cells called fibroblasts. Supporting collagen and elastin fibres weave through the dermis giving the skin firmness and flexibility. The subcutaneous layer lies beneath the dermis and is composed of fat and connective tissue. The muscle lies beneath this layer.
With the aging process, the epidermis thickens and becomes drier leading to a dull lifeless appearance. The breakdown of collagen and elastin fibres in the dermis causes the skin to sag. This also leads to an increase in its fragility. In addition, the collagen producing fibroblasts are less active. Sun damage may stimulate an increased production of capillaries which show up as spider veins.
There are several medical and cosmetic techniques available.
To restore lustre and improve the texture of the skin, the thickened epidermis needs to be thinned and its moisture restored. This can be achieved by using exfoliating products containing alpha hydroxy acids (AHAs) such as glycolic acid and Vitamin A preparations such as Retin-A and Retinol. Exfoliation may also be achieved by using products containing beta hydroxy acids (BHAs), poly hydroxy acids (PHAs), and lactic acid (LA). Chemical peels, microdermabrasion and the newer, Citric acid peels are also effective. A suitable moisturiser is also required. For deep set wrinkles and scars, Dermabrasion (deep replaning with a wire brush or sanding wheel) is an option. It differs from microdermabrasion by going beyond the epidermis. This is not recommended for dark skin because of the risk of permanent scarring and pigment change.
Topical treatments aimed at improving the dermis are available to boost collagen production and these include copper peptide and Vitamin C containing preparations. If you use both, apply at different times of the day or different areas as Vitamin C may neutralise copper. Vitamin A containing products in addition to exfoliating the epidermis, boost collagen production in the dermis.
Kinerase (N-furfuryladenine) is a plant growth hormone which, like Retin-A improves the appearance of fine lines and evens out blotchy skin discolouration. It penetrates the skin cells repairing and slowing down age related damage. It is safe to use during pregnancy and is a good option for sensitive skin types.
Antioxidants slow down the aging process by neutralising free radical damage and stimulating fibroblast activity. These include Vitamins C and E, Copper peptide, Co-Enzyme Q 10 and Alpha Lipoic Acid. There is a wide variety of products containing these.
For the deep furrows and frown lines caused by the build up underlying musculature, treatment is geared towards softening and relaxing muscle contractions. Botox, derived from botulinum toxin, injected, can paralyse muscles that produce "frown lines" on the forehead, fine lines or "crows-feet" around the eyes and other wrinkles found in the upper zone of the face. Injections, required every three to six months, temporarily paralyse the muscles, smoothing out the overlying skin. Results are seen about two weeks after the injection is given. Other derivatives of botulinum toxin are Myobloc and Dysport. Possible complications of Botox use include, headache, respiratory infection, blepharoptosis (temporary eyelid droop), nausea and flu syndrome. Safety depends on the experience of the Physician. There are also less invasive topical creams that relax muscles such as Resolution D-Contraxol by Lancome, Avon Anew Clinical Deep Crease Concentrate and Protox 10.
Surgical facelifts achieve results by pulling and tightening lax skin to smoothen out its surface. There is a cosmetic surgical procedure that permanently erases the frown lines between the eyes. In this procedure, the corrugator muscle which causes the furrow lines in excised.
Non surgical facelifts are aimed at boosting collagen production and tightening underlying tissue. This can be achieved by use of Nonablative lasers which plump up the skin without injury to the outer layer. A series of four treatments at three week intervals is usually required. Laser treatments are not recommended for individuals with darker skin as there is a greater potential for permanent scarring and pigment change. The new ThermaCool facelift lifts and tightens the aging face without surgery, without lasers and without recovery time. This technology uses gentle radio frequency waves which tightens existing collagen and boosts collagen production resulting in tighter, firmer skin. It is safe for all skin types.
Use of wrinkle fillers such as Restylane which is a genetically engineered version of human Hyaluronic acid is very popular. Hyaluronic acid is a jelly-like substance abundant in young skin that markedly diminishes with age causing the skin to cave in and produce wrinkles. It gives terrific results when used to fill nasolabial folds (laugh lines), fine lines around the mouth, crow's feet at the corners of the eyes, cheek depressions and some facial scars. It has little or no side effects and lasts longer (up to one year) than other fillers like bovine collagen (Zyderm collagen for filling fine lines and Zyplast collagen for volume and bulk). Fat cells from your own body may also be injected as a filler to plump up the skin.
Isolagen is a unique filler agent derived from your skin's own collagen producing cells called fibroblasts. It is used to fill wrinkles, scars from acne or chicken pox and for lip augmentation. The cells are obtained from each patient and grown exclusively for them and cultured under a patented process at the Isolagen Corporation for 6 to 8 weeks. The cells are then injected into the defects every 2 weeks for about 3 sessions. Optimal effects are seen in 4 to 6 months and results are long lasting.
No matter what your skincare regimen is, the number one rule to decelerate aging is "Never to leave home in the daylight hours without wearing a sunblock". This is the strongest line of defence. It's important to exercise regularly to improve skin vascularity (blood flow), eat a balanced diet rich in antioxidants and drink plenty of water (at least eight glasses a day). These measures enhance overall health, which is bound to affect your skin positively. Early intervention counts to prevent and repair damage to all layers of the skin.
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