Aesthetics and Beyond
Wrinkles – Love Them or Loathe Them
I was told, “The wrinkles will disappear as they grow older.” Yet my Sharpei dog underwent three facelift operations at the vet in order to fix her entropion. (Inversion of the eyelids due to droopy skin). We are not as lucky, as wrinkles are a telltale sign of aging. Expression lines will gradually become permanent. Fine lines due to lack of moisture, together with sagging of the face as a result of diminished structural support, contribute to “photo” phobia.
Aesthetic treatments are so popular now that instead of denying about fixes to their bodies, men and women openly discuss treatments, costs and where to have them done. It is fashionable to go in for bi-annual services or a total makeover, as this is the means of pampering oneself and boosting confidence. As we can live longer, we do not want to accept that our longevity outlives our looks. Career success many times goes hand-in-hand with a matching physical image, whether people admit it or not.
Lets look at the various ways of managing different types of wrinkles, which can be divided into expression wrinkles, fixed wrinkles and depressed defects/scars.
Botox ® is a Botulinum toxin from UK initially used to treat muscle spasms in cerebral palsy and migraine headaches. Botox ® should be for expression lines only (not silent lines). Common uses in frown lines, forehead lines and crow’s feet give excellent results. Since it temporarily paralyses the relevant muscles, its extended use can be for shrinking the jaw size and calf muscles. Its effect on the sympathetic nervous system can reduce sweating in palms, feet and armpits.
Aneasthesia- None
Length of procedure – 5-10 minutes with no down-time
Side effects and risks – migration of toxin if the skin is rubbed, leading to short-lived drooping upper eyelids and other muscle weakness. Mild headaches and temporary bruising
Duration of results– 6-9 months
Restylane ® is a hyaluronic acid from Sweden that is of non-animal origin and fully bio-degradable. When it is injected in small droplets under the skin, water is absorbed to expand out to fill the defects. This is suitable for fixed lines like laugh lines and wrinkles around the eyes and mouth, as well as depressed scars.
Anesthesia – None, topical or local injections.
Length of procedure 15-30 minutes
Side effects and risks – Pain, bruising, itching, discoloration, swelling and redness Over-injection can cause excessive tension under the skin leading to skin necrosis Duration of results – 9-12 months
Fat grafting is a process of obtaining the patient’s own fat from one part of the body, like the abdomen, using a syringe with a cannula. This is then transferred to the wrinkle, such as a tear trough near the eye-bag, to fill it out. The desired correction can be achieved by repeated transfer of fat. The procedure is popular and is often combined with surgical procedures like liposuction.
Anesthesia – Local
Length of procedure – 2-4 hours due to tedious process of harvesting and processing the fat. There is no down-time
Side effects and risks – Very rare infection from the injection. However, since the fat is the patient’s own, there is no long-term effects or allergic reaction as it contains no foreign materials
Duration of results - The survival of the graft would depend on revascularization of the tissue and the success is sometimes short-lived (up to 2 months) but can be permanent.
Others. Collagen injections, for example, purified protein from bovine origin, is still used but the trends are moving towards materials of non-animal origin. Treatments like stem cell grafting, cultured from the patient’s own blood, or skin tissue, is injected into the wrinkles. Chemical peels and micro-needle therapy also help to reduce fine lines.
Hexapeptitde III is the latest “botox like” serum, which can smoothen out lines and brings tension to the skin. Other modalities using machines to reduce wrinkles include: IPL, LED phototherapy, sonoionophoresis, as well as various fractional lasers which are very effective.
When going for aesthetic treatments, there is always the danger of not getting the result you desire at the end of the day. A treatment that is right for your friend might not necessarily be right for you. Discuss carefully your expectations with the doctor.
Whether you wish to age gracefully with a few wrinkles or iron them out as soon as they appear, aesthetics is in the eye of the beholder. The choice is yours.
Dr Fiona Mak was qualified in the UK in 1987 and runs a practice with aesthetic emphasis in Central, HK.