Anti Ageing
Ageing of the human face is a complex process and is not limited to just the skin. It is a three-dimensional process affecting skin, fat, muscle and bone. Research into this field of medicine is now starting to mature and we are able to predict and understand, in a simplified manner, how we age.
How does the skin age?
Skin health and the maintenance of skin health involves numerous strategic cells and processes. Our skin is at its best while we are still children. Up to the age of 10 years skin can be defined as being smooth, even in colour, firm, tight, well moisturised, tolerant and the process of skin cell repair and regeneration is regular. There is no sebum (oil) production, no inflammation, no dryness and no sensitivity. During our teenage years skin health begins to deteriorate and function becomes altered. Our skin starts to produce sebum, becomes inflamed, and as a result we start to develop irregular textures and enlarged pores, acne, uneven skin colour, and a dull appearance.
By the age of 30, skin becomes inactive. The turnover of skin cells becomes extremely irregular. The skin’s barrier function becomes weak. A lack of cellular activity means critical structures within the skin become depleted, abnormal in structure and hence skin starts to develop lines and wrinkles. There are three main components of the skin that are the focus of the majority of anti ageing treatments. These are collagen, elastin and hyaluronic acid. Treatments that are aimed at increasing their levels as well as optimising the conditions for their production, repair, and regeneration produce the best anti ageing effects.
What happens to fat with ageing of the face?
As mentioned earlier facial ageing is a three-dimensional process. Below the skin of the face is a complex arrangement of self contained parcels of fat. These parcels of fat are arranged either side of the SMAS (muscular system of the face). The deep parcels of fat provide the mid-face with volume and youth. As we age the deep parcels of fat reduce and essentially deflate. This results in loss of volume of the mid-face. The superficial parcels of fat are more variable in their behaviour.
In some people the superficial fat parcels can increase in size and alongside weakened ligaments result in sagging of the mid-face and jawline producing tear troughs, nasolabial folds and jowls. In others the superficial fat parcels deflate with age, there is overall loss of volume in the face. The face can then take on a skeletonised facial appearance. A thorough understanding of the location of different parcels of fat and how they are behaving can lead to excellent results when using dermal fillers and fat transfer to restore balance and plump to the face.
Reverse Neo: Deep dermal skin rejuvenation combined with superficial skin resurfacing
Aerolase Era Elite is a fully ablative Erb:YAG laser suitable in all skin types thanks to its 300-microsecond pulse duration and precise depth control with no demarcation lines enabling bespoke skin resurfacing. It is similar to a Fraxel CO2 laser but is safer in darker skin types.
Aerolase Era Elite can be combined with Neo Elite to offer a fully ablative resurfacing treatment to help improve contours and poor skin texture and skin tone immediately following deep dermal collagen stimulation with Neo. The unique ‘Reverse Neo’ protocol combines Neo and Era in a single session and is considered to be the ultimate dermatological laser protocol. The ‘Reverse Neo’ protocol can be finished off with Target Cool delivered topical rejuvenating E50 Exosomes. This speeds up recovery and can help with redness and pigmentation.
Other treatment options include microneedling combined with Radio-Frequency Energy in the form of Sylfirm X in combination with Target Cool delivered topical rejuvenating E50 Exosomes.
More old school approaches to acne scar improvement includes chemical peels such as the ZO 3 Step Peel or Controlled Depth Blue Peel. Pigmentation can initially be addressed by incorporating hydroquinone into any bespoke skin care program in an attempt to bleach, and in combination with Vitamin A, blend the skin producing a more even skin tone and reduction in post-inflammatory hyperpigmentation scars.
Sylfirm X - Radio Frequency Microneedling for tighter skin
Microneedling is clinically proven to result in new collagen formation and rejuvenation of the skin. Radio Frequency devices result in the delivery of heat to the deeper layers of the skin, known as the dermis, resulting in denaturing (breakdown) of collagen and elastin. This is followed by new collagen and elastin formation making skin tighter. Sylfirm X combines radio frequency energy with microneedling, resulting in skin tightening with collagen induction. Sylfirm X is an alternative to Morpheus 8. The difference between these is that Sylfirm X has the option of using a continuous or pulsed radio frequency beam meaning it is safer to use in delicate areas, such as the upper and lower eyelids as well as helping with hyperpigmentation and redness. Sylfirm X is an excellent choice for non-surgical treatment of heavy eyelids (upper and lower), loose skin on the face and neck helping to address jowls and nasolabial folds, hyperpigmentation from scars and melasma as well as redness associated with rosacea.
©Photos courtesy of Sylfirm X. Individual results may vary.
E50 Exosome Mesotherapy with Sylfirm X
Sylfirm X can also be combined with E50 Exosome mesotherapy. Exosomes are a biological regenerative medicine product derived from salmon testes DNA and packed with growth factors and proteins that have a large number of anti-ageing properties. The thorough microneedling of the skin with Sylfirm X means it can be followed up with the administration of Exosomes using the Target Cool high pressure spray gun device to drive the exosomes painlessly into the skin and help with recovery as well further stimulate collagen and elastin formation. Exosomes can also help with improvements in hyperpigmentation and redness alongside fine lines and wrinkles.
Daily Skin Care with Zein Obagi at Rejuvence
At Rejuvence we recommend using ZO products in your daily skin care routine to help maintain youthful healthy looking skin. ZO offers a range of products and packages that are clinically proven to help with multiple anti-ageing concerns. They are safe and effective in all skin types and go well with all our anti-ageing treatment protocols.
Neo Hydrafacial - #Ultimate Neo Glow
At Rejuvence we are always looking to offer our clients innovative anti-ageing solutions by combining different treatments to offer something a little extra. Hydrafacial is the only hydradermabrasion procedure that combines cleaning, extraction and hydration simultaneously alongside a chemical peel, resulting in clearer, more beautiful skin with little to no downtime. The treatment is soothing, moisturising, non-invasive and generally non irritating. Results are often almost immediate. To take it to the next level, at Rejuvence we offer a Neo-Hydrafacial where we carry out a full face Aerolase Neo Elite laser treatment followed by a Hydrafacial. The Neo helps with a number of skin concerns including Acne, Acne Scarring, Hyperpigmentation, Redness & Rosacea as well as general facial rejuvenation. The result is the #ultimate Neo Glow! This combination is fantastic as a one off treatment and even better as part of a regular hydrafacial skin care routine.
J-Plasma Face – Press the RESET button!
At Rejuvence we are the first and only clinic to bring this revolutionary treatment to the UK. It has taken the US by storm. Prominent US cosmetic doctors regard J Plasma as the greatest innovation in the cosmetic industry in the last 10 years. J Plasma Face helps to hit the reset button and can take 5 to 10 years off someone. J Plasma Face is similar to Fraxel CO2 laser but better. It has the effect of a non-invasive facelift and the results can be stunning. For further details please contact us to book a consultation.
Rejuvence Philosophy
At Rejuvence we have a thorough understanding of the processes involved in the ageing of the face. We are keen to emphasise the 3 dimensional nature of the ageing process and hence ageing at multiple levels need to be addressed in order to achieve good results. In addition we are passionate about using evidence based treatments. Over recent years doctors have realised that treatments, however simple or complex, are about discussing options and shared decision making with their patients. As doctors we have a responsibility to our patients to provide them with treatment options that have the best levels of evidence to prove their efficacy. In the cosmetic industry this, unfortunately, is not always the case. At Rejuvence we are passionate about offering our clients evidence based treatments that have been shown to work. Where the evidence base is not very strong we are quick to point this out. We are the experts in anti-ageing and aesthetic medicine but we also acknowledge you are the experts of your face.
Collagen provides the skin with its tensile strength and is dependent upon a criss-cross structure in the dermis (deep layer) of the skin. As we age the amount of collagen reduces and it loses this arrangement. As a result skin is thinner and loses its strength. Excessive sun exposure, smoking and high caffeine consumption can worsen this process.
Elastin forms a unique relationship with collagen and provides the skin with its elastic properties. With age the amount of elastin reduces and its interaction with collagen is compromised. Skin becomes lax and loose. It tends to sag. Excessive sun exposure and smoking can worsen this process significantly.
Hyaluronic acid is found in large quantities in healthy skin. It is responsible for carrying large numbers of water molecules and provide skin with hydration and gives it a plump and soft feel. With ageing levels of hyaluronic acid reduce and skin can dry out and become sallow and dull. As is the case with collagen and elastin, the process of ageing and reduction of hyaluronic acid is significantly worsened by excessive sun exposure and smoking.
Treatment specifically targeted at the skin includes topical skincare products including serums and creams that help to increase fibroblast activity. Fibroblasts are responsible for collagen and elastin production. Retinol and tretinoin are the best studied products and have been shown to increase collagen and elastin levels. Chemical peels can be used to improve skin texture following adequate skin preparation. Specific collagen induction therapies including micro needling result in increased collagen levels. Platelet rich plasma with micro needling can have a dramatic effect on increasing fibroblast activity and can return a glow to aged skin. This can last up to 18 months. Ultimately the effects of these treatments will be short lived if specific lifestyle changes are not made including reduced sun exposure and smoking cessation. Healthy skin function can be maintained irrespective of age as long as a good skincare program is used.
Regions of volume loss can be addressed using dermal fillers. Injections of hyaluronic acid into the deep fat compartment can go a long way to restoring a youthful appearance. The ultimate natural filler is, of course, your own fat and fat transfer provides the best long term solution to volume loss.
Where there is excessive volume in the superficial fat parcels and together with weakening of ligaments, there is a general sagging of the face. Gravity also plays a significant role over time. In this case a lifting effect is required. This can be achieved with appropriate placement of dermal fillers or fat, to emphasise cheek regions. Sagging jawline can be hidden with clever placement of hyaluronic acid dermal fillers. A direct lifting effect can be provided by the use of threads such as PDO or PCL threads that can be used to lift the jawline and cheek as well as tighten the neck.
With ageing there are changes to the muscles of the face. Most notably with the increased use of facial muscles with age they hypertrophy (increase in size and become stronger). As a result they can over stretch the skin and deeper structures. Alongside increased laxity and thinning of the skin with age, there are increases in wrinkling especially around the forehead and the corner of the eyes (crow’s feet). The down turn of lip corners (marionette lines) and cords in the neck can also form as a result of muscle hypertrophy (increase in size and strength).
The use of wrinkle relaxing injections is amongst the oldest aesthetic techniques. Injection of botulinum toxin type A into regions of the forehead and corners of the eyes as well as around the bridge of the nose can help in the reduction of dynamic facial lines. Dynamic lines are lines that are only seen on moving certain parts of the face in frowning, smiling and in raising the eyebrows. Static lines describe wrinkles and fine lines that are always present irrespective of facial movements. These are only partially treated with wrinkle relaxing injections.
