I am happy to cherish these life wisdom tokens in my soul and let go of the stories these lines hold on the surface.
In this blog, I will list down all the treatment options that I have tried and also have recommended to my patients in clinic. I share my professional knowledge and experience with each as an Aesthetic Doctor for over 15 years and my personal preference as a woman of colour with acne prone, sensitive skin.
If you are also a rebel at heart, I hope this blog will give you some insights and options on reducing, improving and softening your Wisdom or Warrior Lines.
Your face, your rules.
You get to choose which stories to keep or let go.
Before we look at the treatment options, I want to quickly go through the type of wrinkles and what causes them. This will help us reverse engineer and decide on the best treatment(s) for you.
Types of Wrinkles
There are essentially 2 types of wrinkles – Dynamic and Static.
A dynamic wrinkle is a line that comes up when you move a specific muscle. For example, if you raise your eyebrows and scrunch your forehead, and a line appears when you relax the muscles, that is called a dynamic wrinkle. Dynamic wrinkle goes away if you don’t move the muscle.
If a line is already present even when your face is relaxed, this is called a static line.
A dynamic line is caused by the muscle creating a repetitive crease in the skin which has lost its elasticity so it doesn’t spring back, making an etch on the skin.
A static line is caused by a loss of volume or collagen alongside repetitive creasing of the skin. A static line typically follows if a dynamic line is not treated. So it’s like a tiny fold in the skin.
Why do we get wrinkles?
This comes down to the causes of ageing and our skin doesn’t turnover, differentiate or renew as regularly as it used to. So we lose our skin’s plumpness, firmness, thickness, elasticity, hydration and resilience all leading to increasing the likelihood of wrinkle formation.
This can be caused by:
• Genetics and our own cellular clock
• UV damage
• External inflammation (e.g. pollution, chemicals, stress, smoking)
• Internal inflammation (e.g. stress, alcohol, lack of sleep, inflammatory foods)
• Hormonal changes
We get more wrinkles when our skin and body is more in wear and tear vs. rest and repair.
TREATMENT OPTIONS
For the purpose of this blog, I will only focus on the external treatment options.
I will write another blog on my favourite strategies to internally slow the ageing process otherwise we will be here forever!
So without further ado, here goes:
Skincare
During our 40s, skin can be more sensitive, dryer and acne prone due to hormonal fluctuations and stresses of life catching up on us if we’ve not learned to manage it.
The most important step before we use any of the more common sexy ingredients like retinol and acids is to reduce inflammation and repair epidermal barrier so there is less water loss, less sensitivity and the skin is not constantly fire fighting.
I actually take patients off strong active ingredients at the start to get their skin strong and well hydrated before upgrading their skincare. Skin actually self-exfoliates when it is well hydrated.
I recommend a simple and effective routine using:
1. A gentle milky cleanser in the morning and night.
2. Hyaluronic Acid serum.
3. Niacinamide serum to reduce redness, pigmentation and inflammation.
If the skin is still reactive, ingredients like retinoids, alpha hydroxy acids and even Vitamin C can potentially worsen inflammation and cause more ageing.
Personally, I do not use retinol as my skin generally does not like the side effects – dryness, breakouts, dermatitis, redness and itchy skin. If I do, I use them once a month as a boost.
However, I do recommend them to some of my patients based on their skin tolerance. If you would like my approach and would like me to recommend a skin care plan for you, please get in touch with your skin goals and a brief skin history to [email protected].
Resurfacing Treatments
Resurfacing means to remove visible signs of ageing from the outer layers of the skin to induce controlled skin wounds to kick start the healing process and create new skin cells. This can be done via 3 modalities.
1. Physical resurfacing includes in-clinic microneedling and at home derma roller.
2. Chemical resurfacing includes skin peels.
3. Energetic resurfacing includes laser vaporisation or laser ablation.
I personally prefer physical resurfacing as there are less side effects. However, improvements take longer to show.
Chemical and energetic resurfacing treatments are better for improving deeper static lines, acne scars and even help to even skin tone. However there is a higher risk of complications potentially creating further inflammation which can lead to post-inflammatory hyperpigmentation, thinning of the skin and even scarring.
If you are a woman of colour and you wish to go down the chemical and energetic route, I HIGHLY recommend seeking a practitioner who have experience using these modalities on coloured skin.
Skin Boosters
The aim of this group of treatments is to boost the skin’s hydration, collagen, elastin and healing potential so it becomes healthier, more resilient and hopefully the cells act like its more youthful version. I love skin boosters for these reasons.
There are many different types of skin boosters which are typically placed in the superficial layers of the skin via multiple small injections. Skin boosters can also be used alongside resurfacing treatments to penetrate the skin deeper.
Here’s a rundown of some of the more popular ingredients which all act differently to boost the skin:
- Hyaluronic acid (HA) e.g. Teosyal Redensity I and Profhilo to boost hydration. It plumps the skin by adding more moisture. Once the hyaluronic acid breaks down, the skin goes back to its original state.
- Mesotherapy – this uses a cocktail of ingredients e.g. vitamins and HA to “feed” the skin at a deeper level.
- Platelet Rich Plasma (PRP) – this uses growth factors that acts like project managers signalling repairing cells to the area that has been wounded.
- Polynucleotides (PDRN) e.g. Plinest (formerly known as Plenhyage) and Ameela (formerly known as Nucleadyn) contains long chain DNA sourced from salmon sperm. They are building blocks which signals fibroblast cells to multiply increasing collagen and elastin production. PDRN also acts as antioxidants, scavenging free radicals that can speed up ageing.
5. Sunekos is a patented formula of hyaluronic acid and 6 amino acid (HY6AA) that offers results similar to PDRN and more because of the type of collagen it stimulates.
Why is this important?
There are 28 types of collagen in our body – not all are involved in youthful skin.
The common ones we see in our skin are Type 1 and Type 3 which are produced more commonly by skin resurfacing treatments and skin boosters e.g. PRP, PDRN and Sunekos. These are found mainly in the dermis (the red lines in the diagram above). This is important because it provides plumpness to the skin.
Sunekos interestingly also stimulates production of collagen Type 4 (COL4) and Type 7 (COL7) which are found mainly in the dermal epidermal junction (DEJ – the wavy horizontal black line between the epidermis above and dermis above). It acts like a glue, keeping the skin “tight” as there is less “slippage” between the epidermal and dermal layers. It also maximally produces elastin compared to other products.
So apart from improving the skin’s elasticity, texture and firmness, it also improves skin tone, reducing pigmentation as the thickness of the DEJ is restored, reducing the distance of the pigmented cells at the bottom layer to be as visible from the top.
Depending on the ingredient, there is usually a protocol of 3 sessions 2-4 weeks apart as an intensive initial treatment and one treatment session once every 6 months as maintenance.
6. There’s a new kid on the block called exosomes which are membrane-bound vesicles carrying signalling molecules aimed at boosting cellular function. Currently it’s used mainly as a topical treatment after microneedling or laser treatments.
Exosomes derived from human stem cells are illegal in UK due to the risk of DNA transmission in case the donor had a disease or any DNA issues. There are PDENS (plant derived extracellular nanoparticles) that acts similarly to exosomes. However, most of them also contain a mixture of natural skin-boosting factors including peptides, liposomes, nucleic acids and immune-boosting so it’s not clear if the results is actually from the exosomes on its own. For this reason, I’m not a big fan of exosomes.
Collagen Biostimulators
From the Skin Boosters group above, PDRN and Sunekos are also known as biostimulators and they are a part of an exciting growing field of regenerative medicine.
Other collagen biostimulators include:
1. Ellanse – a type of dermal filler made of synthetic Poly-E-Caprolacton (PCL) microsphere suspended in a carrier gel. It is a bio-reabsorbable soft polymer that stimulates connective tissue growth. This is more suitably used when there is larger volume loss creating deeper static lines on the lower part of the face. It’s not suitable for fine areas like the forehead, around the eyes and neck.
2. PDO (polydioxanone) are fine threads made of a biocompatible material commonly used in medical sutures. The threads are designed to stimulate collagen production, lift sagging skin and improve the overall texture and tightness of the area of concern. I personally have had PDO threads in my face and I love the results. It is however more expensive and there is a 2 week downtime.
Muscle relaxant e.g. Botox
This relaxes the muscles and depending on where you have the injections, it helps to soften lines especially dynamic wrinkles.
It relaxes your muscles so when you move it, it doesn’t crease your skin as much. It’s a good way to prevent the lines getting worst and you can focus on a good skin routine to help reduce the static lines afterwards if you have it.
Muscle relaxant treatments takes 2 weeks to fully take effect and can last up to 3 months. It can help soften frown lines, forehead lines, crows feet and bunny lines.
However, if you have too much botox, it can paralyse the muscle so it can either feel too tight, almost giving a shiny plastic look or it can cause unwanted side effects e.g. a temporary eyebrow droop.
It’s important if you do decide to have botox, to have little amounts so you can still have some movement.
Dermal Fillers
Dermal fillers are like a paintbrush to an artist. It allows me to restore youthful features and also enhance your favourite beauty angles.
It is mainly made of hyaluronic acid which is a similar structure to the hyaluronic acid in your skin, joints and eyeballs. Unlike the HA used in skinboosters, these are made denser by cross-linking so it provides more shape. It helps to replace some of the volume that has been lost. A good way to check if this is suitable for you is to stretch the line and see how much it is reduced.
Results are seen immediately. There can be mild swelling in the first 24 hours and results can last up between 6 – 18 months depending on the type of dermal filler used.
FINAL WORDS
I hope you found this blog helpful.
There are many ways to soften the wrinkles you no longer find cute nor wish to keep. It depends on your skin, your lifestyle, your pain threshold, your goals, how much downtime you’re willing to go through and your budget.
If you like my approach and would like me to help you defy your lines and wrinkles, I invite you for an aesthetic consultation so I can assess the best treatment options for you.
In my clinic, I currently offer skincare planning, physical resurfacing with microneedling +/- PRP, skin boosting with Sunekos, Teosyal Redensity I, Muscle Relaxant, Dermal filler, Ellanse and PDO threads.
If you would like to explore this further, get in touch by emailing my team at [email protected] to schedule an appointment.
Here’s to being a rebel at heart with each passing year.
Your cheerleader,
Dr Terry