Mature Skin

Mature Skin

Balance is the keyword. Apply this principle to all ages, including mature skin. A simple 4 step plan is as follows-

Step 1. Improve skin quality. Lasers & chemical peels can improve skin texture, and reduce pigmentation, fine lines & wrinkles.

Step 2. Improve skin tone & turgor. This refers to skin tightening procedures including HIFU (High Intensity Focused Ultrasound), RF, as well as collagen stimulating fillers.

Step 3. Improve volume & support ligaments. This is achieved by strategic dermal fillers.

Step 4. Maintain results. Good skin care, coupled with low cost- low downtime clinical procedure including chemical peels & fractional lasers can slow down the ageing process.

What are ways to slow down the aging process?

Start with good skin care & lifestyle choices. Skin care includes sun protection, antioxidants & vitamins includingascorbic acid, retinol & niacinamide. Add skin acids to exfoliate every week. Preventive anti-aging procedures include-

Laser resurfacing. Simple fractional lasers for lighter skin types, and pico lasers for darker skin patients. We use one of 30 devices to help stimulate collagen, elastin & hyaluronic acid.

Chemical peels include retinoic acid & AHA peels. Peels can address sun damage, dull skin, pigmentation, enlarged pores, and congested skin.

Injectables such as dermal fillers & anti-wrinkle injections can reduce wrinkles & provide dermal hydration, whilst reducing volume loss.

The ideal combination of injectables, peels, lasers & skin care really depends on your age, skin’s clinical condition, ethnicity & aims. Book an obligation-free consultation with my nursing staff @cliniccutis to see what is best for your skin.

What about eye rejuvenation in mature patients?

Addressing skin quality, wrinkles & volume can make a huge difference in perceived age. Procedures include-

• Laser rejuvenation with CO2, erbium & fractional lasers

• Skin tightening with HIFU, RF, Thermage

• Anti-wrinkle injections to the crow’s feet

• Brow repositioning with dermal fillers

• Volume replacement of the orbital rim & tear troughs

A good skincare routine with ascorbic acid, retinol & pigment correctors can complement the gains from laser & injectable procedures.

Do duck lips look good in mature patients?

Duck lips don’t look good on any age group, however, disproportionately enhanced lips on mature patients are even worse! Perioral & lip rejuvenation in this age group is based upon supporting this region.

Dermal fillers are placed around the lip area, especially around the corners of the mouth. This allows for some lip eversion. Struts of filler in the upper lip area can reduce lip wrinkles & smoker’s lines.

How do I treat smoker’s lines & upper lip lines?

The upper lip is one of the very first areas to age. There are a few options that reliably erase upper lip lines and wrinkles.

My favoured treatment for moderate to severe lines and wrinkles is that of laser resurfacing. Laser works by ‘erasing’ the lines and stimulating new collagen. Results are instant, but recovery times vary from 6 to 14 days, depending on depth of your wrinkles.

Deep chemical peels can be effective, in particular Jessner TCA or phenol croton oil peels.

Anti wrinkle injections & dermal filler can treat dynamic & static wrinkles with no downtime.  This method is temporary and needs to be repeated every 3-8 months.

What type of lasers can be used for rejuvenation?

I use over 30 lasers & energy devices, however for mature skin, level 3 to 4 lasers are indicated. These lasers stimulate more collagen & provide much better wrinkle removal compared to level 1 & 2 lasers.

As a guide-

Level 1 / 2 concerns include mild sun damage, pigmentation, fine lines/wrinkles, mild scars & enlarged pores.

Lasers include: Clear & Brilliant, Fraxel, LaseMD, Fractional Pico, CORE CO2, HALO, IPL, Tixel (non laser).

Level 2 / 3 concerns include precancerous sun spots, deeper lines, heavy pigmentation, scars & textural changes.

Lasers include: Fraxel Dual, CO2 fractional CORE, Mixto, eCO2, erbium ProFractional, combination BBL/lasers.

Level  4 / 5 concerns include heavy sun damage, deep wrinkles, age spots & warts, deep scars.

Lasers include: Hybrid CO2 & erbium fully ablative / fractional laser resurfacing. Ultrapulse & Sciton lasers.

What is the best way to treat sun damage?

The standout treatment for sun damage is laser resurfacing. Lasers can address some forms of skin cancer, precancerous cells as well as other signs of sun exposure including pigmentation, dull skin & wrinkles. The type of laser resurfacing will depend on the extent of sun damage.

Fraxel HD is often combined with CO2 fractional for cases of mild to moderate sun damage, whilst ablative lasers such as the Ultrapulse is used to treat moderate to severe sun damage.

In some cases, I combine Photodynamic Therapy or PDT with lasers; most often in DVA patients.

How can you tighten skin?

The standout treatment for sun damage is laser resurfacing. Lasers can address some forms of skin cancer, precancerous cells as well as other signs of sun exposure including pigmentation, dull skin & wrinkles. The type of laser resurfacing will depend on the extent of sun damage.

Fraxel HD is often combined with CO2 fractional for cases of mild to moderate sun damage, whilst ablative lasers such as the Ultrapulse is used to treat moderate to severe sun damage.

In some cases, I combine Photodynamic Therapy or PDT with lasers; most often in DVA patients.

How can you tighten skin?

This is one aspect of skin rejuvenation you can not overlook, especially for mature skin. Put simply, skin tightening can be achieved surgically (face, neck, lid lifting) or non-surgically. If you have poor skin tone, a surgical approach is definitive.

Non-surgical skin tightening follows a highly complex algorithm. I take into account your skin quality, volume, laxity, dermal thickness, degree of elastosis (sun damage), ethnicity, age, & expectations. Options for skin tightening include-

HIFU; or High Intensity Focused Ultrasound treats the collagen in the dermis & the fibroseptal network. This device is best for thicker skin, with little sun damage.

Laser resurfacing; lasers can contract collagen. They provide a good ‘lift’ by tightening the dermis. This form of laser resurfacing is best for lighter skin types. Darker skin patients are best treated with RF or HIFU devices.

RF non-invasive: We currently use Tempsure or Pelleve as I have replaced the older Thermage system.

RF invasive: include FaceTite, often in combination with liposuction & Morpheus 8 or RFM devices.

Threads: include mono PDO, Silhouette & MINT suspension threads, often in combination with skin tightening devices. See the section on thread lifting.

Collagen stimulating fillers: I prefer the use of CaOH & PLLA collagen stimulating fillers in bespoke dilutions over HA fillers in the context of skin laxity. Most often I combine skin tightening devices post procedure to address.

Combination treatments: include threads, fillers, lasers & skin tightening devices.

What is fat transfer?

Fat transfer can be used to replace volume & to improve skin quality (nanofat). In most cases I prefer dermal fillers over fat, however for patients who have severe atrophy – volume loss, fat transfer is an option.

This procedure involves harvesting fat from the flanks / abdominal area with liposuction. I then process the fat & re-inject autologous fat into the areas of volume loss. In the context of nanofat, & adipose stem cells, most patients will see some improvement of skin quality, however, this is not as predictable as simple laser or chemical peel procedures. Nevertheless it can be a useful adjunct.

Why should you use less muscle relaxants in mature skin?

I am not a heavy user of anti-wrinkle injections. I am more of a sprinkler than a big-unit injector. I do not like big units around the crow’s feet as I do believe the muscle around your eye holds up your cheek- most importantly as one matures. I don’t do big units in the frown, nor the forehead (unless you really have frown lines).

As the patient ages, you should adapt your technique of anti-wrinkle injections to reflect the change in movement. In mature patients I want a lift, rather than a drop. Injection of small units to the DAO can evert the corners of the lip. The chin can be injected to reduce the upward pull of mentalis.

In some patients, micro botox can be really helpful in reducing redness, enlarged pores as well as fine lines, and wrinkles. I combine neurotoxin with procedures such as TIxel or Aquagold to deliver muscle relaxants, hyaluronic acid & other skin care ‘actives’ into the dermis.

Can microneedling help?

In this age group (beyond mid 40s), microneedling has marginal effects, especially on established wrinkles & sun damage. Procedures that produce controlled healing will deliver better results, hence why I prefer RF microneedling for skin rejuvenation & tightening in mature patients.

Microneedling can be used to aid in delivery of skin care ‘active’ such as retinoic, ascorbic, ferulic acids into the deeper layers of skin.

What is a surgical lip lift?

The lip to nose ratio increases with age. This can elongate the philtrum, cause inversion of the upper lip & hide the upper teeth. A surgical lip lift can address all these issues, providing better ratios & proportions. In most cases I augment surgery with dermal fillers to provide support to this area. I also use ablative lasers to treat smoker’s lines during the surgical procedure.

Why does ethnicity play an important role in determining the best treatments?

The biology of skin differs across ethnicities. Skin directed treatments must address these differences as treatments are tiered towards your particular skin type. The algorithm is very complex as there are particular variations with both skin type, & individuals. A simplified way of thinking is as follows-

Lighter skin types: European / Caucasian skin are more prone to photodamage, sun damage, sunspots & rosacea. Less prone to some forms of pigmentation, dermal layer thinner with more broken collagen.

Darker skin types: Asian / Middle Eastern / Mediterranean skin. More prone to pigmentation, less prone to rosacea & sunspots. Thicker dermal layer with less broken collagen (elastosis).

*The above is just a broad generalization as there are always exceptions. For those individuals who have taken good care of their skin, photodamage will be much less.

How does skin change with age?

Skin changes are frequently seen in the early 40s. Mature skin has several key issues-

1. Your skin may be more sensitive than before. Menopause may lead to flushing, blushing, & redness. Rosacea is a frequent manifestation of mature skin. The skin should be tailored accordingly.

2. Pigmentation may be more pronounced, both hormone related & sun related. Mandibular melasma is more common in mature skin, additionally late onset melasma is more commonly associated with ethnic skin types.

3. Xerosis or dryness increase with age, hence more occlusive skin care may be required, especially in drier, less humid climates. Think hyaluronic acid, tocopherol, niacinamide, & shea butter as key ingredients.

4. Skin thins with age, this includes the fat, dermal & epidermal layers. Skin care should reflect this change & address these issues.

What skin care ingredients & products should you consider?

Choosing the right skin care ingredients can be tricky, especially in mature skin. We need to consider many factors including your skin type, sensitivities, as well as specific skin goals including anti-aging, anti-pigment, & anti-redness.The algorithm is really complex as we also need to take into account your current skin care routine.

Read more on how to incorporate antioxidants, niacinamide, retinols, & skin care acids as part of your skin care routine.

Why antioxidants?

Antioxidants are the second layer of defence after sunscreens. These molecules protect your collagen & DNA from free radical damage due to UV radiation & environmental pollutants. Look for the following ingredients-

• Vitamin C or ascorbic acid is one of the most powerful antioxidants. This is why most dermatologists will advocate its use in the AM, under SPF. The activity depends on the formulation pH. You should aim for a pH range of 2.5 to 3.5 for maximal penetration into the deeper epidermis. I suggest starting at 10% for mature skin types as sensitivity is often an issue. Don’t use if you have rosacea as this will often flare this condition up.

• Vitamin E or alpha tocopherol is a fat-soluble vitamin & often incorporated with ferulic acid & ascorbic acid. It has a low irritation potential.

• Vitamin B or niacinamide is a good choice for rosacea/sensitive skin. This has antioxidant as well as anti-inflammatory properties.

• Ferulic Acid is a naturally occurring antioxidant found in cereals like oats. It stabilizes vitamin C & E, and hence has synergistic effects with these skin vitamins. The best formulations will have CE & Ferulic mixed in.

• Resveratrol is a naturally sourced antioxidant from red wine. Green tea, isoflavones, soy, ginseng, & botanical berries: all excellent naturally occurring antioxidants found in organic skin care products.