Wrinkle Removers, Backed by Science

Nostrums that promise to smooth wrinkled skin are a staple of snake-oil salesmen everywhere, but now there is strong evidence that certain kinds of treatment are effective. Over the past decade, researchers have been learning which treatments work, and why.

The key is a growing understanding of the skin’s connective tissue, called the dermal collagen, and a recognition that damage to the mechanical properties of the collagen outside the skin cells, and not necessarily genetic damage to the cells themselves, causes wrinkled skin.

A recent review in The Archives of Dermatology concludes that three anti-aging treatments are proven clinically effective: the topical application of retinol; carbon dioxide laser resurfacing; and injection of hyaluronic acid, a moisture-retaining acid that occurs naturally in the skin. Each depends on the same mechanism, the interaction of skin cells called fibroblasts with the collagen they produce.

“This is an area where there’s a lot of hype and not much substance,” said David J. Leffell, a professor of dermatology and surgery at Yale who was not involved in the review. But, he said, this study is “good science.”

Theory and experiment back these treatments, the authors write. Fibroblasts — connective tissue cells — secrete a complex group of polysaccharides and proteins that creates collagen, which gives the skin shape and elasticity and supports the blood vessels that permeate it. The network of collagen tissue is maintained by its mechanical tension with these skin cells.

Skin deteriorates as it ages, but its exposure to sunlight inhibits the ability of fibroblasts to produce collagen. The hands, face, neck and upper chest all suffer more than unexposed skin, and light-pigmented people wrinkle more readily than others. This damage, the authors write, is essentially an accelerated version of chronological aging. Ultraviolet radiation induces production of the same enzymes that degrade collagen with age.

Collagen fibers last as long as 30 years. But with age and ultraviolet exposure, they deteriorate and fragment, and fragmented collagen impairs the collagen-producing function of the fibroblasts that created it. As the fragmented collagen accumulates, new collagen production declines, the connections between the fibroblasts and the collagen weaken, and the skin, now lacking support, begins to wrinkle.

But there are treatments that counter this process. Topical application of retinol, a form of vitamin A, was the first to be proved useful. Although the molecular pathways are not well understood, retinol causes new collagen to form in chronologically aged skin and in skin damaged by ultraviolet light.

Skin creams with retinol are available over the counter, but many do not indicate the concentration of the active ingredient. “Many products just refer to retinol or vitamin A as a buzzword,” said Gary J. Fisher, the lead author of the review and a professor of dermatology at the University of Michigan.

Concentrations of 0.2 to 0.6 percent are enough, Dr. Fisher said, but preparations strong enough to have an effect can also have a side effect, a rash called retinoid dermatitis. Dr. Fisher’s advice is to stop using it if a rash occurs. The rash can sometimes be avoided if the concentration is increased gradually.

Retinol also makes the skin more sensitive to damage from ultraviolet light, so protection from the sun while using it is essential. “O.T.C. products tend to try to walk the line between effects and side effects,” Dr. Fisher said. “But many intentionally keep the concentration too low to have any benefit.”

Dr. Robyn S. Gmyrek, an assistant professor of dermatology at Columbia University, is also skeptical of over-the-counter wrinkle creams. “If something shows true biological activity, it’s regulated as a drug,” she said. “A cream bought over the counter is certainly not going to do what prescription-strength retinol will do.” Dr. Gmyrek was not involved in the study.

Carbon dioxide laser resurfacing is another well-tested treatment for wrinkles. The laser removes thin layers of skin without damaging surrounding tissue. As the wound heals, new collagen is produced. The treatment works first by inducing high levels of matrix metalloproteinase, or MMP, an enzyme that destroys fragmented collagen. Then it reduces MMP and increases the production of new and undamaged replacement material. The procedure is also used for removing scars, warts and birthmarks.

Healing takes two to three weeks, and the wound has to be cleaned with saline or diluted vinegar and treated with ointments to prevent scarring. In most cases, the procedure is done only once, Dr. Fisher said, and lasts many years.

There are now some less invasive laser procedures, the authors write, but their effectiveness is doubtful.

The third effective treatment is injecting a form of hyaluronic acid, similar to a substance the skin normally produces, into the dermis that underlies the wrinkles. This was originally designed as a space filler, with no intended physiological effect. But as the injection stretches the dermis, the fibroblasts respond by producing more collagen and less MMP. The authors cite studies that have demonstrated that increased collagen production is visible within a month after the injection. The benefit lasts about six months, Dr. Fisher said.

This type of hyaluronic acid, he said, should not be confused with hyaluronic acid in some topical cosmetic products. Rubbing such products on the skin will not stimulate collagen production.

Do the benefits of these treatments outweigh the risks?

“It’s a matter of the kind of problem a person perceives and how he wants to deal with it,” Dr. Fisher said. “For these treatments, which have sound research behind them, and for people who want to improve their appearance, the benefits far outweigh any problems.”

Summary- use a retinol cream, and judicious use of  a dermal filler can slow aging.

This article appeared in The NY Times on 19th August 2008.

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ISAPS-Melbourne 2008

If its febuary, it must be Melbourne!

ISAPS, stands for International Society of Aesthetic Plastic Surgeons, and this year was the first time it was held in Australia. We last attended in Rio de Janeiro in 2006.

Well what did I learn-

1. Permanent fillers = Permanent problems, I have seen many patients treated by other doctors with these fillers, and usually the result is a major headache!From lumps to infection, even years after getting treated, they can cause problems. Fortunately, there are some options for treatment. We can certainly help.

2. Looking tired? Well, then you might need some rejuvenation around your eyes, see our gallery of 2 examples. With the appropriate placement of fillers, we can reverse the tired, and “baggy” eye look.

3. If you have fine wrinkles under the eye, use of skin needling, as used by South African Plastic Surgeon, Dr Des Fernandes, can have marvellous results, without surgery-

so come in and see us about this treatment. This is also great for deep wrinkles and scars.

4. Various optimum dosage studies were discussed with regards to Botox. So our patients will know they get the right amount!

5. “Fern -pattern” technique of dermal filler placement by Dr Tom Van Eik(Belgium), as was Dr Woffles Wu(Singapore) talks, were both excellent, and this knowledge will certainly help the treatment of our patients. I look forward to even better results now!

6. Liposculpture tips, by various European surgeons were also enlightening.

So now with even greater knowledge, we are ready for 2008,

come in now for a consultation, to see how FRESHface Clinic can help you!

1300 46 37 37 ( GO FRESH)

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Imcas- Parisienne beauty for everyone?

Well, greetings for the New Year, I trust everyone had a lovely holiday.

The FRESHface team has just come back from overseas, Dubai, Paris, and Berlin were our ports of call.

First up, Dubai-what an amazing city, a desert playground, being transformed into a metropolis of outstanding proportions literally overnight. Yes, from the Sofitel Old Town, we marveled at the Burj Dubai(Dubai tower), this building is currently standing at 600m, and in over a years time will be finished at 700m. Being close to it, one doesn’t quite grasp that it really is huge! The panels on its outer surface are meant to resemble a desert flower.

The Arabian food and culture is splendid, with tremendous history and passion, I have never tasted such wonderful dates.

Ski Dubai, a winter playground inside the cavenous Mall of the Emerites, was very interesting, considering that the temperature inside this area was -4deg celcius.

Meeting some local Cosmetic Surgeons, shed some light into the regions needs and wants.

There is a large emphasis on day spas, and restorative treatments, with use of laser and non-surgical cosmetic enhancements extremely popular.

Cultural aesthetics is very important- looking like your culture, and just enhancing the aging areas.

Next, we went off to Paris in winter. What amazing city it is, having been there many times, it still never ceases to amaze me.

The city and its occupants, Parisiennes in particular, are passionate about everything.

Be it the patisseries, or the goats cheese(fromage de chevre), it had to be this type, not from that store etc,

Macaroons, a delightful biscuit-type cake were a revelation, the esteemed Laduree, on Rue Royale, had a queue of 40 people snaking outside onto the pavement, when we went to purchase some, but it was well worth the wait!

The taxi drivers were both very well dressed, and well mannered, their knowledge of what’s happening in Paris, for example Fashion Week, or the best restaurants were outstanding, I wish the local guys could take note.

IMCAS, International Masters Course on Aging Skin, is the annual conference for all cosmetic surgical treatments, it is held in a wonderful venue in west Paris. Over four days, there were some stand out talks, Dr Rajiv Grover(UK)spoke on the role of L’oreal and Garnier cosmetics companies informing the public of the role of skin tightening, to the latest anatomy of fat pockets in the face.

Finer points of technique for Botox, and some new uses, with the addition of more volume-fillers, were showcased.

As were some great new ideas for Liposculpture.

Ogee curves, and other architectural descriptions of the aging face, leant more credence to the idea that cosmetic surgery really is all about design and art, blended with science.

Talking about blending, wow, what beauty abounds in Paris! From the Metro, to bistros’, to Le Bon Marche, there were beautiful ladies everywhere, most likely due to wonderful mixing of genetics. So unselfconscious, just being, just French. Paris was also about not being ‘over the top’, or “trop” in French. This also translated into their fashion, and also how to look, many local surgeons stated that the natural look was the only way for cosmetic enhancement.

So now is the new year, we look forward to improving all our patients looks and health!

A bien tot ( see you soon!)

PS

Next week we are off to Melbourne, for ISAPS(International Society of Aesthestic Plastic  Surgeons). This is one of the largest and best cosmetic surgery meetings and is being held for the first time in Australia.

So stay tuned for more of the latest news.

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Anti wrinkle injection risks….

How Safe are anti-wrinkle injections(AWI)? by Patricia Woloch

As we age, cellular changes, collagen depletion and gravity begin to take their toll on our skin. Wrinkles begin to crop up on the face in the form of forehead furrows, loose jowls and prominent nasolabial folds (the deep wrinkles that form at the base of each nostril down to the corners of your mouth). There are many cosmetic procedures that patients can choose from to help reverse these signs of aging. These range from surgical options like facelifts, to injectables like AWI. Most patients who do not want the risk or recovery associated with surgery, usually opt for the latter - but many people still wonder if AWI is safe.

AWI is a protein produced by Clostridium botulinum bacterium. When injected into the muscles of the face, the toxin blocks nerve impulses that move the muscles, so they become temporarily paralyzed. Since wrinkles form where muscle movement has creased the skin repeatedly, the result of AW injections is smoother, less wrinkled skin.

AWI was initially approved by the FDA in 1989 to treat conditions like facial and eyelid spasms, and is now approved for use in patients age 18 to 65 for the temporary treatment of wrinkles. Since used for this purpose, it has become an extremely popular outpatient procedure. Almost 3.3 million AWI procedures took place in 2005, and that number continues to grow with time.

Although the thought of injecting a toxic bacterium into your face doesn’t sound safe, there are no known long-term side effects, the results are temporary and complications are very rare. In some patients it can cause droopy eyelids if not injected correctly, and a small percentage of patients experience flu-like symptoms, headaches or nausea immediately following the procedure. When these risks are compared to those of invasive surgical procedures used to treat the same condition, AWI is clearly a safer alternative.

How the Procedure Works, AWI is administered through a series of tiny injections into the muscles causing the wrinkles you’d like to treat. Since the location and size of these muscles is different for every person, the surgeon will examine how each muscle moves on your face before deciding where to inject the AWI. Once administered the wrinkles should begin to dissipate within days and the results can last up to four months before a repeat session is needed. There is no downtime, no recovery time and most patients can schedule a quick session during their lunch break.

“AWI is a great, simple way to combat the signs of aging for many of my patients,” says Dr. Mandraccia, a renowned plastic surgeon from the Bonita Springs, Florida area. “It can take as little as ten minutes and the results can last several months.”

About the Author

To learn more about the benefits of AWI, you can visit Dr. Mandraccia’s website at www.mandraccia.com. Or, you can schedule a private consultation with Dr. Mandraccia today. During your appointment he can discuss all your cosmetic options with you in detail and answer any remaining questions you have about AWI.

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Don’t sweat the big stuff!

Four Excessive Sweating Treatment Options by Katrina Myers

Excessive sweating, also known as hyperhidrosis, is a condition caused by a hyperactive sympathetic nerve. The main symptom is excessive sweating in the patient’s face, underarms, feet, head or hands. Or a combination of some or all of these.

Hyperhidrosis has a number of possible treatments that diminish the symptoms and help improve patients life conditions.

It is reported that excessive sweating can evolve into psychological problems for patients who are too ashamed of exposing themselves to social situation in which their excessive sweating will be under public scrutiny.

Therefore it is important to discuss excessive sweating treatment options. This article provides information about four of the main options available.

Sympathectomy: this is a minimally invasive surgical procedure in which the patient is back in his/her home the same day of the operation. Basically the intervention consists on removing the sympathetic nerve which is the one causing the excessive sweating.

Anti-wrinkle injections- is also used as treatment for hyperhidrosis patients. A regular dose of AW injections will help reduce the excessive sweating on patients for 8 to 12 months.

Beta Blockers: also called beta-adrenergic blocking agents. Beta blockers block the epinephrine, which is also known as adrenaline. This reduces the heart rate speed and the blood pressure, relaxing vessels and improving blood flow. As a consequence of slowing down the metabolism, excessive sweating is drastically reduced. You should consult your doctor if you go with this option because it does have some side-effects.

Detox: detoxing your body is yet another excessive sweating treatment. Basically by reducing the amounts of toxins in your body you are reducing the need of the body to eliminate such toxins (because they are not there anymore). So stay away of nicotine, caffeine, fatty foods, alcohol beverages and sodas. Eat healthy, drink lots of water and work out.

About the Author

Visit the website at http://www.clickbuy.org/hyperhidrosis/index.html to find out the honest truth about Sweat No More where all Excessive Sweating Guides are exposed for what they are.

The author of the article used to suffer from hyperhidrosis and enjoys helping people to overcome this problem.

Having treatment with Anti-wrinkle injections  will entail approximately 45minutes, and will give atleast 10months of reduced sweating!

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Putting your best neck forward.

Not everyone can claim to having a nice smooth, contoured neck/jawline, with little pigmentation of their neck/decolletage. Can you?

The neck can really be a tell-tale sign of aging.

The platysma is the layer of muscle from the collar-bone to the chin. Changes in the platysma may lead to characteristic banding, the cause of this is unknown .

These bands and horizontal necklines(necklace lines) are most amenable to treatment with Botox.

Well, recently there have been two studies out of America, looking at the use of Anti-wrinkle injections  for treatment of the aging neck.

In the February issue of respected journal Plastic and Reconstructive Surgery, the first study looked at the management of platysmal bands( the cords in the neck which give a “turkey-gobbler” appearance).

Here in a 3-year period, 1500 patients were treated by 3 independant practices.

THe indications for admission into treatment were

1. platysma banding not warrenting surgery

2. residual bands after surgery

3. horizontal neck lines with bands

4. and patients who were psychologically not ready for surgery, or had medical problems deeming them unfit for surgery.

Results-

1. 98.5% had good-to- excellent results,

the best rest results were in found in these groups-

- mild horizontal lines

-thin or mild flaccidity of bands

-mild skin laxity

-thick bands with moderate flaccidity of bands and moderate skin laxity.

So, with a thorough consultation, you may be able to have these necklace lines and bands reduced.

“What about your neck would you like to be improved?” is the question I ask you,

fortunately we have a safe and new , non-surgical treatment for these problems, don’t forget, we can also in some cases give your lower face a lift!

Side -effects of treatment are few, from bruising, to rarely neck weakness and swallowing difficulty.

So why don’t you call 1300 46 37 37 ( GO FRESH)

to put your best neck forward!

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Cut the cake, and get less wrinkles!

Recently, we talked about aging. And how we can slow and sometimes reverse these signs.

Well, how about reducing you sugar intake, and getting less wrinkles.

Yes!

How does that work, you ask.

In addition to creams, sun screen, Botox, dermal fillers etc etc what we put in out mouth may do more than raise you sugar level, but actually crystallize the collagen and blood vessels in your skin.

Lets Explain- in a nutshell the sugar we eat makes the collagen and elastin fibres(protein) brittle and prone to cracking, a process called glycation. It also decreases the blood vessels walls ability to expand= less blood/nutrients to your skin.

New molecules are formed-advanced glycation end products(AGE’s).

Final point= skin turns saggy and loses its bounce!

In addition, we cut the calories we eat, meaning less weight gained, and less strain on our pancreas.

So, from one sweet tooth to many others lets reduce our sugar intake and get less wrinkles!

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The best skin cream !

Retinoid creams

It’s not enough to try and fix what’s already wrong with your skin. You also need to think about your future and try to prevent more damage from occurring.

Retin A and Renova are the best known brands of tretinoin (short for trans-retinoic acid), a substance related to but distinct from vitamin A.

To be precise, tretinoin is a biologically active metabolite of vitamin A. Tretinoin produces multiple effects in the skin. It works by triggering molecular switches in skin cells called retinoid receptors. These switches affanti-aging effects on the skinect many intracellular processes including cell growth and differentiation, synthesis of proteins (including collagen and elastin), sebum production(skin oil), and possibly even the cell’s lifespan clock. Furthermore, tretinoin indirectly inhibits the enzymes that break down collagen and elastin, the skin’s key structural proteins. These enzymes become overactive as we age and contribute to wrinkles and sagging skin.

Topical tretinoin is one of very few substances whose anti-aging effects have been documented in many well-designed studies.

It was found to reduce fine wrinkles and skin roughness, increase epidermal thickness and stimulate deposition of collagen. Typical strength of topical tretinoin creams is 0.025 - 0.1 percent.

Side-effects are not uncommon and include skin-irritation, dryness, peeling and sun sensitivity. With tretinoin, more is not necessarily better.

Studies indicate that 0.025 percent tretinoin may be almost as effective as 0.05 or 0.1 percent, but with lower incidence of skin irritation. According to the studies, improvement on tretinoin may continue for up to a year of continued use.

The first tretinoin brand to appear on the market was Retin A, initially developed to treat acne and later adopted as an anti-wrinkle product. Later, other formulations were developed in an attempt to reduce skin irritation and other side-effects. Those included Renova (tretinoin in a highly emollient base to reduce dryness), At present, all topical tretinoin brands are sold by prescription. Users should watch out for the side-effects even with supposedly less irritating formulations. If persistent, the side-effects of tretinoin may lead to skin damage and accelerated aging, i.e. the result opposite to the goal of the treatment.

There are two types of skin aging, intrinsic and extrinsic, and both contribute to wrinkling,” says dermatologist Dr. Ellen Gendler in The Doctors Book of Home Remedies for Women. Intrinsic aging is something that happens as the genes we’ve inherited from our parents trigger a reduction of two connective fibers, collagen and elastin. Collagen supports the skin and elastin gives it flexibility. Together collagen and elastin give skin structure and tone. After age 30, connective fibers start to break down, and the skin starts to become more lax. So its about time you did something!

Extrinsic aging is aging that comes from environmental factors, especially sun damage, says Dr. Gendler.

As we age, this process normally slows down and layers of dead, sun damaged skin cells build up on the skin. This causes our skin to look dull and thick; pores look large and we see the visible effects of sun damage such as age spots, uneven skin tone and less elasticity.

Using a retinol cream will encourage the exfoliation of these dead skin cells so healthier cells can surface. Skin will appear softer and smoother and pores will appear smaller. Skin will look younger and healthier. With the stimulation of collagen production, skin cells will be plumper, more like they were in our youth.

(Tanning salons should be called wrinkling salons. So don’t use them- use a fake tan, there are great natural looking products out there- Clarins, Shiseido.)

At FRESHface Clinic, we provide a complete skin care assessment, with the view to reversing age changes and preventing further changes,

so call now on 1300 46 37 37 (GO FRESH) to kick start your skin care! We sell these products at discounted rates!

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Ageing gracefully

Hi, everyone, well what is “ageing gracefully”?

How can we do it, can we turn the clock back? What’s this hype about anti-ageing this and that?

Well, for starters there’s good and bad news, the bad news first!

There is NO anti-ageing treatment that works! We can’t stop/reverse the ageing process.

quackwatch.org/01QuackeryRelatedTopics/antiagingpp.html

Now the good news, we might be able to do the something about ageing in the future, and we can do things to slow/treat signs of ageing( at least our skin).
For now, lets age-well, yes that means a healthy, furfulling life, whilst maintaining our looks as best as possible, trying to stay looking maybe 5 years younger than we really are! We don’t want to be eighty, but look 50? Or do we?

At FRESHface, we really try hard to keep our patients as happy as possible, and healthy, looking great (slightly younger than your true age).

Using specific fillers in certain areas can really make a difference, as when we age, we inevitably lose volume in our skin/tissues, so areas will look flatter, or creases get deeper.

Contact us on 1300 46 37 37 ( GO FRESH) to see how we can make sure you’re ageing gracefully!

Some things to stay healthy and age-well-

1. Stop Smoking- apart from a premature death from lung cancer, it will starve your skin of nutrients

2. Excercise regularily/keep busy

3. Eat a well balanced diet, more tofu, reduce calories, preferably also less meat, more fish, more raw food, drink a small amount of alcohol, red wine from Bordeaux etc Click here for calorie restriction articles-

4. Use a retinol based cream- FRESHface regularily advised our patients to use one! Click here to read an article discussing one of many on these creams

5. take some multi-vitamins, and anti-oxidants

6. listen to your body, know your family history of diseases eg. Cancer, go for regular health checks- e.g Breast examinations, pelvic ultrasounds if you a history of breast or ovarian cancers in your family

7. Avoid unecessary prolonged sun exposure/solariums(they age your skin faster)- think of leather when you lie on Bondi! Use a sun block, and oh yes keep an eye on your moles!

8. Find happiness in your life- partner/friends/work/hobbies

9. sleep well

10. meditate, do yoga

11. learn a language, yes being bilingualpeople may stave off memory loss, click here to read this

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What is beauty?

In our first monthly Freshlog, we talk Beauty.

How do we define “beauty”, is it in the eye of the beholder, (beer holder)?

Is “beauty “ a concept created and influenced by our mother prior to birth, i.e pre-conceived? www.jyi.org/volumes/volume6/issue6/features/feng.html

Can we really make a scientific measurement where a measurement is taken of a persons face and a beauty score given, or a Helen Score( as in Helen of Troy, a high score = lots of ships launched, a low score = not many ships) www.harunyahya.com/articles/70golden_ratio.html

Do men “see” beauty differently to women? Click here to read a great article from Newsweek, how important is a womens waist- to -hip ratio? http://hss.fullerton.edu/sociology/orleans/symmetry.txt

How beauty was /is perceived has changed over the ages, eg Cleopatra, to Chinese foot binding.

Today our thoughts are strongly influenced by the media images we are bombarded with, are influenced by them?

My own feeling is intuitive, and comparative, I have my own inate ideas of what beauty is, or looks like, this may be because I look at all living and inanimate objects for beauty, it may be the wonderful Muon speakers designed by Ross Lovegrove for Kef, click here for a picture www.kef.com/products/muon/, or work by the great Australian Industrial designer Marc Newson eg. Lockheed Chaise , click here for a picture www.designmuseum.org/design/marc-newson.

In terms of human beauty, it is not defined by age, yes we can age gracefully, as Mark Twain said “wrinkles should merely indicate where a smile has been”, www.twainquotes.com/smile.html .Yes they can be “laugh lines”, but I believe softening and preventing the footprints becoming the treadmarks of a long life is another thing.

Also I believe character, as defined by” a lasting impression left by a person’s personality, look”, adds to there individuality and beauty. Some wrinkles/lines can give a false impression- eg anger lines = unnecessary.

Having a nose which is out of proportion to the rest of the features may give character e.g a Roman nose, Barbra Streisand.

How important is symmetry? Are subtle differences a sign of a natural look?

Natural beauty doesn’t necessarily need to mean that you didn’t have cosmetic surgery, it may mean you had excellent treatment that “looked natural” and preserved cultural, familial traits. This in my opinion is good treatment and something I strive for in FRESHface Clinic.

My list of beautiful women-

Grace Kelly (Irish)

Elizabeth Taylor(English)

Charlize Theron(South African)

Alessandra Ambrosio(Brazilian)

Diane Keaton(Irish)
Keep up to date with what happening with cosmetic surgery- join our FRESHlist! Go to the Contacts page to do this.

Next Month-

All about aging.

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