Rejuvenating Face Lifts for Aging Skin

A Face Lift is a procedure that most people can benefit from. This may sound too radical but most people feel a need and desire to look their best. When skin creams and lotions, Botox, lasers, chemical peels and fillers fail - face lift may offer the solution that is difficult to resist. Of course, many people are afraid of having surgery and having a “surgical look” but fortunately face lifting techniques have evolved considerably to offer patients less invasive methods that even the most sophisticated patient can find attractive.

How The Technique Is Performed:

Face lift remains one of the most effective rejuvenating methods for the aging face. Its technique varies from simple skin excision to complex procedure including the repositioning of muscles, fat and skin. Recent trends in patients desires of having effective facial improvement while minimizing down-time have led to the development of newer, less traumatic, short scar, less recovery methods. Full understanding of the face and neck anatomy as well as the changes associated with aging process is required by the physician prior to undertaking any face lift procedure.

Two key subcutaneous structures are at the core of face-lift surgery - superficial musculoaponeurotic system (SMAS) and platysma. SMAS is a fibrous interlocking, sometimes ill-defined, structure/sheath deep to the skin fat. It extends from platysma muscle (a thin, fan-like muscle that extends from both collar bones to the jaw line) and reaches cheekbones as well as temple and scalp components. These two structures are utilized and modified in most face lift procedures.

As we age, several facial components undergo significant changes. The skin becomes less elastic that is associated with decrease in collagen support. Furthermore, there is modification of the facial fat with respect to its amount and position. In addition, there is remodeling of facial bones that in combination with fat and skin changes lead to aged facial appearance.

Most of the surgical face lifts procedures today are a variation of two-plane face lift - use of the epidermal-dermal component (full thickness skin) as well as the SMAS-platysma component. Optimal results require modification of SMAS-platysma component through resection, placation and/or suspension. It is this modification that is at the core of most face-lifts. These adjusted deep supporting structures provide durable framework over which skin can be safely re-draped. It is imperative to realize that stretching skin alone will not result in any sustained improvement and can lead to skin death, appearance of “surgical look” as well as significant facial distortion and scarring.

The Latest Techniques:

Latest face lift techniques utilize shorter skin incisions and are primarily designed for patients with mild to moderate jowls and neck laxity. With the recent advancements in local anesthetic and, in particular, the development of tumescent anesthesia, most face lift procedures can be safely and comfortably accomplished without the need for the traditional general anesthesia. These modified procedures have accomplished several things. Shorter incisions and local anesthetic make the recovery from modern face lifts much easier than in the past. In addition, the shorter scar and resulting less significant distortion of hairline make these methods much more appealing for modern men and women.

What Every Patient Needs To Do

As with any aesthetic procedure, pre-operative consultation is an optimal time for defining patient’s motivation for aesthetic improvement and developing plan of action. It is at this time that patient’s desires and fears can be explored. It is important for the patient to ask pertinent questions regarding the expected degree of sustained facial rejuvenation, the length of the scar as well as modification of the temporal and post-auricular hairline. With proper patient selection and optimization of desired procedure, most patients can achieve rewarding sustained results that can benefit most if not all of us at some point in our life.

Anti-Oxidants And Sun Damaged Skin

Sun damage or photo damage produces both skin cancers as well as photo-aging. Photo-aging shows itself on the skin as wrinkling, scaling, dryness, and mottled pigmentation. Ultra-violet light is absorbed by skin, which in turn produces a photo-chemical reaction.

The UVA light is absorbed by both DNA as well as urocanic acid, the photo-chemical reaction produces oxidation of both DNA, nucleide acid, and protein, as well as lipids, this is known as oxidative damage. Anti-oxidants have been evolved to protect against, and reverse some of the damage produced by sunlight. An anti-oxidant mechanism is very advanced in plants that protect against the damage from sun exposure.

Oxidation:

Oxidation is produced by reactive oxygen molecules. The DNA absorbs ultra-violet light mostly in the UVB (290-320 manometres) range. This produces damage mainly within the epidermis. UVA (320-400 manometres) penetrates deeper into the skin and produces damage in the epidermis, the dermis as well as affecting blood vessels. The UVA has a much more oxidizing effect on cells.

The carcinogenic or cancer forming effects of ultra-violet B produce mutations within the DNA. This initiates tumours within the epidermis. The UVA promotes these tumours as it has much more oxidizing stress on the skin than UVB. It may as a result be more cytotoxic and immunosuppressive.

Sunscreens:

Sunscreens certainly protect against ultra-violet light, the sunburning spectrum is UVB and sunscreens are very effective. Ultra-violet A is the most difficult to protect against. It is important to realize that the SPF numbers are calculated with an amount of sunscreen on skin that exceeds what most of us put on our own skin.

The SPF is calculated with a quantity of 2mg. of sunscreen per centimetre2. Most people will put on about half to one quarter of this when used as sun protection. Unfortunately, low quantities of sunscreen of per centimtre2 will have minimal sun protective effects. Usually if 5mg. per cm.2 of sunscreen is applied to the skin, the sun protective factor is in the region of an SPF of 3.

Anti-Oxidants:

Anti-oxidants play a significant part in the protective and repair mechanisms within animals and plants. This can be achieved by anti-oxidants that are produced within the skin itself or by those consumed or applied from plants. The anti-oxidant effects can be divided into those that have their protection through enzymes, and those that tend to reduce the quantity of hydrogen peroxide as well as lipid hydroperoxides.

Topical Anti-Oxidants:

The use of topical anti-oxidants has certain requirements, these have to be stable as well as being cosmetically acceptable. It is clear that anti-oxidants have a photo-protective benefit. The physiological anti-oxidants include vitamin C, vitamin E, and ubiquinol. Vitamin C is water-soluble and is a free radical scavenger, it is required for collagen synthesis and may inhibit elastin formation in the dermis.

It may also reduce pigment synthesis, as well as enhance epidermal barrier function. For it to be active it must be present on the skin at a pH of 3.5 or lower in order to have an anti-oxidative effect. Vitamin E is different from vitamin C, in that it is lipid soluble, there is evidence that combining vitamin E and vitamin C may be of some benefit. Other anti-oxidants to be considered will be selenium as well as zinc.

Plant Anti-Oxidants:

Plants synthesize vitamin C, vitamin E and flavones, and polyphenolic compounds.

• Silymarin
• Soy isoflavones
• Tea
• Polyphenols

These are all potent plant anti-oxidants.

Silymarin:

This is a Milk Thistle extract, the main component in terms of anti-oxidants is silybyn. This prevents lipid peroxidase action. It also has been shown to inhibit tumour promotion in animals.

Soy isoflavones:

Soy has been connected with a reduction in cardiovascular disease, and in some incidents’ of breast cancer when taken by mouth in large quantities. It has a phytoestrogen effect, which can reduce menopausal symptoms. The isoflavones are genistein and gaidzein. The genistein has a collagen synthesis effect. It is also anti-cancer. It has been used both orally as well as topically.

The genistein is a powerful scavenger of peroxyl radicals. This has a significant reduction in lipid peroxidase activity. It has been shown to reduce redness in the skin of mice which are subject to ultra-violet A. It also has an anti-inflammatory effect. The use of this compound reduces the immune suppression effect of ultra-violet light.

Tea polyphenols:

Tea is fermented initially to green, and then to black tea. The drinking of black tea has been shown to reduce the frequency of squamous cell carcinomas. Work done with green tea both topically and taken orally, shows that it reduces the ability of ultra-violet to produce skin cancers and redness, particularly in animals. The possibility of combining tea, plus vitamin E, to work together as anti-oxidants is interesting.

Much more work needs to be done in order to establish how combining anti-oxidants with sunscreens will have a very beneficial effect on reducing sun damage to skin.