The Best Ways to Remove Wrinkles
As we age, wrinkles develop and skin sags, which accentuate natural facial lines such as nasolabial folds. This ageing process is accelerated by sun damage and smoking.
Dynamic wrinkles that move with facial expressions are best treated with botulinum toxin, while natural facial lines, especially nasolabial folds, are best reduced by fillers as they provide volume.
Glabella (forehead) frown lines are a combination of dynamic and static lines. Fine, static wrinkles can be treated with skin resurfacing procedures such as chemical peels or lasers, and complemented by fillers and platelet-rich plasma techniques.
Attractive lips have definition, velvety texture, and adequate volume. The youthful mouth is uplifted at the corners whereas the ageing mouth is down and thin, the upper lip lengthens and sags, the vermillion border (the line around the outside of your lip) thins out and loses definition, the corners droop, the philtrum flatten and the ‘cupid’s bow’ loses its curves. Vertical wrinkles appear, and nasolabial creases become furrows.
Fillers can be used selectively to redefine the vermillion skin junction, otherwise known as the ‘white roll’ and the two ridges extending from the cupid’s bow to the nose.
An ideal filler would be non-reactive, non-migratory, remain soft and maintain its original volume. Temporary fillers are useful if the patient is uncertain about having a permanent change in the fullness of their lip. If they dislike the augmented lip, the filler would be absorbed in six to nine months and they would have their original appearance.
In general, complications with fillers are temporary and resolve within days. These complications include swelling, redness, bruising, and lumps under the skin. Swelling, redness and bruising settle in a week, and lumps can be massaged to help them blend into surrounding skin. Most patients are happy with the improvement in their appearance.
Mixing fillers is not recommended. It is best to allow time for temporary fillers to wear off before introducing a semi-permanent or permanent filler into the area.
Patients with active skin disease, autoimmune disease or have a tendency to keloids are discouraged from filler treatment. Diabetic patients and patients on systemic corticosteroids have a tendency to infection. Patients with active infections need to have the infection treated first before considering filler treatment. If a patient is pregnant or breast feeding, it is best to wait until both events are over before undergoing filler treatment.
Fat injections were popularised by Dr Coleman in the 1980s, then became less popular as synthetic fillers became widely available as there is less downtime with synthetic fillers. Fat injections absorb over a couple of months before the retained volume stabilises, so areas of the face have to be overcorrected initially. Synthetic fillers give more predictable results and are associated with less bruising and swelling. However, fat injections have a role in larger volume rejuvenation such as cheeks and where there is facial muscle atrophy.
Deep wrinkles in the cheek area that have been present for a long time may not respond to fat injections or fillers. Facelift surgery can help smooth out the skin.
As with all facial rejuvenation treatments, smoking, poor nutrition and lifestyle factors affect the final result. The quest for the perfect filler material is still on.
DR SAWJIN TEW