Premature ageing on this highly-visible area is common for Australians. Changes include uneven pigment and pigmented lesions (dyschromia), redness and capillaries, fine lines, wrinkles, laxity along with collagen and elastin damage. They are also areas where care is required as inappropriate treatment can cause scarring. A combination of treatments is often needed for best results to address this range of skin changes. For the neck we use medical Intense Pulsed Light, which can help with redness and pigment. For laxity and skin tightening, Microfocused Ultrasound (Ultherapy / Ultraformer); and for more severe laxity, we advise combining Biostimulatory Calcium Hydroxylapatite Injections with Microfocused Ultrasound. We can treat the chest area with Photodynamic Therapy (Intense Pulsed Light).
Sagging is caused by the loss of structural-supporting facial bone and deep fat pads with age, along with laxity of the ‘SMAS’ and skin. Hyaluronic Acid (HA) fillers are safe and can be dissolved. HA is a natural water holding skin component. These are often the best fillers to start with. There are however different HA fillers, which vary in the size of contained molecules and the cross linking of molecules. Lifting of sagging skin can be achieved by deep cheek injections with HA fillers. Other sites of injection that can assist may also include angle of jaw and jawline and/or the nose and chin projection. Calcium hydroxylapatite is another good option for holding shape well and for a stronger, more defined cheek bone and jawline (desirable in males and many females). Some fillers also have a biostimulatory effect (lead to new collagen +/- elastin production to improve sagging skin) this includes l-poly-L-lactic acid and Calcium hydroxylapatite. This can assist to improve the quality of sagging facial skin.
Acne scarring is often most effectively treated by a combination of therapies depending on the type of scarring that is present. Red flat scarring can be quickly and effectively treated by vascular laser and Intense Pulsed Light. Radiofrequency (RF) needling is proving a good alternative to non-ablative fractionated (fraxel style) lasers, allowing less treatment sessions (more skin tightening and new collagen and elastin production for the full skin thickness) and less downtime. For more severe acne scarring, ablative lasers are often best with CO2 fractionated lasers (powerful ablation of scarred tissue with skin tightening). Fillers should be considered where a patient has soft depressed scaring. For scars that are indented or bound down by fibrous scarring, subcision or breaking of these fibrous scar adhesions is performed at the same time. Ice Pick scarring can be treated with TCA CROSS, combined with RF needling. Acne scar excisions are sometimes needed (performed before RF needling or laser).
This varies between individuals. It is good to start before deeper more fixed wrinkles and lines are established in the frown and forehead. When lines no longer settle with a resting facial expression, Botox can be used to create a smoother forehead and reduce crow’s feet (lines around the eye area). Some patients who have been exposed to more sun or frown a lot may find they will have these lines in their late 20s, while others may not see them until they’re in their 30s.
This has become an increasingly recognised benefit from some cosmetic treatments. This is where treatments lead to the remodelling and repair of the skin as seen in younger, more youthful skin. Certain treatments are better at doing this and result in new, greater amounts of normal collagen, even elastin fibres and skin blood vessels. This includes treatment devices such as those delivering radiofrequency treatments (these result in more elastin production than laser treatment). Some filler injections such as calcium hydroxylapatite are biocompatible and biostimulatory, providing a scaffold that leads the body to respond with new collagen and elastin production. These treatments work by activating and utilising the body’s own healing mechanisms to improve the skin appearance both visibly and microscopically and physiologically.
Lips that have been treated well should look natural, both at rest and with movement. This involves making sure they match a person’s face and age. Often using two different HA products – one for providing shape where needed (such as the lip tubercles) and another softer one for the margins and edges – helps achieve more natural, beautiful looking lips. Injections need to be done both safely and in areas that enhance the lips natural shape, rather than distort. A mixture of injection techniques are often needed to achieve this (cannula, threads, microboluses) and over volumising should be avoided.
For pigmented spots, IPL is a good option which balances fast recovery with great results. ‘Fraxel’ style laser can also reduce pigmentation (dark spots) but the treatment usually involves week or more downtime for the face. For more severe pigmentation, fractionated ablative laser such as the CO2 laser is my treatment of choice (+/- combined with photodynamic therapy where precancerous skin changes).
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