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The impact of ageing in relation to injectable treatments.

Updated: Aug 2, 2023

Young people tend to have smooth skin and full facial fat pads giving their face the appearance of youth. Skin tone is also mostly even and not excessively sun damaged. As we age sun damage becomes more pronounced without regular spf use as this may cause pigmentation of the skin.


A report by Save Face showed that of 934 cases audited regarding different aesthetic procedures in the UK, many of these cases related to dermal filler injections, of those performed the lips were mostly treated and the greatest age range was in females between 18-35 years old. It would then appear that younger women are looking to enhance the features they already have perhaps due to pressure from social media and the wider media in general.


As we age, we begin to lose volume in our facial fat pads and the facial skin can begin to sag from the brow, the cheek, the corners of the mouth and create jowls on the jaw line. In a young face the width of the face is greater in the mid face and slim as we get to the jaw, almost with the appearance of a downward pointing triangle. As we age the weight of the skin and fat tends to accumulate at the bottom of the face like a pyramid. This also changes how light is reflected off the face and can exacerbate the aging appearance. Filler treatments into the temple area (although of high risk) as well as the cheeks and jaw line are popular to try to replace lost volume and lift the face. However, it is debateable whether filler lifts, but it certainly adds volume and this would need to be discussed with the patient as to the effects they are looking for.


We tend not to have many expression lines when we are young but can certainly have dynamic lines and wrinkles with facial expression. As we age the collagen production in these lines can change leading to static lines. People often request botulinum toxin treatments to reduce the appearance of these lines and wrinkles. It is not unheard of that young people without static lines are requesting prophylactic botulinum toxin treatment to prevent and delay their appearance. Older people with established lines may be requesting botulinum toxin treatment to soften their appearance and prevent progression.


Alternative treatment options where injectable treatment options are not advised due to ageing


Broad spectrum sun protection is the foundation of younger looking skin, and all people should be advised to start protecting their skin from a young age. It’s said that the skin is a reflection of the internal environment so good nutrition and hydration and seeing a nutritional therapist might be a useful thing to do to improve the appearance of the skin. Good nutrition and hydration, combined with sunscreen and the use of anti-aging skin care products can help to improve the appearance of the skin and fight the aging process. Products might include hyaluronic acid, antioxidants and lipids.


Botulinum toxin injections are only licensed for those under 65 so anyone requiring treatment beyond this age would need to seek alternative treatment options. Cosmetic acupuncture may be an alternative treatment method. Cosmetic acupuncture aims to improve circulation of blood and body fluids, absorption of nutrients and excretions of waste thereby positively influencing general health. It also aims to increase cellular activity and stimulate collagen production when delivered into the lines and wrinkles in the face and may soften their appearance. Using hyaluronic acid face masks and infrared light therapy in conjunction with cosmetics acupuncture can enhance the effects of the treatment. There is not a lot of evidence other than anecdotal reports that this treatment is beneficial


Hyaluronic acid fillers are popular in younger women (for larger lips) and middle age as we start to lose volume of fat pads from the face and the cheeks, jaw line and neck skin begins to sag. However, they add volume and weight to the face and can widen the face over time, they can’t lift the face. Threads also do not have good long-term effects to lift the face with results for only about 6 months.


As we come into older age and the skin sagging becomes more pronounced hyaluronic acid filler may no longer be appropriate as they will lead to over filled and abnormal looks as people try to achieve a younger look with tighter skin. At this stage skin boosters, or even surgery may be the correct procedure to consider. Blepharoplasty and face lifts are becoming more popular in the aging face. Recent advances in surgical technique and lifting the face upwards rather than pulling the fascia laterally may improve appearance.


There are other treatments that can improve the appearance of the skin such as micro needling or collagen induction therapy (micro needling) either alone or in conjunction with platelet rich plasma or exosomes can help to improve the appearance and tone of the skin with patient’s reporting the result can last months


Lasers such as IPL can deliver light and heat energy into the skin that can reduce the appearance or rad and brown spots which can again improve the appearance of the skin, but will do little to reduce facial sagging and wrinkle production. Caution would be needed with either micro needling and especially with laser treatments for people with Fitzpatrick type 4, 5 or 6 as they may stimulate the melanocytes leading to pigmentation.


References


Save face (2022a). Consumer Complaints Audit 2017-2018. Available at: https://www.saveface.co.uk/complaints-report/. (Accessed online 17th October 2022).




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