WINTER NEWSLETTER: COLLAGEN, ELASTIN & AGING

Collagen & elastin are two types of proteins that form the fibrous component of the connective tissue in your skin. Collagen gives strength to the skin’s structures, and is produced throughout your life, although its production begins to decrease at 25, and dramatically decreases after menopause. Elastin makes the skin’s structure elastic, giving it that “snapback” quality, and naturally depletes as we age. Elastin production starts in the womb at the fetus’s early developmental stages and ends with puberty.  

Along with aging, sun exposure is the number one destroyer of both proteins. Followed by smoking and diet. Collagen is also affected by autoimmune disorders and high sugar consumption. Elastin is affected by changes in weight, dehydration, lack of sleep and stress.  

As collagen production slows and elastin depletes with age, the skin’s structure weakens. Skin becomes more fragile. This is caused by a flattening of the area where the epidermis and dermis (the layer of skin under the epidermis) come together. Skin becomes slack, and starts to hang loosely. This also causes static wrinkles to form and dynamic wrinkles (wrinkles caused by repetitive motion) to become more noticeable.  

Other changes that occur with age in your body that cause your face to change include the loss of fat below the skin in the cheeks, temples, chin, nose, and eye area which result in a leaner look, contribute to loosening skin, sunken eyes, and a "skeletal" appearance. Bone loss, mostly around the mouth and chin, may become evident after age 60 and cause that puckered skin look around the mouth. Cartilage loss in the nose causes drooping of the nasal tip and accentuation of the bony structures in the nose.  

The good news is that there are options to correct the results of aging in the face, before you run off to the plastic surgeon. Using a combination of fillers and neurotoxins provides dramatic improvements to smooth wrinkles, and add volume. And the collagen-building filler Sculptra actually increases the production of collagen thus improving the structural support for the skin. Laser skin tightening and microchanneling work to stimulate collagen on a more superficial level helping to tighten and smooth the skin on your face and neck.

Don’t fear aging, it happens to all of us. A knowledge and understanding of what’s happening, the right combined course of treatment for your situation, and a targeted at-home skincare routine are you best tools to age gracefully.

Q. So what exactly does Sculptra do?

Sculptra multitasks. It rebuilds your own tissue at the collagen level – which is one of the proteins found in the connective tissue of your skin – rebuilding structure in your cheeks, jawline and lower face. As a filler, it adds volume to the treated region. What I love about this procedure is the natural looking results. You won’t look like you’ve had “work done.” And the results are long lasting, from three to five years in some cases, depending on the person and their lifestyle.

Q. What doesn’t Sculptra do?

It doesn’t tighten skin per se, but think of it like blowing up a balloon. Your skin is like an empty balloon. Sculptra is like the air. Because it’s injected subcutaneously, filling out the area below the skin, the volume it creates will cause the skin to look less slack, just like the balloon becomes round and full when you put air in it. And it works great in conjunction with facial skin tightening which works on the fibroblasts, and microchanneling, which work more superficially for the fine lines and wrinkles. Sculptra hits the deeper lines and wrinkles, and rebuilds the underlying structure of the skin.

Q. How do you determine the number of treatments and vials needed?

Honestly, despite what you may hear, everyone will need at least three treatments. I tell my patients three to four, depending on how much loss of volume and structure I see when they come in for their consultation. The more mature the face, the greater the volume and structural loss, and the more treatments the patient will need to rebuild that collagen. The larger the area or region the patient wants treated, the more vials she (or he) will need. 

Q. Can’t you do the same thing with regular hyaluronic acid fillers?

Well you can certainly add volume with them, but at a certain age, filler just doesn’t give the results. The patient will need too much, and too often, for it to be a cost effective solution. Not to mention regular HA filler doesn’t rebuild collagen so you’re not getting any of the long-term reparative benefits you do from Sculptra.

Q. Do you have to prep for a Sculptra treatment?

Not any more than a regular HA dermal filler treatment. You should stop any blood thinning medications, vitamins and supplements like aspirin, ibuprofen, vitamins E & D, fish oil, and the like for about a week prior. Also don’t drink for 24 hours before or after. And I suggest patients start on an arnica supplement about 5 days prior and for 5 days after. This will help with bruising and swelling and excessive bleeding. Yes, you will see superficial bleeding during the procedure, so cutting out the blood thinners will help minimize it.

Q. What else can someone expect during treatment?

There are a fair number of injections in the region being treated and they do go deeper than hyaluronic acid fillers. The solution does have Lidocaine (a local anesthetic) in it, so you will numb during the treatment. But if you are extra sensitive, you may want to come in about 15 minutes early and we can pre-numb you.

Q. What is the most important to do after a Sculptra treatment?

Massage! First the motion help stimulates the dormant collagen in the area while spreading the Sculptra evenly over that area. Think of it as putting fertilizer on your lawn. If you miss a spot, you have grass that doesn’t grow in that area, surrounded by fresh green healthy grass that did receive the fertilizer. Second, one of the side effects from Sculptra treatment can be the formation of nodules, which are essentially little bumps of collagen. These won’t show up for months, so massaging spreads out the Sculptra so it doesn’t “pool” thus preventing those nodules from forming. Follow the 5-5-5 Rule: 5 minutes of moderate pressure massage up and out following the structure of the area treated, 5 times a day, for five days after each treatment. Your first massage will be done by one of our estheticians, who will teach you the proper technique.

Q. What else should be done after treatment?

You should ice the area to help avoid or minimize swelling and bruising, and I recommend you sleep with your head elevated on an extra pillow or in a recliner for the first one or two nights after treatment.

Q. What else should someone know who is considering Sculptra?

Unlike HA dermal fillers, Sculptra is NOT instant gratification. It takes to at least until after the second treatment to starting seeing noticeable results, and improvements continue over several months after the last treatment, at which point you will then see your final results. And remember, it lasts 3-5 years, so the investment in time you put in up front, really pay off in the end.

Peptides, also called polypeptides, are strings of amino acids that act as the building blocks for the proteins needed by the skin. More specifically, collagen is made of three polypeptide chains, so those peptides stimulate your skin to make collagen. The more collagen you have, the firmer and plumper your skin, and the less visible your wrinkles. In addition to collagen, peptides also make up elastin fibers, the other essential protein in the skin. These fibers make skin look firmer and tauter. Peptides also protect the skin barrier, help ease inflammation, repair damaged skin, and even out skin tone.

Peptides naturally occur in the body, but they are in more and more skin care products because they are such powerful collagen and elastin generators. Collagen can’t be applied topically, because the molecule is too large to absorb through the skin, so therefore it just sits on the skin, not getting underneath where its work needs to be done. Peptides, on the other hand, easily penetrate the outer layer of the skin, sinking in deeply and get to work, sending signals to the cells telling them to produce collagen and elastin. There are several types of peptides that are absolute collagen building powerhouses, but a few others worth mentioning that offer additional benefits for the skin are:

• Copper peptides — Copper Tripeptide-1 works at the epidermal (outer layer of skin) and basal (stem cell) levels to rejuvenate skin cells in aging tissue, restoring normal tissue architecture, which in turn boosts the production of collagen and elastin, helps the skin regain elasticity and strength, and reverses damage done to the skin from sun exposure (photodamage – external), and excessive sugar intake (glycation – internal).

• Neurotransmitter peptides – This is an entire family of neuropeptides that work at a cellular level to temporarily block chemicals that cause muscle contraction (similar to a neurotoxin which works at a muscular level) and are great for extending the results and efficacy of a Botox or Dysport treatment.

Peptides work well with other ingredients, including vitamin C, niacinamide (vitamin B3, an anti-inflammatory which eases skin redness), antioxidants and hyaluronic acids. Using a peptide with an alpha hydroxy acid (AHA) will actually make the peptides work less efficiently.

Peptides should be in your skincare products that stay on your skin for a prolonged period of time, like a moisturizer or serum. So, for example, don’t waste your money on a wash with peptides because it doesn’t stay on your skin long enough to absorb and work. Peptide products should be used consistently, and applied twice daily, morning and night. The peptide product’s molecule size determines the order of application in your skincare regimen. The smaller molecule (thinner) product would be applied before the larger molecule (thicker) product so the bigger molecules don’t block the smaller molecules from penetrating the skin. So for example, if you’re getting your peptides in a serum, that would go on first, whereas if you’re getting them in a moisturizer, that would go on last (before SPF which is always last, by the way). And this order of application rule applies to all skincare products in your routine.

Here are a few products that we carry and I recommend as part of your at home skincare routine that work hand in hand with your services and procedures:

PCA Skin: Perfecting Neck & Décolleté

This corrective cream is designed to target crepiness, sagginess and laxity of the delicate skin on the neck and chest. Key peptides are palmitoyl tripeptide-38 and palmitoyl tripeptide-5, which strengthen, firm and plump the skin, minimizing the appearance of lines, wrinkles and crepiness in as little as one week. 

iS Clinical Youth Intensive Creme

This luxurious and intensely hydrating moisturizer visibly reduces wrinkles, smooths and firms the skin over time. Plus it goes on like butter, and smells great! The key peptide is copper tripeptide growth factor (bioidentical), which is clinically proven to stimulate the synthesis of collagen in the fibroblasts.

Q. What is Laser Skin Tightening?

Heating the dermis to a degree that stimulates the fibroblasts in the skin. Fibroblasts are the cells in the connective tissue of the skin and are responsible for collagen production. Heat stimulates them to build more collagen. The heat actually increases the blood flow to the fibroblasts, which is what stimulates the collagen.

Q. How does that tighten the skin?

Heating the epidermis (outer layer of skin) and dermis (second layer of skin down) causes the collagen in the skin to contract which inadvertently tightens the skin, which smooths out moderate wrinkles. 

Q. What are some of the benefits?

It is a non-surgical, non-invasive treatment that will improve laxity, minimize redness in the skin, improve the appearance of pore size, and improves acne scars.

Q. Does it really get rid of skin laxity?

Depending on how much laxity in the skin, it will improve it. But if you’ve lost too much collagen, thus having greater laxity, there is only so much you can do non-invasively. It will not improve elasticity in your skin, it’s not a facelift.

Q. What’s the treatment like?

We use the Candella GentleMax Pro laser, set on1064 nm yag wavelength that can safely treat all skin types. First we randomly apply the heat from the laser to warm the epidermis. Then using a continual painting – or sweeping – motion, we pass systematically over the area being treated, and often make a third pass to drive the heat in even deeper to the dermis. More aggressively, we can stamp problem areas, where we actually let the laser sit for a moment on a single spot to really drive the heat down deep. This technique is also done in two to three passes. Overall, the skin tightening treatment is relatively pain-free, although people with more sensitive skin may feel a slight stinging in spots, especially where there is not as much tissue under the skin, such as the forehead and jawline.

Q. What areas do you tend to see the most improvement?

Results vary person to person, but often the most noticeable improvement is found in the delicate skin of the neck, chin and chest areas.

Q. What do you need to do before you come in?

Stop using retinols 3-5 days prior, no antibiotics or photosensitive medications 10 days before, and no direct sun exposure for 2 weeks prior and 2 weeks post. No spray tans or bronzing agents that sit in the skin. Bronzing powders and makeup are fine, they can be removed before treatment, as they don’t sit in the skin.

Q. Is there any downtime? Or post-care instructions?

No downtime, you’ll leave with some erythema (flush, produced by heat in the skin, similar to after working out). This typically goes away within an hour. You can resume normal activities, and go right back to your regular skincare routine right after treatment, 

but remember no sun for 2 weeks! 

Q. Is it permanent?

Like most treatments, it’s not a one and done service. Yes, it stimulates collagen, but like with anything, time marches on and we continue to age, meaning that production continues to slow, so regular maintenance keeps that stimulation steady and production ramped up. Think of it like gardening. Yes, you weed your garden once and it looks great. But those weeds grow back, and if you don’t keep up weeding on a regular basis, they’ll choke out your plants, and your garden won’t produce nutritional vegetables or beautiful flowers.

Q. How often should you have it done?

The results are immediate on most people, and cumulative on all. So, depending on your age and skin condition, we recommend 4-6 treatments about 4 weeks apart. Then, maintenance as needed, because again, everyone is different. But we’ll chart your progress and results to help you come up with the optimal course of treatment and maintenance schedule for you.