Chapter 12

Anti-ageing treatments

BEAUTY IS NOT A luck-by-chance thing. It requires diligence and hard work. Very few are really blessed with genes that retain youthful skin without much effort. For the rest there is science. Aesthetic dermatology has advanced, like in other branches of medicine, to help you look your best at every age.

The idea of ‘anti-ageing’ is not to freeze your face of all expressions, iron out all lines, or make skin artificially stretched and glistening. In fact, these are things you should not do! There are tools available, but the result depends on the person who wields the tool. It is like a magic wand. Just imagine if a spell were to go wrong. You’d blame the magician not the magic itself, right?

Everyone need not go to the doctor on the first sign of wrinkle and request for a Botox treatment. There are so many options available to you now that are so much more gentle and easy to do. So here I have created a list of important treatments that you can get at your doctor. I have also put down the dos and don’ts of every treatment.

To make it easy for you to understand, I have divided the various treatments into three basic types. Go ahead choose your treatment.

Simple office procedure

Takes all of 10 minutes. Can be done by a trained technician without much down time and can be repeated every 10 days to once a month as maintenance.

Medi-Facials

Medi-Facials are facials which are done under medical supervision. When you go in for a regular facial, they scrub, steam, and extract your comedones, and then apply a cream and massage for 20 minutes. Right? Have you ever asked at the salon if the extractor is sterilized? If the steam is affecting your pigmentation or not? If they are taking care to shrink the pores thereafter before applying the cream to your face? Is the massage cream suited to your skin type? Are the strokes right for your face? These are all the concerns that will be specially taken care of and individualized at an expert’s clinic when you go for a Medi-Facial.

Medi-Facials that you can ask for

Acid peels

It simply means applying an acid on your skin, face, or body to chemically exfoliate the top dead layer of your skin. Now what it does to your skin depends on the type of the acid, strength, layers applied, duration of application, and depth achieved.

Peels can

Microdermabrasion

Popularly called skin polishing. It is a physical exfoliating treatment. It could be done just with abrasive specks of diamond on the tip of a suction apparatus. Or continuous aluminium micro crystals hit your skin and scrape the top layer which is sucked back through a vacuum method. In my clinic, I do not use this on the face at all. We only use this on the body skin as I know there are better, gentler, and newer ways to achieve the same result on your facial skin.

Skin polishing can be done

A note of caution

BEFORE THE TREATMENT

AFTER THE TREATMENT

Equipment-based procedure

Not all equipments at your doctor’s office are lasers. Depending on the technology that is used, it could be laser, lights, radio frequency, ultrasound, and infrared.

Laser

Lasers are of different kinds. The type of laser used on you depends on the specific problem that needs to be addressed. Your doctor is the best judge in choosing the type. Lasers do not understand skin, hair, or blood. They only work on colour or pigment. However, there are some that work with water in your tissue as their target.

Then there are different ways of delivering the beam to your skin. So your doctor can work with full beam, fractionated, or pixelated so it’s not bulk heating which leads to the unwanted effects of a laser. Depending on how much time is taken to pass the given beam, it could be long pulsed, or Q-switched. It could be ablative or non-ablative depending on whether it burns off a portion of your skin or just works with it intact.

These can be administered by a qualified technician after a doctor’s consent. Different doctors do it differently. In my practice I do it all myself. Others choose to set the parameters and have the technician perform the treatment. Most of these have to be repeated multiple times to achieve results. You will also have to go for maintenance sessions later at certain intervals.

Laser can be used:

A note of caution

BEFORE THE TREATMENT

AFTER THE TREATMENT

Microneedling

Multiple tiny needles are poked together into your skin to achieve a wound depth of anywhere between 0.5 mm to 3 mm. This stimulates collagen and drives the active products in to help repair and restore the skin further.

How does this work? Brain perceives these tiny needle injuries as any other injury. So it immediately starts the tissue repair process by stimulating the collagen. So this is a very pocket friendly option to laser if you want simple solution to acne scar, anti-ageing or even a dose of a skin brightening vitamin. It can be administered through disposable derma rollers or the doctor could also use stamps of multiple needles on an automated equipment. I have found great results when I have combined micro needling with radio frequency.

Injectable

These are procedures performed with a needle and syringe. When done right, the results are magical. These can be used to erase fine lines, lighten and tighten skin, and even contour facial features. The popular injectables are:

Botox

A protein that relaxes the muscle underneath your skin, so the lines on them relax.

Filler

A volumizer when placed in appropriate layers of your face can either fill in deep lines, or hollows like the under eye and temple; fill to lift the cheek and the brow, fill to contour your cheek and chin. For me it is a great sculpting tool, without actually holding a knife. It is an inert substance and slowly degraded by the body, so the results can stay from anywhere between 6 months to a couple of years.

What is the difference between botox and filler?

It’s amusing that most people think Botox and filler are two solutions that one can choose from to address the same issue! NO. Here is the difference:

BOTOX

What: Botox is a protein which relaxes the muscle to which it is injected. The doctor decides the dose after examining and taking into consideration various indicators.

Why and where: It is usually used for active wrinkles, i.e. lines that come on expression. But the newer indication are towards reshaping like in the jaw, reducing the downward tug of the facial muscles like the ones on the neck or the ones that pull your brow down, functional correction like bunny smile or flared nostrils, or for general health and well-being benefits like treating migraine or excessive sweating.

How long: procedure should take no more than 10 minutes. The result is temporary, lasts 3 to 4 months, depending on the dose and site may vary a bit more. The result takes anywhere between 3 to 10 days to be visible.

For more information on Botox, you can look at this video on my website: http://www.drrashmishetty.com/ pages/botox.html

FILLER

What: Filler is a biological gel of varying consistency and composition.

Why and Where: This is injected to the area of deficit; passive lines (lines that show up even when the face is at rest) like the laugh lines, deep set frown lines etc., volume loss like in mid cheek or under eye, facial enhancement like lip/chin/cheek augmentation, any scars; or for hydration, skin refreshing, fine static lines as well.

How long: Depending on the complexity of the area or work, it may take anywhere between 5 to 20 minutes. It lasts between 6 months to 2 years, and maybe even more varying from person to person. Repeated treatments tend to last longer. The result is instant!

For more information on filler, you can look at this video on my website: http://www.drrashmishetty.com/ pages/filler.html

So basically they do different jobs, which complement each other. In a few situations like crow’s feet, frown lines, puckered chin , smoker’s lines around your mouth—they kind of can be used either/or and even together to get better and long lasting results.

The magic is in the doctor’s skill and the time most spent is on assessment + planing the treatment.

Mesotherapy

Can be used to deliver different substances—depending on what one wants to achieve—into the skin. It can be used for skin tightening, hydration, lightening, and to treat severe hair fall and hair thinning on the scalp. The areas to be treated are all injected in tiny amounts with tiny needles into the mesodermis—one of the deeper layers of the skin.

Lipo dissolve

Substances like phospodylcholene, L-carnitine are used to burn fat in a spot of area. I inject this right at the pocket of fat that you may want to melt. It is a great sculpting method for the body. It can be used to reduce love handles, slim down lower abdomen, thighs, or even the fat on your too-rounded cheeks.

While Botox and fillers are usually one-time treatments that give you the desired results, the other injectables require multiple sessions. However, know that none of the treatments can give you permanent results, so you need to get them done again at set intervals.

What happens if you do not wish to do these treatments anymore?

Any of these treatments always leaves you feeling better and enhanced, even if the best result wears off with time. But you never go worse from your starting point. So even if you want to try them once, or want to pamper yourself for an occasion, go right ahead.

What can go wrong?

Your face could freeze!

You could look like someone else!

You could end up like a chipmunk!

You could look a little too ‘done’.

Okay, calm down. All this ‘can happen’ but need not happen. Go to the right doctor. It is the aesthetic sense of the doctor that counts. We all study the same science as doctors, but it is how the doctor wields the tools of beauty that counts. In our line of aesthetic cosmetology, the doctor is an artist. Work should be done in such a way that everybody compliments you about your fresh face and beauty but keeps wondering what’s your secret.

For more detailed information on various forms of treatment, please visit my website http://www. drrashmishetty.com/

Make up that takes five years off your face

Make up that takes five years off your face

Age aggressors

A few things that have definite downward effect on beauty and ageing and that you can very well live without are

Sugar: As I mentioned in the chapter on skin and hair care during the festive season, sugar, in all of its forms—high fructose corn syrup, cane sugar—suppresses the activity of our white blood cells and so makes you more susceptible to colds, flu, and worsens allergies. It breaks down good proteins, leading to advanced glycation end products (AGE). AGE makes the proteins in the collagen and hair stiff and hard; thus speeding up the skin ageing and making hair brittle, and therefore it is one of the main contributors to wrinkles, deep lines, and sagging skin. When our blood sugar and insulin levels rise, whether from dietary sugar, starchy foods, or from stress, we experience a serious increase in inflammatory chemicals. This causes acne to worsen dramatically along with Cortisol and other adrenal steroids that stimulate the sebaceous (oil) glands.

So overloading on high sugar foods in the name of desserts or a spoon of sugar in your daily tea, or our great Indian weddings and festivals which are round the year, causes damage to your skin and hair.

My suggestion is be mindful of what you are eating all the time. Alpha lipoid acid is one of the best to combat AGE, whether eaten or applied. Instead you can take in natural sugars found in fruits and vegetables which are high in anti-inflammatory antioxidants.

Salt: Excessive salt in your body increases all sorts of inflammation and retains fluid everywhere. The swollen joints, breasts, and belly are partly because of fluid retention aggravated by salt. Ayurvedic doctors say that your joint pains and systemic illnesses can be helped with a no salt diet. For us now think swollen face and puffy eyes! So NO salt, especially post sunset, because salt makes you retain water. So if you have puffy eyes early in the morning, or a water retained feeling on the bust and belly areas, then the easy and best trick will be to cut down on your salt intake in the second half of your day.

Smoke: Smoke and pollution damages hair and skin. You will find your hair feeling dry and scalp irritated and even itchy. Too much exposure can lead to boils/ folliculitis, skin rash, and acne exacerbation. Wearing a scarf and braiding your hair will prevent it from harmful smoke. But the smoke that you drag into your system is the most harmful. Smoking pretty much does to your skin from inside what sun does from the outside—it makes your collagen weak, skin look tired, interferes with your blood supply, and slows down wound healing. I always tell my patients that drinking alcohol once in moderation is okay but smoking is an absolute no!

Alcohol: Alcohol adds to your woes! What is left of your skin and hair will be done to with alcohol. It makes the skin flushed with broken capillaries and dehydration. Alcohol is okay in moderation, but flood your system with water after you indulge in drinking.

Skimping on your sunscreen: I have told you all through my book how sun harms your skin and how important sunscreen is. Now if you take a very little quantity, the size of a bitter pill, it’s not going to help. You actually need a dollop, about 2 big pea size, for your face alone to even come near to achieving the SPF protection mentioned on the tube.

Using the wrong cleanser: It can strip all your moisture, making your skin further dry and increasing the fine lines, irritating the area around the eye and mouth. So go for a creamy cleanser.

Overeating: When you gain a lot of weight, you know what happens to the skin—it gets mottled and flushed. And then when you lose weight, stretch marks and sagging appears. Yes, there are creams and oils and lasers and peels and radio frequency and micro needling. But even when we put them all together, we can’t get back your skin ‘just right’. But the issue I want to highlight is—post 40 how will you lose it? I have been 49 kg since I started getting on the scale and today at 40 and mom of a teen, I still am 49. The difference is I could eat a lion’s share and stay that way earlier but ever since I touched 40, everything changed. Now I cast a fleeting glimpse at greasy, carb-ridden food and walk away.

Sleeping positions: Be mindful of your sleeping positions. Always sleep on your back. Compressing your face against the pillow will cause more creases, alter facial shape, and cause acne.

Facial expressions: Keep repeating only the happy ones. Sad ones stick on too.

You know your skin is undergoing premature ageing due to UV rays when: