Facial rejuvenation – all about looking younger


Facial rejuvenation is a huge topic.


What I want to do here is provide an overview of facial rejuvenation strategies. Links will take you to specific treatments. We’ll start easy and superficial and gradually go deeper. We’ll finish with a age-specific suggested timetable of approaches.


Firstly the basic stuff


Everyone in Australia should know about skin care. We have arguably the worst skin in the world, seeing as we do amongst the most sun, with some of us bearing the fairest skin, and thanks to our health care system living amongst the longest lifespans on the planet.


Click here for the P.E.A.C.H. skin care system


And no responsible doctor in this field can omit saying something about lifestyle factors that may contribute to the ageing of skin. Have you heard it all before? Maybe – or maybe not (don’t we usually surprise you in at least some way?)


But most people clicking on the topic “facial rejuvenation” want to know about PROCEDURES


1) Easy, superficial procedures for facial skin rejuvenation


Walk-in-walk-out, no pain, no downtime, no side effects and you’ll look ten years younger!” – what is wrong with this sentence?


It’s implausible.


Don’t get me wrong. Easy superficial procedures have an important place in cosmetic skin care. But so does truth.


Our easy, superficial procedures for facial rejuvenation include microdermabrasion, microhydrabrasion, chemical peels, derma-needling, Refirme and Omnilux.


Omnilux is the easiest. This pleasant bright red light stimulates the production of new collagen in the dermis by tricking your skin into thinking its been a bit burnt. It stimulates blood flow and seems to hasten healing after some of our other procedures. There is evidence of it improving crows feet wrinkles.


As with all easy superficial procedures, you need to do a SERIES of these in order to see a reasonable difference, and we cannot guarantee the degree of improvement that occurs in any given individual. Omnilux is not a face lift. But it is safe easy pleasant a proven – why not?


Chemical peels can be, of course, not easy and not superficial. TCA peels and phenol peels can give spectacular results but may also cause spectacular side effects and spectacular down time – we don’t offer these at Peach because we have better alternatives.


What we DO offer are superficial hydroxy acid and retinol peels. These act primarily at the epidermal level, inducing dermal collagne as a secondary event. Now, it should not surprise anyone that chemical peels can cause – peeling. They can cause some redness and stinging, varying from patient to patient and from peel type to peel type. And the skin looks fresher and renewed afterwards, and a series of these will brighten your appearance.


Microdermabrasion and microhydrabrasion are our great workhorses when it comes to easy superficial procedures. Gym for your skin! These predictably safely and inexpensively induce dermal collagen and tightening. We see exfoliation, brightening, firming, improvement in pores and acne. Virtually no allergy risk, and no surprises, as the process is entirely physical.


One thing I feel I must add about all these superficial treatments, though, is that I believe their role in the managment of pigmentation is limited. These treatments generally should not be thought of as first line treatments for hyperpigmentation, since there are many forms of hyperpigmentation and some will not respond to these treatments. Superficial treatments can help diminish epidermal pigment by simply peeling or rubbing it off, but they do not address the underlying pigment production and could actually worsen it.


ReFirme is a radiofrequency-based device that creates little zaps of thermal energy under the surface of your skin with a view to inducing collagen formation and tightening. We have found ReFirme’s primary role to be in the inducing of firming of quite thin skin, such as that found on the neck. It’s role on thicker facial skin is limited.


Derma-needling is yet another approach. The idea here is to directly stimulate new deep skin collagen by pricking the skin with thousands of tiny pinpricks. And before you pass out at the thought of it, relax – the needles are extremely tiny and our anaesthetic cream makes this one of our most comfortable treatments.


That said, we can dermaroll to various depths depending on the degree of effect sought. Typical first treatment is with the shortest needle length. Most patients report no downtime at all, or sometimes a few hours or puffiness or pinkness.


 In sum, each superficial treatment you have is just one step towards facial rejuvenation. Whatever the modality, you will need a course of treatments, and you will in most cases need maintenance treatments to sustain the effect.


Try not to be disappointed. After all, you have to keep exercising to maintain muscle health, don’t you? Skin is no different.


2) Step two: facial skin procedures with a bit more downtime


These can bring about more skin change in one or a few treatments. They can bring about long-lasting or even permanent effects. This comes at the cost of some degree of downtime. Side effects and adverse outcomes can arise when performed by untrained individuals on unsuitable patients – happily here at Peach we have many years of experience with these modalities under Dr Mahony’s supervision, so adverse outcomes are extremely rare in our hands.


IPL Photorejuvenation involves intense pulses of light flashed onto and into the skin. The light will heat, specifically and in a targeted manner, red blood cells, melanin pigment, and therefore also dark hair. The penetrating light will also stimulate some new collagen formation, improving skin texture and reducing fine lines.


The treatment is mildly uncomfortable – typically we aim for discomfort around 4 -5 out 10 on a 0-10 pain scale. Enough to bring about an effect but not enough to cause damage. (Sensitive patients appreciate our having nitrous oxide gas or “laughing gas” available to reduce discomfort).


Afterwards your skin may be pink for hours to days.  Freckles will appear darker for about a week then mostly flake off!


IPL is a Godsend for those with sundamaged mottly pigmented skin (in absence of melasma). Freckles and rosacea respond very well too. And a series of treatments will nicely improve texture for those in 30s and 40s. Pores improve as well.


Photodynamic therapy has a special role in the management of patients concerned about skin cancers.


After a microdermabrasion session to exfoliate the surface, we apply a solution of 5aminolevulinic acid (5ALA) which is then kept under a light-opaque cover for 1 to 2 hours. During this time the 5ALA is preferentially taken up into early skin cancer cells and acne-producing cells. After this time, we expose the area to an Omnilux session, and the Omnilux light activates the 5ALA (by now converted to Protoporphyrin IX if you want to be picky) to kill the cancer cell or the acne-producing cell.


This is a great way to get rid of all those flakey unsightly little precancerous “sunspots”


Fractionated Erbium laser (our version of  “Fraxel”) goes a little further again. The Fractionated Erbium laser applies the laser energy into tiny “pixels”, each only 300 microns wide (under 1/3 of a millimetre) but typically around 20,000 such pixels per minute. Each tiny treatment zone ablates a dot of old skin, which later heals in from its edges, leaving you skin with a more even appearance and with more collagen.


Fractionated ablative lasers such as ours and the CO2 lasers takes facial skin rejuvenation further than is possible with IPL or non-ablative lasers. Lines improve, texture firms, tone evens. Then again, the process is more involved (Dr Mahony does these himself) and there’s more downtime


3) Maximum skin rejuvenation treatments


OK. You’ve tried everything else. Your skin is a mess. You are prepared to spend a week or more at home.


Then you might consider deep fractionated erbium laser resurfacing or full erbium laser resurfacing.


This is the most potent skin rejuvenative treatment we offer. The goal is to eliminate tonal irregularities, induce skin collagen, further reduce dermal lines. New skin.


However, there really is some downtime. Around a week of time at home.


And some skin types ae not suitable. The treatment can cause pigment increase, pigment loss, or an irregular patchwork of the two in susceptible patients. And who is susceptible to these side effects? Anyone with moderate natural skin pigment, such as people from Asia, Middle East, Africa, etc.


So, this sort of treatment is really only well suited to those with very fair skin.


4) Going under the skin – facial rejuvenation treatments with a needle


To have a young-looking face (or “younger-looking”, if you prefer) you need more than young-looking skin.


First steps in this direction usually involve reducing the line-forming actions of certain facial muscles with anti-wrinkle injections. By relaxing the muscles that cause lines we allow the skin to remodel and diminish these lines.


Time will also leave certain depressions and creases on the face. Fine ones can be treated with the skin treatments mentioned above, but deeper ones will need a filler.


When there’s a dish of emptiness, such as in the temple or under the cheekbone, you should look at replenishing that volume with Agent SS, and if the need for volume is greater still, there’s no better substance to use than your own fat in a fat transfer procedure.


Sometimes Time will give you too *much* volume in a certain spot. Here I’m thinking jowls, and that double chin. Pulling up this extra fat in a face lift is a nice idea but expensive and generally less effective than you would think. When the extra facial volume is


5) Going further still – facial rejuvenation with threads and loops


Doctors have always sought ways to acheve facial rejuvenation in the safest and most practicable manner. Around ten years ago we saw the emergence of APTOS threads as an alternative to face-lift surgery. These threads were 10-15cm pieces of monofilament polypropylene (like 20lb fishing line) with little notches or “barbs” cut into them. The idea was that the careful placement of these barbed threads under facial skin would create little suspension bridges of support.


With time, some patients remained happy with their results, but most did not.


Then we saw the emergence of Contour threads as a stronger alternative. These were still barbed bits of fishing line, but were anchored in the galea aponeuritica to provide a firmer base for support.


But – they didn’t last. The company went bust in 2007. Some Contour patients remain happy with the lift they achieved, but most are not.


I then started offering lifts using the technique of South African plastic surgeon Des Fernandes. These “Fernandes loops” are technically more demanding to put in, but because they rely on a firm knotted loop to achieve a lift rather than the rather flimsy barbs of the APTOS and Contour devices, they promised better duration.


And this has been my experience – that the Fernandes loop lift lasts.


HOWEVER, each Fernandes loop lifts a POINT. Therefore, the technique is prone to lead to skin dimpling at the lifted point. In order to overcome this problem, one has to apply quite a number of loops in order to distribute the lifting load over all these points. Further, the load of the various loops has to be balanced. All in all, it isn’t easy to achieve a smooth lift with the Fernandes loop technique.


Pondering this problem, early in 2011 I managed to conceive of a technique that would avoid the dimpling of the Fernandes loop. Here at Peach I can now lift a brow or a cheek using a broadknotted loop, thus avoiding the dimpling that bedevils the Fernandes technique.


We’re calling it the Peach Loop Lift (unless you, dear reader, have a better idea) and patients thus far treated report seeing an agreeable and even lift to cheeks and/or brows, as the case may be.


The beauty of the loop lift technique (using silk, btw) is that any problem can be solved by either adding or removing the loops.


There are no facial skin incisions involved. No scars.


Local anaesthetic. No scars. Reversible. Augmentable (put in another loop). Looks to be long-lasting. Smooth natural-looking lift using natural silk.


6) Going all the way – facial rejuvenation with scalpels


7) Going all the and leaving something behind – facial rejuvenation with solid implants


8) The final frontier – facial rejuvenation with a bone saw