Start early to forestall cosmetic effects of aging

Sabrina Fabi, MD: “There is not a lot out there to show us when it’s appropriate to start treating these patients.”

An aging body is like aging machinery; it doesn’t break down overnight but wears down gradually. This has led a growing number of people to begin maintenance cosmeceutical treatments before the aging process sets in.

The approaches to treating the aging body, with a focus on the face, were examined March 5 in “Aging Gracefully” (S043). Nine speakers explored anti-aging and prevention treatments at younger ages, different skin type reactions to the aging process, treatments for more mature patients, and men versus women.

“There is not a lot out there to show us when it’s appropriate to start treating these patients. We usually start treating them when they are already noticing the actual lines, the wrinkles, and the folds,” said speaker Sabrina Fabi, MD. “But we actually use the pathophysiology of aging as a blueprint to start doing these procedures earlier.”

The aging process begins by 25; by 35, the bones have significant reductions in osteons and osteocytes that lead to decreased support of muscles, said Dr. Fabi, a volunteer assistant clinical professor at the University of California, San Diego.

That early treatment start can begin with the use of neuromodulators and individualized anatomic assessment, said speaker Shannon Humphrey, MD, clinical assistant professor of dermatology at the University of British Columbia.

She reviewed a study of botulinum toxin type A and concluded that it is the “gold standard for the temporary treatment of dynamic wrinkle reduction.” It upregulates collagen expression, increases skin pliability and elastic recoil, prevents etched lines, and improves skin quality.

Qian Zheng, MD, PhD, of L’Oreal Research & Innovation, also examined the evidence of anti-aging treatments, including cosmetics that improve skin texture, repair skin damage, skin protection, and sunscreens to protect the skin.

Dr. Zheng said studies have shown the effectiveness of ingredients used in cosmeceuticals:

  • Hyaluronic acid, which improves the quality of elastic fibers and the collagen architecture
  • Retinol/vitamin A, which reduces wrinkles, provides higher density to the dermis, and homogenizes the complexion
  • LR2412, which is a derivative of jasmonic acid that shows significant improvements in wrinkles, skin texture, and pores
  • Vitamin C/ascorbic acid, which offers significant protection against photodamage and reduced sunburn cells

However, it is important to note that the vehicle and packaging of the cosmeceutical ultimately determines efficacy of these active ingredients.

Sunscreens with broad-spectrum high UVA protection can help prevent hyperpigmented lesions, global skin darkening, and uneven coloration, Dr. Zheng said.

Sabine Zenker, MD, evaluated newer alternatives to standard injectables and devices for facial rejuvenation, such as abosorbable lifting sutures and injection lipolysis.

Absorbable lifting sutures are used to create zones of traction to lift and reposition tissue. They are used in the midface, jawline, and eyebrows. In injection lyposis, drug mixtures are used to reduce localized fat pads. Compounds used include polyenyl-phosphatidylcholin and deoxycholic acid, said Dr. Zenker, a dermatologist from Munich, Germany.

As important as these treatments are, they should be used as part of a plan, said the session director, Heidi A. Waldorf, MD, associate clinical professor at Mount Sinai Health and a dermatologist in Nanuet, New York. A major part of that plan should be to not change the overall look of patients but to make them look like younger versions of themselves.

The plan starts with evaluating lifestyle issues, such as whether the patient smokes or if his or her weight goes up and down, Dr. Waldorf said. The plan should also prioritize skin color, texture, tone/laxity/redundancy, and volume/proportion.

Once a plan is developed, the dermatologist should outline which procedures will be used, their cost, and the time involved. Finally, it should all be documented, and include photographs and a discussion.

Andrew F. Alexis, MD, MPH, associate professor of dermatology at Icahn School of Medicine at Mount Sinai, stressed the importance of recognizing the role of ethnicity in aging skin. Dyschromia, textural irregularities, benign neoplasms, structural changes, fine lines, and wrinkles can vary in different types of skin and can affect treatment options.

For example, black skin has increased melanin, which provides protection from ultraviolet light, but dyspigmentation can be a complication on black skin after cosmetic procedures, he said. In addition, those with dark skin form keloids 15 times more frequently than those with light skin.

Susan H. Weinkle, MD, an affiliate clinical professor of dermatology at the University of South Florida, focused on the treatment of mature patients who have already suffered significant wrinkles and skin cancers from UV exposure.

Many female patients are more interested in having their skin look and feel new, and prefer to look about 13 years younger than their actual age, she said. They also prefer treatment with dermal injectables over surgery.

The demands of these patients vary in each decade of life, so treatments need to be adjusted for each age and face style, Dr. Weinkle said. Aging patients can also need treatments in other areas than the face and neck, such as the hands.

While most of the focus was on treating women, Terrence Keaney, MD, an assistant clinical professor of dermatology at George Washington University, focused on men, who age more quickly than women.

Men are more concerned about their hairline, eyes, and jawline, he said, adding that they require a gender-specific approach that is different from female patients.

Michael H. Gold, MD, of Gold Skin Care Center in Nashville, Tennessee, looked into the future of cosmetic treatments. He pointed to intense pulsed light, a minimally invasive treatment whose efficacy has been documented for treating vascular lesions and pigmented lesions.

Other technologies that have been proven effective, he said, are ablative and non-ablative fractional devices, pin and microneedling radiofrequency devices, picosecond lasers, and radio frequency and ultrasound for skin tightening.

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