How does the face age?

How does the face age?

We all hear about ‘ageing’, but what does it really mean?

Although most of us think of wrinkles as the main culprit of ageing, the reality is far more complex. The entire structure of the face, including skin, subcutaneous fat, muscles and bones change over time.

Before you read on – this post is not meant to shock or shame. The reason it’s important to understand the science behind ageing is because once understood, it allows clinicians to tailor clinical interventions to the root cause.

By using a scientific approach to ageing and combining synergetic modalities, we are getting vastly better outcomes and can achieve natural-looking results non-surgically.

What causes ageing skin?

Collagen

Collagen is the mesh-like component that makes up around 75% of the skin. It gives skin structure and support and holds the landmarks of the face in position. With age, the number of collagen fibres decreases, and the ones that remain become less organised, weakening the tissues. This results in stretching of the skin, pores become larger, wrinkles, and sag.

For women, collagen loss is accelerated in the years around menopause, when up to 30% of collagen is lost. This is compounded by the a tendency of skin to thin out and become more dry in the latter stages of perimenopause, due to reduced oestrogen This is why some women come to us feeling they have “aged overnight”, and why having a collagen inducing treatment in perimenopause is so important.

Clinical interventions that increase collagen include: wearing sunscreen, using retinol, peels, and collagen induction therapies such as dermal needling, Tixel (for skin), and High-Frequency Ultrasound (for skin sagging and laxity). Last on the list are surgical modalities such as a facelift or neck lift. surgery, make sure you see a qualified plastic surgeon, not a cosmetic surgeon, as plastic surgeons are regulated and recognised as specialists (anyone can call themselves a cosmetic surgeon - beware!)

Fat

All faces have fat, and these areas of volume help support the skin and keep us looking healthy, particularly in the midsection (cheek and lower eyelid regions) of the face.

Unfortunately, as we age, or due to other factors such as weight change, medical illness, or medications, these fatty areas reduce in volume which leads to deflation, and sunken, tired-looking eyes.

Don’t ask me why we lose fat on the face and put it on in the middle! There is no justice! Catherine Deneuve famously quipped that “at a certain age, you have to choose between your face and your arse” …and to some degree this is true!

Clinical treatments that improve fat pad loss include judicious use of dermal fillers, fat grafting, and plastic surgery. These procedures should be done AFTER skin tightening (the adage “lift then fill”) to minimise overfilling and bloating the face. Despite what the filler companies may tell you, fillers do not lift… they fill.

Ligaments

Skin is anchored to the facial skeleton via ligaments. As we age, these ligaments slacken and gravity pulls them down, causing the face to descend, forming jowls and an uneven jawline.

Currently, the best non surgical intervention to improve ligament laxity is HIFU (High Frequency Focused Ultrasound). This where the Ultraformer 3 is in its element, and the reason why we love it so much. The Ultraformer 3 has revolutionised the HIFU world with the introduction if the 4.5mm cartridge, that heats and tightens the aponeurosis and ligaments that sit above our above our facial muscles,

Although the gold standard treatment for laxity is a surgical facelift, for most people, this is not attainable due to the cost. However, the Ultraformer 3 is a viable alternative for mild to moderate skin laxity, especially when used early and regularly. Most plastics surgeons have a device like Ultraforrmer, which again is a testament to the validity of the technology, and many surgeons will advocate an annual treatment to maintain surgical results.

Bones

Just like the bones in our hips and back, our facial bones shrink and become more porous with age.On the face, this is most notable around the eye socket, the base of the nose, and the chin. This contributes to the look of “tired eyes”, drops the tip of the nose, and pulls the mouth and chin downward.

There are several interventions to manage these issues such as dermal fillers to disguise volume loss, and neuromodulators (“Botox” or “Dysport”) to reduce overactive muscles in the lower face. Make sure you see someone who knows what they are doing if they are treating the lower face as these are tricky areas.

If you want to talk or learn more about your skin and ageing, please book a consult. Having a consultation with an experienced practitioner is THE most important aspect of any treatment, as it will allow us to formulate a bespoke plan based on your concerns, your clinical issues, and your budget.

WRINKLES- prevention is better than cure

It’s something that we look at every day in the clinic, lines & wrinkles! Whether we’re treating them, consulting about them, or just having a chat, wrinkles and fine lines are always on the agenda at Thrive. The main area of concern is prevention, we’re constantly being asked the question

“What can I do to stop my wrinkles showing?”

“I’m young and don’t want to get wrinkles, what can I do?!”

1. Don’t smoke. This one’s a big no-no when it comes to premature ageing!

2. Eat a variety of fruit and vegetables which contain antioxidants to prevent glycation and wrinkle formation. If you want to know more about glycation click here.

3. Protect your skin from the sun. Be sensible about sun exposure and wear a good quality sunblock every day to avoid sunburn. Using a mineral makeup on top of your sunblock adds an extra layer of defense. For example, try Mineral Whip as it contains suncream and has active ingredients that feed the skin.

4. Avoid pollution. Using Enviroshield under your makeup not only improves the look of your makeup after application, but it also creates an invisible shield to stop environmental toxins like heavy metals, environmental allergens e.g. lead, cadmium, and arsenic from penetrating into the skin and causing premature ageing. 

5. Exercise daily. Exercise increases the circulation to our skin, delivering oxygen, and removing cellular debris, which can cause premature ageing. exercise also reduces stress and helps to manage inflammatory skin conditions such as eczema and psoriasis.

Common mum skin issues & how to solve

Issue: Dull Skin
Recommended Clinic Treatment: NCTF BOOST 135HA AKA our “Skin Cocktail” 

What is it?

The unique topical skin-boosting treatment contains a cocktail of over 50 active ingredients, including hyaluronic acid, Vitamins (A, B, C, and E), minerals and amino acids to improve skin brightness, tone, and hydration. This is not just a sales pitch, it is backed by numerous clinical studies, which show increases in hyaluronic acid, fibroblasts, and collagen - the cells in the lower part of the skin that we lose as we age. NCTF Boost 135HA is one of the top-selling Aesthetic products in Europe - it’s only new to Australia and recently TGA approved. Thrive Skin Clinic is one of the first clinics in Australia to stock it and it’s just hit our treatment rooms, waiting to boost your skin!

The number of treatments required:

Most trials show it is being used every 2-4 weeks for 3-5 sessions. The treatment involves a clinical peel, infusion via medical micro-needling and finishes with an HA mask. There is definitely time to have 1-2 treatments before Christmas/New Year!

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Issue: Breakouts/Congestion
Recommended Clinic Treatment: Hydrafacial

What is it?

The Hydrafacial treatment will immediately address congestion and breakouts. In a single treatment session, we can exfoliate, extract impurities (the best bit!) using Vortex vacuum technology (think, a vacuum cleaner for the skin!) and then infuse antioxidants back in to finish off the treatment. This treatment is only $185 per session, results are instant with NO downtime. 

The number of treatments required:

You could squeeze in a treatment between now and Christmas time to get your skin glowing! We get them done monthly!

The recommended home care products:

AHA/BHA serum (try Synergie Practitioner Range Exfol-X!): This is a chemical exfoliant that will help to knock out breakouts. You can also be a bit sneaky and leave it on a bit longer, like a home peel once a week. GREAT for the holidays - Ask us about how to do this properly before you do it, please!

Vitamin A (Retinol) (try Synergie Practitioner Range A+!): This night time serum regulates oil production, promotes new collagen, reduced pigment and clears the skin. This product is one of the best Vitamin A serums on the market as it is part of a doctor only skincare range and formulated to reduced irritation and redness. Skin will look smoother, wrinkles will not be as noticeable and oil production will regulate.

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Issue: Wrinkles
Recommended Clinic Treatment: Anti-Wrinkle Injections / Tixel

Anti-wrinkle Injections:  

What is it?

Anti-wrinkle injections are used to improve the appearance of wrinkles. Common treatment areas include around the eyes, the forehead and the frownlines.

The number of treatments required:

A single treatment session lasts up to 3-4 months. We would recommend booking in now for anti-wrinkle injections for the best results at Christmas time! You’ll start to see results in 2-5 days and are at their maximum at 2 weeks.

Tixel:

What is it?

Tixel is an in-clinic treatment that works similarly to laser, but with different technology. It is safer than laser treatment, with less downtime, and can only be used under the supervision of a doctor. Tixel can be done all over the face and body and will leave the skin looking and feeling fresher after 2 weeks, with reduction collagen induction (less fine lines and wrinkles) seen from 6 weeks. It is a game-changer for those fine crinkles on the lower and upper eyelids and can be used to firm the fine crepey skin of the neck and décolletage.

The recommended home care products:

Zinc Oxide moisturiser (try Synergie’s UberZinc): 80-90% of skin wrinkles and pigmentation are caused by environmental exposure, mostly UVA and UVB light. If you care about your skin and reducing skin cancer, investing in a good quality sun cream, and applying it daily, is your number one priority. UberZinc is our best selling product for a reason - it works! It smells great, feels gorgeous and it is suitable for even the most sensitive and reactive skin types. Pop in for a sample if you’re keen to give it a try!

Anti-aging moisturiser (we love Synergie Reclaim): A good quality anti-aging moisturiser used at night will hydrate the skin giving it a more youthful appearance. If you are really dry, then try Synergie's Hydrolock. And don’t forget a weekly intensive overnight treatment with Synergie’s MasquErase, a gorgeous product (our clinic directors favourite!) that contains peptides to heal skin and get it glowing.

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Issue: Pigmentation
Recommended Clinic Treatment: Cosmelan

What is it?

Cosmelan® works by decreasing the production of melanin from the pigment-producing cells of our skin. It is a 2 step program involving an in-clinic peel followed by 4 months of home care to breakdown both hormonal pigmentation (Melasma) and environmental pigmentation. Thrive Skin Clinic is the only clinic in the Illawarra offering this amazing treatment! It’s intense, and should only be done by a medical clinic - but the results are phenomenal. (I mean it - check out the 'before and afters' on our social media!) The beauty of Cosmelan® is it can be done on ANY skin type (Caucasian, Asian, Mediterranean, and even very dark skin), at ANY time of the year and IT WORKS. 

The number of treatments required:

Only one in-clinic treatment is required, however, allow a week of downtime after the procedure. We suggest booking in now, or over the holidays, to get results from this amazing treatment!

The recommended home care products:

Vitamin C (try Synergie’s SupremaC+) in the morning, under sun cream. This is a powerful antioxidant, with years in the making. It will help to reduce hyperpigmentation and prevent it from occurring.

Tyrosinase Inhibitor (try Synergie’s Vanish, or see Dr. Grant for her patented medical-grade cream). If you have pigmentation, then a Tyroniase Inhibitor is your key to reducing pigment and preventing it from recurring. Pop in and discuss it with us, as pigmentation is really complex and often needs a medical solution. Please don’t use any heat-based or laser treatments on your skin!

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REMEMBER! The skin is not a one size fits all situation. We pride ourselves on our client consultation and only offering evidenced-based interventions that are clinically proven and medical grade. If you are unsure of what your skin needs to look and feel its best, book an appointment with one of our clinicians! We have a team of doctors, registered nurses and dermal therapists who are experienced and passionate about all things skin.

If you haven’t already, look out for our upcoming 12 Days of Christmas Specials on our social media pages for some great seasonal deals!

Note that we will be open most days over the Christmas Holiday period, with an online booking system and late-night/Saturday appointments available so you don’t miss out! We also have made up a few bespoke gift boxes and also offer gift vouchers in-store and online (you can even email it to someone on the spot, great for a last-minute gift!).

There are some things you just can't assess via telehealth!

WARNING: If you are offended in any way by the term vulva, switch off now! 

Let’s face it, all women have a vulva.

I often find that women put off discussing vulval discomfort with their doctor because they are embarrassed. Thankfully, as a female GP who specialises in skin issues, a mother of 3 and WOMAN I’m not embarrassed at all- I’ve seen hundreds of vaginas, and it’s my job to look after your whole body (yes including the vagina!).

What are the causes of vulva itch?

Over the last 15 years, I have seen many women with vulval discomfort misdiagnosed as having “thrush” ( an overgrowth of Candida, a normal fungal bug found on our skin and in our genital and intestinal tract.

The take home message from this blog, however, is that not all vulval itch is thrush.

Lots of things can cause vaginal and vulval skin symptoms such as infections, hormone issues, retained foreign bodies in the vagina (such as tampons or toilet paper), sexual infections, pinworms, and sometimes even skin cancer.

Breastfeeding, peri- menopausal/menopausal women commonly present with itch due to low oestrogen and dry skin. Children rarely suffer from thrush- in fact pre-pubescent girls develop itch due to dermatitis from hygiene issues, overuse of soap and rough/scented toilet paper.

What to do before you see the doctor

Now, as you now know, not all vulval itch is thrush. However, thrush is very common- over 75% of women will have a symptomatic episode of thrush in their lifetime. So, all women should be aware of it. If you have had thrush before, and note the tell - tale signs (e.g. a cheesy white discharge, itch, vaginal discomfort and odour) then I am OK for patients to self manage and start using an over the counter medication from the pharmacy. You can use a combination treatment such as fluconazole tablet and clotrimazole cream, a vaginal pessary (which is a small tablet you place the vagina), or a vaginal cream. Pros/cons of these include: oral tablet (the least invasive option, but not as effective and more expensive); pessary (less messy than cream, inserts using an applicator- but you still have to put in your vagina!, more effective than oral medication); or cream (messy, but it comes with a syringe applicator to help get the medicine where it needs to go. For a bad case- I suggest both an oral tablet and a 3 day pessary or cream. If it comes back- use the 6 day cream.

If you don’t have symptoms of thrush, but remain itchy, look for lumps or discharge. If you do have a lump, new discharge, pain or you’ll l really worried,- see a doctor ASAP. However, if the symptom is just itch- start the general measures discussed below, and start a 5 day trial of an over the counter hydrocortison/clotrimazole cream three times a day for 5 days. If things don’t settle, or they get worse, see a doctor.

A word on seeing a doctor

If you book to see a doctor- you may need to lead the consult a bit. Explain your symptoms. Expect (you may need to ask) for a physical examination and a swab of the area. Consider doing an STI screen if you have had unprotected sex. If you have thrush and it keeps coming back- please ask for a swab to confirm the diagnosis, and exclude that you have an uncommon variant of thrush that does not get better with the standard over the counter anti- fungal treatments. Arrange a followup consult to discuss the results.

DO NOT let a doctor diagnose you with thrush without examining you and considering investigations.

What about Lichen Sclerosis?

I am particularly interested in vulval lichen sclerosis,  a condition I am seeing more often in my practice. It is thought to only affect 1% of the population, however, I have a suspicion it’s more common than this, but that women don’t seek help.  Lichen sclerosis is thought to be an inflammatory/ autoimmune condition, whereby the body attacks the skin on the vulva or perineal area (the skin between the rectum and the vagina).  It can also occur on penis or elsewhere on the body such as the moist part of the mouth.

It is more common in post-menopausal women, although 10% of cases are in children, and I have also seen in teenagers and young women.

Lichen sclerosis (L.S) presents with symptoms such as vulval itch, often worse at night in bed. It can also cause pain passing urine or bowel motions, and commonly causes pain during sex. Some women can’t even walk down the street due to pain, but this is rare. If we diagnose and treat L.S. this early, we can avoid such severe symptoms

I have seen countless women who have been using over the counter thrush treatments for YEARS , having been told they have “thrush”. Unsurprisingly, their symptoms did not improve, until we actually looked and saw they had the typical signs of lichen sclerosis.

Once diagnosed, lichen sclerosis is managed using a potent steroid cream regularly. This can be weaned over time and most women only use it once or twice a week, even when symptoms settle. This must be done under medical supervision. Sometimes, you will need to see a gynecologist or dermatologist if things do not settle easily, and all women need annual review, even if their symptoms abate. The reason for this is that L.S can continue to cause an issue without symptoms, and is also associated with a slightly increased risk of vulvar skin cancer (most up to date studies estimate this to be 1-2% , which is a very low risk). There are also some new studies suggesting topical immune modulators might help, which is exciting and I am looking forward to more research in this area. 

How to Care For Your Vulval Skin:

My general approach to vulval itch starts with some really simple measures: do not over wash/clean the vulva excessively- it’s delicate! In many cases, over washing can cause pain and itch, so don’t overdo it. Use a thick cool moisturiser regularly, and stop all irritants such as soap, scented toilet paper, and anything with a fragrance. I recommend Olive and Bee Intimate cream as a natural and effective moisturiser, which can also be used as a  lubricant. Reduce the use of occlusive clothing such as activewear /yoga pants and synthetic fabrics- sleep free and easy if you can.

What To Do If You Have Ongoing Problems

Management depends on diagnosis. If things do not settle, or the clinical examination suggests lichen sclerosis, ask your G.P to refer you to a doctor confident in vulval biopsy - a quick procedure performed under local anaesthetic, where a small sample of tissue to taken. A biopsy helps to exclude or confirm a skin issue lichen sclerosis, or something else.

Hopefully, this information has given you the courage to think about the vulva more, and educated you on this taboo issue.

Take Home Messages

If you have a vulva itch - don’t scratch it, share it! (with your GP). Anything that is bothering you in the nether regions needs attention and a thorough examination.

Glycation... What is it & How do I treat it?

Have you heard of Glycation?

If you haven’t, you’re not alone. But once you realise that it could affect ALL of us, you’ll wonder why you hadn’t known sooner. We are all very aware of the effects of what excess sugar can do including what it does to both our waistline, teeth and our health, and now we are going to add another notch to that belt by outlining a potential effect it has on the skin. Besides the sugary break out we all often get a day or two after enjoying one too many of those chocolate freckles, sugar could actually play one of the main roles in our skin’s process of ageing.

What is Glycation?

Glycation is in fact a natural process where the glucose in our bloodstream may attach to proteins such as collagen in our bodies and form new molecules called advanced glycation end products or AGEs. These AGEs have the ability to degrade collagen and elastin, the fabulous fibers that normally keep our skin firm and supple. Unfortunately this process may ultimately contribute to a more rigid and aged looking skin. Many describe the appearance as having a yellow-ish tinge and affects the lower face more commonly, particularly the jowls and chin.

It’s important to remember that this is a natural process, but when a diet has a high sugar focus, this can possibly lead to an accelerated response.

What can we do?

The most useful counter to glycation and skin ageing is to of course to include healthy and balanced foods in our day, keep up our water intake and never forget sun protection. To add to this, an all-inclusive skincare regimen will ensure the right ingredients are targeting our collagen and elastin stores.

Our Pure-C Crystals from Synergie Skin provide the most stable and effective method of delivering Vitamin C to the skin. It features pure L-Ascorbic acid, an antioxidant that was found to inhibit AGEs by 52 percent. This product is an active anti-aging essential recommended for:

• Fine lines and wrinkles

• Hyperpigmentation

• Uneven skin tone

• Mature skin

• Sun-damaged skin. 

Syngergie’s Superserum+ was specifically designed as a triple threat to premature aging, with powerfully active peptides, marine extracts and botanical ingredients. The use of peptides in our skincare regime will help serve our skin the right building blocks for the stimulation of potential collagen and elastin fibers. This product is an essential for all those concerned with aging skin and is recommended for:

• Mature skin

• Fine lines and wrinkles

• Dry/dehydrated skin

• Dull skin

Our final thoughts

If you’re wondering what else you can do to prevent or treat glycation, rest assured that here at Thrive Skin Clinic we have a team of professionals to help you. Book in a consultation with one of our Dermal Clinicians to assess your skin and prepare a treatment plan for you. We have incredible treatments to help combat the signs of premature aging, sun damage and collagen loss. From our new Tixel treatment, to an array of Synergie Peels, we have what’s needed to help you on your skin journey.