Turning back the clock

Facial aging is typically thought of as having two contributing elements — the constant pull of gravity and degeneration of the tissue components that make up the skin.

Gravity is always present, and short of space travel, is beyond our control. But the collagen and elastin components of skin, change as a result of time and the assaults of environment and lifestyle.

As we age, the collagen layer, which makes up the bulk of the substance of the skin, begins to thin.

The alignment of these protein fibres becomes less regular, and the collagen layer weakens. The elastin fibres become less resilient as well, and the skin no longer snaps back into place. There are lots of ways we can avoid accelerating this process, and even reversing it early.

But when elastin and collagen are weakened, wrinkles and folds develop.

Some of these, like the nasolabial lines coursing from the outside of the nostrils to the corners of the mouth, are classic signs of aging.

What begins as a line soon becomes a fold.

And the fold soon descends from the corners of the mouth down to the jaw line. Other deep wrinkles or folds include the vertical frown lines between the eyebrows, vertical lines in the upper lip and wrinkles outside and beneath the eyes. There is more than one solution to these encroaching signs of aging, but we will concentrate on the nasolabial fold. This is often the first to manifest itself, the most genetically determined, and most frequently dealt with by the use of fillers.

The philosophy is fill in the fold, eliminate the shadow and turn back the clock — and largely, it works.

The first successful filler was liquid silicone. The good results were permanent, and the complications were permanent, and frequent; the procedure was far too risky for general use.

Next came injectable collagen. This was a good product, though hampered by significant allergy. Therefore, a several-week testing period was necessary.

Hyaluronic acid fillers soon supplanted collagen.

This is a mucopolysaccharide, which is a sugar-like substance that occurs naturally in the body. For use as fillers, various sources are employed in production. Some bacterial, some animal.

In all cases the incidence of allergy is extremely low. This makes it convenient and there is no waiting period.

Hyaluronic acid fillers injected into the nasolabial folds last for up to a year, but six months is a more realistic expectation. Another popular filler is made of synthetic calcium hydroxyapatite, similar to the substance found in bones.

This is a somewhat thicker and more long-lasting filler — hence, its uses are usually confined to deep folds or tissue augmentation.

A very popular third alternative is fat transfer. This is wholly natural and the longest lasting filler. Under most circumstances, I find this the best choice of filler for most uses.

Up to 50 per cent of the filler is permanent — the downside being that fat is not as quick a fix as the synthetic fillers.

In the next weeks, we will discuss these options in further detail.