A Comparison of Different Anti-Aging Strategies

A Comparison of Different Anti-Aging StrategiesAs a mild exfoliating procedure, microdermabrasion (MDA) every 1 to 3 months depending on the skin event would be a good balk anti- ripening strategy. A combine of MDA with chemical teguments is helpful in photoaging. MDA is always done first followed by the peel. Several studies support the efficacy of this regime for photo dateing. Superficial glycolic acid peels and 5% retinoic acid bewilder been utilise. MDA can also be employ as a transdermal drug delivery for various topical antioxidantsAmongst lasers, pan optical/ infr ard lasers and uncomplete lasers urinate been used for facial rejuvenation. Light systems including raging pulse light systems (IPL), light emitting diodes (LED), photodynamic therapy (PDT) and infr ard lights have been used for correcting intensity and textural alterations. Radio absolute frequency ( RF), ultrasound and germ plasm resurfacing technologies are non-laser systems useful in tissue tighte ning. discordant devices have been substantial which combine varied technologies- the junto of electrical and optical energy techniques is termed as electrical and optical synergy (ELOS). All these technologies for non- ablative case facial rejuvenation have been discussed in depth in chapter 43.Microneedling with dermaroller or in crew with RF engineering has shown good results for skin rejuvenation. 55,56 Hyaluronic acid, vitamins and idebenone have been used as mesosolutions for hobble and therapeutic anti-aging benefits. 57 These therapies are frequently used in compounding therapies.Botulinum toxin is chiefly indicated for dynamic lines correction (by relaxing the facial muscles) whereas fillers is indicated for the correction of volume loss which occurs with aging. For the upper 1/ tertiary panorama, botulinum toxin is the anchorman with hyaluronic acid as a supplement. Fillers are the mainstay for mid face, whereas a combination of toxin and fillers are needed for t he lower 1/3rd face. 58 Autologous fat transfer, dermal fibroblasts and platelet rich plasma is now organismness used for volume enhancement in patients who do not desire artificial fillers.Thread lifts with polydioxanone (PDO) threads are being commonly used for lifting up of facial droopging and is chiefly used for structural changes due to aging. It is frequently used in combination with other(a) techniques.Combination therapy is the mainstay in management of aging face. Relax, Refill and surface are the three main Rs for facial rejuvenation. Combination therapy of fillers and botulinum toxin is master and frequently used in facial rejuvenation for relaxing and refilling. This combination provides a three dimensional come on to correction of aging face. give of chemical peels and lasers, lights and radiofrequency technologies help in effective resurfacing. A systematic progress should be adopted based on the patient needs.An algorithmic and serviceable approach to manage ment of the aging face in different decades of life-time based on authors experience has been outlined below. Illustration 50.6, 50.7 and 50.8clinical case scenarios of aging face and the management in different age groups has been provided. Figures 50.5 to 50.925 to 35 eld Illustration 50.6 a and b / inning 50.5clinical scenario Management in a 35 year venerable fe manly concerns somewhat periorbital f honest-to-goodnesss and perioral lines Figure 50.5Products Sunscreens, moisturizersProcedures Treatment of tear troughs, marionette and dim nasolabial folds with injectable HA restylane. Thread lifts across the angles of the mouth.35 to 50 years Illustration 50.7 a and b/ Figure 50.6 a and bclinical scenario Management In 42 year old female homemaker with PIH to acne/ textural changesProducts Sunscreens, arrogate face washes, topical adapalene, non HQ skin lightening component twice daily along with azithromycin pulse dosesProcedures Electrocautery of DPNs, Chemical peels w ith glycolic, salicylic and yellow peel at 2 weekly intervals, counseled for laser rejuvenationIt is important to occlusion for volume loss begins in this decade, however different parts of the face can age at varying rates. Mid facial sag is more evident with prominent nasolabial folds in this 40 year old lady. (Figure 50.7 a) Associated diseases such as diabetes mellitus or hypothyroidism should also be looked into, since it can make haste the aging process as seen in this obese lady with hypothyroidism. (Figure 50.7 b)50 years onwards- Illustration 50.8 a and b ( figure 50.8 and 50.9 a and b)Clinical scenario Management in a 60 year old male executive (Figure 50. 8)Products Sunscreens, moisturizers, Skin lightening agents initially the Kligmans triple combination cream containing (HQ 2%, tretinoin 0.05 and fluocinolone) on alternate night for 2 months followed by non HQ skin lightening agents.Procedures Chemical peels with glycolic 35 to 50%, salicylic and mandelic peels.3 HA syringes for his tear troughs, nasolabial, marionette lines and chin fold.6 monopolar radio frequency sittings.Clinical scenario Management in 50 year old menopausal home maker ( Figure 50.9)Products Sunscreens, moisturizer, Skin lightening cream with arbutin, niacinaminde, kojic and flavonoidsProcedures Electrocautery of DPNs, MDA 2 sessions, followed by chemical peels glycolic 35 to 50%, alternately in combination with lactic, salicylic, pyruvic and tretinoinThere has been tremendous advances in understanding the molecular mechanisms of aging. Knowledge about newer theories of aging and development of newer bioengineering techniques has led to a validated approach towards objective evaluation of various newer anti- aging products and procedures. Use of optical 3D skin imaging systems along with use of subdue instrumental software package has led to a standardized approach. 1Products Based on the newer aging theories, modern anti- aging cosmeceuticals such as Sirtuin activatin g and anti- glycation products are being developed.59 sweet topical drug delivery systems for anti- aging products for example pectin micro and nano capsules of retinyl palmitate and nano lipoidal forms of isotretinoin are being developed. 60,61. Systemic and topical anti-oxidants are complexed with chitin nanocrystals and these have a positively charged influence on aging skin. 62The interest and clinical research into the newer propagation cosmeceuticals such as peptides, growth factors, cytokines and stem cells is continually increasing and controlled studies on the relevance of these emerging products are being performed. 47 Use of phytohormones and selective estrogen receptor modulators (SERMs) for skin aging is still in the nascent phase. 63,64Procedures mingled devices including microneedles, microdermabrasion, electroporation, ultrasound and radiofrequency are now being used as transdermal delivery systems for the anti- aging actives. Amongst the novel use of injectable s in anti- aging, mesobotox has been used for facial rejuvenation, and PRP, dermal fibroblasts, adipose tissue derived stem cells and autologous venous transplants have been used for soft tissue augmentation. 65,66 Amongst the technology based devices, non-ablative fractional lasers and radiofrequency is being increasingly used for rejuvenation of the aging skin. Newer wavelengths are being developed for example infrared laser at 1565nm and a new fractional 1940 nm laser consisting of thulium rod pumped by pulsed alexandrite laser.67,68 The mistake towards combination of technologies and home based devices is seen amongst the various technology based equipment for anti- aging. RF devices are being developed in combination with other technologies or devices such as microneedling, ultrasound, cryolipolysis, LEDs and lasers. Home based non ablative diode and radiofrequency devices are being investigated for their role in photorejuvenation. 69To conclude, the process of aging begins e arly in life. Both the patient and the dermatologist need to accept the factors which cannot be treated, key the factors which can be treated and adopt evidence based preventive and corrective modalities for management of the aging face. It is the duty and responsibility of a dermatologist to provide appropriate anti-aging measures based on the patients needs and at different decades of life.Skin aging is a continuous process and begins early in life. Cutaneous aging can be classified as intrinsical and extrinsic types both of which have classical clinical and histological manifestations. soul the pathomechanisms and newer concepts of skin aging has helped in designing optimal anti-aging strategies. A little history taking, clinical examination and needs estimate helps to formulate an appropriate treatment schedule. During evaluation of an aging face, changes in the three major characteristics-colour, textural and wreak should be assessed. An objective evaluation can be done by standardized documentation and use of various grading/ rating systems. The preventive aspects imply avoiding exogenous factors such as smoking, stress and UV shaft along with adoption of correct lifestyle habits in the form of ceaseless exercise and a balanced diet. The corrective aspects include use of appropriate anti- aging products and procedures based on the age and needs of the patients. Anti- aging products include antioxidants, cell regulators (retinods, alpha hydroxyl acids, peptides, growth factors, cytokines, stem cells) and hormone alternate therapy. The procedural modalities of treatment include basic procedures (electrocautery, microdermabrasion and chemical peels), use of technology based devices (lasers, lights, radiofrequency) and injectables (botulinum toxin, fillers, fat transfer, PRP, microneedling and mesotherapy). Combination of procedural therapies is most effective. Management of an aging skin should be done on a long-term grounding and should be tail or made based on the needs assessment of an individual.