wrinkle removal, the full story!

What are wrinkles?

Wrinkles are one of the most noticeable features of photoaged skin. Wrinkles are associated with a weak cellular epidermis and have reduced structural proteins in the dermal extracellular matrix (ECM), such as collagen and elastin, giving skin its firmness and elasticity. Synthesis of ECM components slows naturally with age, and ultraviolet (UV) light stimulates degradative enzymes that weaken and accelerate protein breakdown. Sweat and oil glands start to lose functionality, and fewer ECM glycosaminoglycans, which reduces skin hydration. In certain cases of advanced photoaging, skin can have solar elastosis changes with tangled masses of damaged elastin protein in the dermis.


Can we prevent wrinkles?

Yes. Several factors expedite the formation of wrinkles. The most vicious factor is UV light. Extended exposure to sunlight with proper protection is considered the skin’s enemy number one. The results will be loss of skin quality, wrinkle formation, and pigmentation. Wearing good quality sunblock is usually sufficient to protect your skin. Another important factor is hydration; it is important to keep your face hydratede by using a quality skin moisturizer and consistently peeling the dead layer of your skin. Skin peeling could be chemical (Jessner peel), mechanical (silk peel microdermabrasion), or laser (carbon peel). Vitamin C products have shown efficacy in delaying skin aging and wrinkle formation. Other products contain amino acids, polypeptides and proteins that help skin rejuvenation and tightening.

Who suffers from wrinkles the most?

When the degree of skin aging was compared between races, such as Asians and whites, it was reported that pigmentation occurred more often and wrinkling occurred less often in Asians than in whites. It is increasingly obvious that the rate of skin aging progression differs between races, as exemplified by a study comparing the onset of wrinkles between Chinese and French subjects. The report showed that the Chinese subjects started wrinkling approximately 10 years later than the French subject.

What is the most effective treatment for wrinkle removal and skin tightening?

Any wrinkle removal and skin tightening treatment aim to reverse the time and mechanism behind wrinkle removal. In other words, to help the skin have a thinker epidermis, increase the structural proteins by inducing the fibroblast to produce more collagen and elastin to restore the skin’s firmness and elasticity. This can be done by providing the skin with the required nutrients and creating a micro-wounding environment. Once stress from creating the micro wounding environment, the skin will start to recover naturally and build a new extracellular matrix through new coils of collagen and elastin. To our knowledge, these are the most effective and frequently used skin tightening and wrinkle removal therapies.

  • Fractional ablative laser (CO2 laser and erbium YAG laser): Ablative lasers used for skin resurfacing remove epidermal and dermal tissue. After treatment, a healing process stimulates collagen and other ECM component synthesis. They use water as a chromophore. Immediate improvement in wrinkles is seen post-procedure due to thermally induced collagen denaturation and shrinkage, and delayed improvements subsequently occur due to fibroblast proliferation and synthesis of new collagen, referred to as dermal collagen remodelling. In addition to wrinkle reduction, collagen. RAblative lasers’ remodelling effects include improved atrophic scars, hypertrophic scars, pore size, rough skin texture, and laxity.
  •  Furthermore, benign epidermal pigmented lesions are also removed with ablative lasers. Pigment removal is nonspecific and results from the vaporization of tissue containing epidermal pigment. This is the most aggressive treatment that anybody can get, and the results are usually great, but it has lots of disadvantages, mainly the log downtime (could be as long as three weeks) and the high risk of infections and post inflammatory pigmentation PIH. We usually do not recommend this aggressive due to the risk associated and high complication portfolio.
  • Fractional nonablative laser (Fraxel dual): Nonablative skin resurfacing lasers* offer a gentle means of improving skin texture and wrinkles with minimal downtime. They are versatile and can be combined with other lasers to treat pigmentation and vascularities, as well as other minimally invasive procedures such as botulinum toxin and dermal fillers. Devices used for nonablative resurfacing are a heterogeneous group of technologies but are all similar in that they induce dermal collagen remodelling with collagen synthesis while keeping the epidermis intact. Wrinkle reduction results are modest compared to ablative lasers; however, nonablative lasers are a good option for patients seeking gradual cosmetic improvements who want minimal or no disruption to daily activities. Common terms for wrinkle reduction with nonablative lasers include nonablative, nonablative, skin toning, and noninvasive laser rejuvenation. With recent advances in fractional devices that deliver higher energies and have deeper cutaneous penetration, nonablative lasers have become one of the primary modalities used for rejuvenating photodamaged skin. The advantages of nonablative lasers are that they maintain an intact stratum corneum while causing mild thermal injury to the dermis. A wound-healing response ensues after treatment resulting in collagen shrinkage and fibroblast activation with the synthesis of new collagen and other ECM components referred to as dermal collagen remodelling. Expanding the ECM thickens the dermis and smoothes the skin, resulting in the clinical reduction of wrinkles. In addition to wrinkle reduction, collagen remodelling effects with nonablative lasers also include improvement in atrophic scars, hypertrophic scars, pore size, striae, and rough skin texture.
  • Microneedling: The newer form of microneedling combines mechanical wounding with radio-frequency technology. The insulated needles penetrate as deep as 3 mm in the skin and release a radio-frequency current. Due to the tissue’s high resistance, the radio frequency will be turned into heat and create a coagulation point. There is no risk of having PIH after the treatment or restriction on sun exposure, but the treatment is more painful and has more blood exposure. We love using this specific treatment for scars and stretch marks.
  • Platelet-rich plasma (PRP) and Vampire facial: I would love to think of this treatment as a maintained rather than an initial treatment. It has been shown that using plasma injection directly after laser or microneedling will result in shorter downtime and higher treatment efficacy.
  • Microdermabrasion and chemical peeling are less effective and are more used as maintenance.
  • High-intensity focused ultrasound (HIFU) Ulthera: Without damaging the skin surface, Ulthera delivers intense ultrasound energy (HIFU: High Intensity Focused Ultrasound) to the muscle fascia to tighten the sagged muscle fascia. It is a device to guarantee instant lifting. Its specially designed cartridge for the body produces focal thermal coagulation points to destroy fat cells and helps the body slim; Ulthera is a non-invasive and non-surgical device to offer safe and effective treatments.

We should understand that one session of any treatment will not be enough; we must be realistic about our expectations. Our policy at Albany cosmetic and laser center is to be honest with our clients and patients and offer a package of more than one treatment to get the best results. Our consultation is always free, and we offer six-month treatment plans. Let us help you shine again.

Fact of Edmonton
In 1892, Edmonton was constituted as a town; in 1904, it was a city. ____________________________________________________________________________

About the Author

Kamal Alhallak, Ph.D. in Pharmacy, MBA

Dr. Alhallak has established himself as a leading figure in the field of cosmetics and aesthetics, notably in the Canadian healthcare industry. In 2016, he established the Albany Cosmetic and Laser Center, which offers patients cutting-edge procedures such as laser skin resurfacing, IPL photofacials, neurotoxic and dermal fillers, and more. Because of its mix of cutting-edge technology and individualised attention from Dr. Alhallak, the facility has become one of Alberta's most popular places for aesthetic care and laser research. Dr. Alhallak was designated one of the Top 100 Healthcare Leaders by the International Forum for Advancement in Healthcare (IFAH) in 2021.

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