Wrinkles are lines and creases that form as part of ageing.
As people get older, their skin becomes drier, thinner, less elastic and less able to protect itself from damage, with less fat.
Faint wrinkles can become deep furrows or crevices over time. Grooves form under the skin during facial expressions. Young flexible skin springs back into place, but as skin ages, it loses its flexibility and springing back becomes harder and less frequent, resulting in permanent grooves.
Ultraviolet light exposure and smoking accelerate wrinkle formation and the ageing process.
Wrinkles can be divided into
Winkles that we've treated frequently:
Neurotoxin injection for treatment of facial wrinkles is one of the most frequently performed cosmetic procedures. Neurotoxins inhibit release of acetylcholine at the neuromuscular junction. Treatment of specific overactive muscles causes localized muscle relaxation that smoothens the overlying skin and reduces wrinkles.
Injectable dermal fillers are intended to fill in the lost volume in wrinkles, giving a smoother appearance. Most fillers are temporary and are eventually absorbed into the body. Temporary fillers can be classified into 2 broad groups:
Fillers can be injected directly into deeper lines. They can also be injected more superficially using an injector gun to hydrate the skin and ameliorate fine lines (Hydrashine / Skinboosters).
Deep facial lines may be tethered down to the deeper structures such as the superficial musculoaponeurotic system (SMAS) or bone. In subdermal incision (subcision), surgical tools inserted under the skin via small needle punctures are used to release the tethering of the wrinkles to the deeper layers.
Filler is then interposed to prevent the two layers from sticking back together during the healing process.
Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full-thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.
Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy.
Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating collagen production with almost no downtime.
Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.
Skin remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.
Topical medications such as peptides, retinoids, hydroxy acids and antioxidants may help prevent and improve wrinkling and other signs of ageing. They tend not to work so well for deep wrinkles.
Dr Wan believes in a tailored combination approach using all the tools available:
Wrinkles with a dynamic component should have neurotoxins wherever feasible. This will help to smoothen out the wrinkle and prevent it from getting worse. Long-term treatment with neurotoxins can actually prevent the development of imprinted facial lines, so Dr Wan prefers to initiate treatment early rather than wait for the wrinkles to progress into static lines. Dr Wan prefers to initiate treatment at a lower dosage of toxin and aim for a natural reduction rather than the total elimination of wrinkles.
These help to build up collagen and tighten the skin. The choice of which treatment to use depends on:
These usually give rapid improvement for depressed, static wrinkles. Rheology of filler should be appropriate for the wrinkle (e.g. hydrashine / skinboosters for very fine wrinkles vs harder, longer-lasting fillers for deep glabellar troughs). Subcision is indicated to lift deeply tethered wrinkles first before filler.
Helps to potentiate the effect of energy devices and maintain collagen stimulation
FOUNDER / MEDICAL DIRECTOR
Wrinkling appears around the eyes, mouth and forehead due to repeated underlying muscle action resulting in permanent changes to underlying tissues, progressing from fine dynamic wrinkles initially to deep static wrinkles over time. Sagging occurs due to a relative skin excess, lack of elastic recoil as well as fat accumulation.
Fractional Energy Devices tighten skin, improving wrinkles. The choice of which device would depend on the relatively thickness of the skin and wrinkles. The availability of multiple fractional devices allows Dr Wan to choose the most suitable and effective one for the clinical scenario.
HIFU with shallow depth cartridges such as 1.5mm or 2mm tighten skin, but Fractional Energy Devices may be more cost-effective especially for fine wrinkles in small areas of thin skin, like the eyelids and area around the lips where it can be difficult to position the HIFU applicator and even 1.5mm may be too deep.
Makunyanzi ni mistari na makunyanzi yanayofanyizwa wakati wa kuzeeka. Kadiri watu wanavyozeeka, ngozi yao inakuwa kavu, nyembamba, na isiyo na nguvu na haina uwezo wa kujilinda dhidi ya uharibifu. Makunyanzi madogo-madogo yanaweza kuwa miiba au nyufa zenye kina kirefu baada ya muda. Matofali hufanyizwa chini ya ngozi wakati wa kujieleza kwa uso. Ngozi ya vijana huanza kugeuka tena, lakini wakati ngozi inapokuwa na umri, inapoteza kubadilika na kugeuka tena huwa ngumu na mara chache, na kusababisha nyufa za kudumu. Kuathiriwa na mwangaza wa ultraviolet na kuvuta sigareti huongeza mwendo wa kufanyizwa kwa makunyanzi na mchakato wa kuzeeka. Wrinkles inaweza kugawanywa katika Wrinkles kwamba sisi kutibiwa mara kwa mara: Neurotoxin sindano kwa ajili ya matibabu ya wrinkles uso ni moja ya mara kwa mara uliofanywa taratibu za mapambo. Neurotoxins huzuia kutolewa kwa acetylcholine katika makutano ya neva na misuli. Matibabu ya misuli hususa overactive husababisha relaxation misuli ya mahali ambapo smooths ngozi juu na hupunguza wrinkles. Vipimo vya kuingiza damu kwenye ngozi vinakusudiwa kujaza kiasi kilichopotea katika makunyanzi, na hivyo kutoa sura laini zaidi. Vifuniko vingi ni vya muda tu na hatimaye huingizwa mwilini. Vifaa vya kujaza vya muda vinaweza kugawanywa katika vikundi viwili: Vifaa vya kujaza vinaweza kuingizwa moja kwa moja kwenye mistari ya kina. Inaweza pia kuingizwa kwa njia ya uso kwa kutumia bunduki ya sindano ili kuingiza maji kwenye ngozi na kuboresha mistari midogo (Hydrashine Skinboosters). Mipaka ya uso inaweza kuwa imefungwa chini ya miundo ya kina kama vile mfumo wa musculoaponeurotic ya juu (SMAS) au mfupa. Katika upasuaji wa subdermal, vifaa vya upasuaji vinavyoingizwa chini ya ngozi kupitia vidonda vidogo vya sindano hutumiwa kuondoa mikunjo kwenye tabaka za ndani. Kisha, fillers huwekwa ili kuzuia tabaka hizo mbili zisishikane tena wakati wa uponyaji. Fractional laser resurfacing inahusisha kuweka muundo wa pixelated wa majeraha ya laser microscopic kuzungukwa na tishu nzuri, na kusababisha ufanisi mkubwa na muda mfupi wa kushoto ikilinganishwa na matibabu yasiyo ya fractionated. Inaweza kugawanywa zaidi katika ablative na non-ablative. Ablative fractional lasers kuwa na urefu wa mawimbi mrefu (kwa mfano CO2-10600nm, na kusababisha uharibifu wa unene kamili wa ngozi, wakati lasers zisizo za ablative zina urefu wa mawimbi mfupi (kwa mfano, laser ya sehemu). Erbium Glass 1550nm (Kichwa cha ngozi) CO2 ina ufanisi mkubwa ikilinganishwa na glasi ya Erbium lakini muda mrefu wa kupona na hatari kubwa ya matatizo. Fractional Infrared Lasers kuwa na mwili mzuri wa ushahidi wa utafiti kuonyesha usalama na ufanisi. Pico Plus ni kizazi cha pili picosecond laser ya wimbi tatu ambayo inazalisha nguvu ya juu zaidi ulimwenguni. Lens microlens ni kifaa cha kuelekeza nishati ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi ya mionzi. Nishati ya juu ya msukumo hutokeza laser-induced optical breakdown (LIOB) kuchochea uzalishaji wa collagen na karibu hakuna downtime. Fractional Radiofrequency huunda eneo la jeraha la joto la piramidi (eneo kubwa la kuganda ndani ya ngozi na uharibifu mdogo wa uso) kinyume na umbo la nguzo la lasers za ablative. Kwa hiyo Fractional Radiofrequency ina mazuri upande-athari profile (kama vile downtime, baada ya uchochezi hyperpigmentation) katika kulinganisha na lasers fractional. Kubadilisha ngozi huhitaji kupelekwa kwa joto kwenye sehemu ya ndani ya ngozi. Hata hivyo, katika matibabu mengi ya mashine ya kuondoa makovu kama vile laser, nishati nyingi hutolewa kwenye uso wa ngozi na kidogo hufikia tabaka za ndani. Micro-needle radiofrequency ni njia ya kuokoa sehemu ya juu ya ngozi na kutoa nishati ya radiofrequency kwa usahihi hadi 4mm ndani ya ngozi, na kusababisha uponyaji wa haraka, ufanisi wa juu na usalama. Dawa za kawaida kama vile peptides, retinoids, hydroxy acids na antioxidants zinaweza kusaidia kuzuia na kuboresha wrinkles na ishara nyingine za kuzeeka. Wao huwa hawafanyi kazi vizuri sana kwa ajili ya makunyanzi ya kina kirefu. Wan anaamini katika mbinu ya mchanganyiko wa kawaida kwa kutumia zana zote zinazopatikana: Wrinkles na kipengele cha nguvu inapaswa kuwa na neurotoxins popote iwezekanavyo. Hilo litasaidia kurekebisha makunyanzi hayo na kuzuia yasizidi kuwa mabaya. Kwa sababu matibabu ya muda mrefu ya neurotoxins yanaweza kuzuia maendeleo ya mistari ya uso, Wan anapendelea kuanza matibabu mapema badala ya kusubiri kwa ajili ya makunyanzi kuendelea katika mistari ya static. Wan anapendelea kuanza matibabu kwa kipimo cha chini cha sumu na lengo la kupunguza asili badala ya kuondoa kabisa wrinkles. Hizi husaidia kujenga kolageni na kuimarisha ngozi. Uamuzi wa matibabu ya kutumia unategemea: Hizi kwa kawaida hutoa uboreshaji wa haraka kwa ajili ya depressed, wrinkles static. Rheology ya kujaza inapaswa kuwa sahihi kwa ajili ya wrinkles (kwa mfano Hydraxin ni dawa ya kuimarisha ngozi kwa ajili ya wrinkles nyembamba sana na filler kwa ajili ya glabellar. Subcision ni alionyesha kuondoa wrinkles kina tethered kwanza kabla ya kujaza. Inasaidia kuongeza nguvu ya vifaa vya nishati na kudumisha msukumo wa collagen.Kuna makunyanzi karibu na macho, mdomo na paji la uso kutokana na hatua ya misuli ya chini ya mara kwa mara, na kusababisha mabadiliko ya kudumu kwa tishu za chini, na kuendelea kutoka makunyanzi madogo ya nguvu kwa makunyanzi ya kina. Sagging hutokea kutokana na ngozi ya ziada ya jamaa, ukosefu wa recoil elastic pamoja na mkusanyiko wa mafuta. Vifaa vya Nishati ya Fractional huimarisha ngozi, na kuboresha makunyanzi. Chaguo la kifaa hicho litategemea unene wa ngozi na makunyanzi. Upatikanaji wa vifaa vingi vya sehemu inaruhusu Dk Wan kuchagua moja inayofaa zaidi na yenye ufanisi kwa hali ya kliniki. HIFU na cartridges ya kina kidogo kama 1.5mm au 2mm huimarisha ngozi, lakini vifaa vya nishati ya sehemu inaweza kuwa na ufanisi zaidi hasa kwa ajili ya makunyanzi madogo katika maeneo madogo ya ngozi nyembamba, kama vile eyelids na eneo karibu na midomo ambapo inaweza kuwa vigumu kuweka applicator HIFU na hata 1.5mm inaweza kuwa kina sana.