Facial Rejuvenation
Throughout the different stages of our lives, the pursuit of a beautiful and healthy appearance is a goal widely sought by most. So much so that as early as the 16th century we find publications of compounding cosmetic formulas to achieve facial rejuvenation, camouflaging or correcting facial and body defects.
In the late 20th century, aesthetic surgery advanced significantly, followed by a firm commitment to promoting non-invasive techniques, which form the basis of Aesthetic Medicine, with mitigating the signs of facial and body aging being a core competency of this field.
There is a belief that most aesthetic-medical treatments aimed at improving our facial and body appearance depend on the implantation of exogenous substances — the famous fillers — and that these can radically and irreversibly transform our facial features. In this regard, nothing could be further from the truth, as there are numerous skin rejuvenation procedures that can improve the health of our skin, without altering our anatomy or individual beauty, with or without the use of fillers.
In this article, we will teach you about the factors linked to skin aging and show you the best aesthetic procedures to achieve facial and body rejuvenation.
Skin Aging
In today’s competitive society, having a pleasant appearance is essential, and strategies to prevent and treat aging become especially relevant. Physical attractiveness is therefore an important factor for personal acceptance, social integration, and self-esteem. Today, the concept of a healthy lifestyle is only understood through the combination of health and aesthetics.
The skin aging process occurs due to an alteration in the skin’s regenerative potential. The skin becomes fragile as a consequence of disorganization and decreased collagen production, loss of hydration in the extracellular matrix, and nutritional deficits in the diet.
Aging Skin
The skin consists of 3 fundamental layers: the epidermis, dermis, and hypodermis. The second layer contains dense connective tissue with a percentage of collagen bundles and thick elastic fibers, which provide strength, extensibility, and elasticity to the skin — in short, its youthful characteristics.
Facial and body sagging is a well-known morphological characteristic of aging, produced by the reduction in dermal elasticity. Skin aging is an inevitable biological phenomenon resulting from both intrinsic and extrinsic factors.
Intrinsic Aging Factors
Among the intrinsic factors responsible for aging, we find hormonal changes such as decreased growth hormone and estrogenic hormonal function, particular genetic and immunogenic characteristics, epigenetic changes linked to DNA methylation — mediated or not by exposure to external toxic factors, oxidative stress, changes in telomere length and telomerase function, among others.
Extrinsic Aging Factors
Tobacco use, inappropriate nutritional habits, lack of physical activity, environmental pollution, exposure to ionizing radiation and ultraviolet light are all factors related to body aging through events such as DNA methylation and increased oxidative stress, the latter due to free radical formation.
As the skin ages due to the imbalance between free radical production and elimination, the number of keratinocytes and fibroblasts decreases, resulting in a reduction in collagen and proteoglycans. This leads to the tissue atrophy and increased fibrosis characteristic of body aging.
More on Photoaging
It involves premature skin damage caused by solar radiation and its degenerative effect on skin functions and keratinocyte life. Ultraviolet (UV) radiation is the main cause of photoaging.
Up to 50% of the free radicals produced in the skin are due to sunlight in the visible spectrum range, and no skin phototype is protected against damage caused by these radiations. Recently, it has been suggested that light from electronic devices such as computer screens, televisions, and smartphones can also produce harmful effects on the skin.
The types of solar radiation are ultraviolet radiation, visible light, and infrared light, each with different effects on the skin.
Ultraviolet (UV) radiation is associated with skin aging and pigmentation. It penetrates deeply, producing reactive oxygen species (ROS) that damage DNA, increase the number of inflammatory cells in the dermis, and decrease their antigens. It is divided into UVA (295-400 nm), UVB (280-320 nm), and UVC (100-280 nm). UVB is responsible for sunburn and DNA strand breakage and is associated with non-melanoma skin cancer.
Light perceptible to the human eye or visible light (400-760 nm) produces pigmentary alterations in the skin lasting a few weeks. Infrared light is absorbed mainly in the epidermis and deeper dermis, where it converts to heat, which produces degradation of collagen and elastic fibers, contributing to solar elastosis and skin sagging.
In summary, photoaging generates changes in skin texture and pigmentation due to alterations in its barrier, thermoregulatory, immune, and regenerative functions.
Anti-Aging Therapies and Skin Biorevitalization
Anti-aging therapies have evolved over time. For the reader’s simplicity and based on the authors’ experience, we can divide these therapies by their aggressiveness toward the skin into invasive and non-invasive, and by their fundamental mechanism into physical and chemical therapies.
Cosmetics in Facial Rejuvenation
While we cannot strictly consider cosmetic application an aesthetic medicine procedure, in the daily practice of aesthetic professionals, evidence-based recommendations should be provided about these products, both for their selection and efficacy.
The use of cosmetic products is a practice begun at early ages. These products aim to increase skin regeneration, elasticity, and softness, thereby temporarily changing the condition of aging skin. Today, cosmetics are adapted to every skin type.
Cosmetics normally include antioxidant products such as vitamin C, vitamin B5, vitamin E, polyphenols, and flavonoids, as well as cellular regulators like retinols, peptides, and growth factors.
Through cosmetic application, we specifically target the degradation of collagen and elastin, proteins fundamental for providing youthful characteristics to our skin.
As an example, vitamin C present in many of these formulations acts against free radical formation, intervening in collagen synthesis by fibroblasts. It has also been shown to have a protective effect against ultraviolet radiation, an effect enhanced by the use of vitamin B5.
Photoprotection
Photoprotection is part of cosmetic skin care and is the main strategy for preventing photoaging. It involves a combination, to a greater or lesser extent, of a physical barrier and secondary treatment through the use of exogenous antioxidants and other compounds that cannot be synthesized in our body.
Photoprotectors or sunscreens are based on the use of substances that block, at least partially, the arrival of ultraviolet radiation to skin cells. A photoprotector should produce the following effects: direct photon absorption, modulation of immunosuppression, inhibition of chronic inflammation, in addition to direct and indirect antioxidant activity.
Now that you know the benefits of proper cosmetics and photoprotection, here are some cosmetic products used in the practice of professionals at Clínica Skin Esthetic. You can start or include these products in your facial care routine. Remember, for additional advice and information on using these and other cosmetic products, visit the Skin Esthetic Shop. Additionally, by subscribing to our Magazine, you get up to 10% discount on selected products. Without further ado, let’s continue.
“Natural Botox” Facial Cream by Herbal Skin
Reduces wrinkle depth while firming the skin and providing greater elasticity. Acmella Oleracea extract provides a completely natural Botox effect.
Get itFacial Bio Serum with Triple Hyaluronic Acid
Combats visible signs of chrono-aging and photoaging. Ideal as anti-wrinkle, anti-aging, and eye contour treatment.
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Benefits of Caloric Restriction
Obesity mediated by high caloric intake leads to the production of elevated levels of reactive oxygen species (ROS), which accelerates skin aging, producing premature aging.
It is important to consume foods rich in antioxidants such as vegetables, avocado, soy, fruits like oranges and pineapple, among others. These foods provide significant amounts of vitamin C, vitamin E, carotenoids, and trace elements like copper and selenium. We have previously described the benefits of these substances in preventing oxidative damage caused by ROS.
Say No to Tobacco
Smoking leads to irreversible alteration of inflammatory cellular function and induces expression of metalloproteinases, enzymes responsible for degradation of the extracellular matrix, where collagen and elastic fibers responsible for the youthful characteristics of our skin reside. Therefore, it is important to stop tobacco use as a measure for facial and body rejuvenation.
Chemical Peels
This procedure is based on controlled and limited destruction of skin layers at different depths through the application of one or more chemical agents, aimed at improving intrinsic chrono-aging factors or skin imperfections.
The cascade of pro-inflammatory mediators released during the application of these chemical products produces, at the dermal level, stimulation of new collagen and glycosaminoglycan formation, resulting in uniform and firm skin.
Peels can be superficial (e.g., hydroxy acids or HA, trichloroacetic acid or TCA at 10-30%) that act no deeper than the basal layer of the epidermis, medium (e.g., TCA 30-60%) reaching the upper reticular dermis, and deep (e.g., TCA 50% and phenol) penetrating the lower reticular dermis. The depth reached depends on the product used, its concentration, pH, and exposure time. The depth of the peel, in addition to determining the procedure’s aggressiveness, translates into different effects on the skin and represents specific indications.
Biorevitalization Methods
Facial Mesotherapy
Mesotherapy refers to the application of bioactive substances through multiple subcutaneous or intradermal injections to biostimulate the treated area, thereby improving its elasticity, pigmentation, and the presence of wrinkles.
Facial rejuvenation with mesotherapy is a controversial aesthetic-medical procedure, as there is still a knowledge gap regarding its efficacy. Despite this, mesotherapy has continued to be used for this indication based on the empirical experience of its effectiveness.
Without intending to validate or invalidate the efficacy of this treatment, the authors have observed subjective improvement in aspects related to facial rejuvenation such as pigmentation, brightness, and skin elasticity.
Mesotherapy and Hyaluronic Acid Fillers
Hyaluronic acid (HA) is a glycosaminoglycan with a structural function, providing support to various tissues. This compound has the ability to retain large amounts of water. It has a viscous texture and is found in the synovial membrane, vitreous humor, and connective tissue of numerous organisms.
In humans, it is notably concentrated in joints, cartilage, and skin. Roughly, for an average 70 kg human, we find about 15 g of HA, with one-third being degraded and synthesized daily. Due to its ability to retain up to a thousand times its weight in water, it is used for skin hydration, as it rebuilds the fibers that support skin tissues. In aesthetics, its main function is as a filler material and biostimulant.
Hyaluronic acid treatment improves fibroblast biosynthesis, inducing improvement in collagen, elastin, and additional hyaluronic acid synthesis. This treatment can also eliminate free radicals, harmful tissue byproducts derived from oxygen metabolism, which can cause chronic inflammation.
The face is a dynamic structure; facial rejuvenation with filler products depends on mechanical forces in the facial region. Facial expressions convey emotions and indicate characteristics such as age and quality of life; therefore, facial rejuvenation treatments must produce natural-looking results.
Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favorable safety profiles and consistent, efficient results.
Adverse events associated with these products are usually transient and of mild to moderate severity, with serious adverse events such as infection and intravascular occlusion being rare.
HA fillers maintain their effect for 3 to 12 months. This period may vary based on factors such as particle size, product cross-linking, and the type of cross-linking agent used. The depth and technique of product application also play a role.
Platelet-Rich Plasma (PRP)
Platelet-Rich Plasma (PRP) refers to a type of autologous plasma — plasma extracted from the patient themselves — in which the platelet concentration is well above the normal blood value, between 4 and 7 times higher. As a facial rejuvenation treatment, PRP has been shown to improve wrinkles, texture, and facial volume. In improving skin elasticity, this procedure has shown even better results when used in combination with microneedling.
PRP consists of the application of multiple injections of this platelet concentrate to harness the biological effects of various mediators released by platelets. Among these mediators are platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF). All are secreted from platelet alpha granules after the platelets have been activated upon contact with aggregation and activation inducers found in tissues. Platelet mediators induce collagen synthesis and other extracellular matrix components, stimulating fibroblast activation, with the consequent rejuvenating effect.
Carboxytherapy and Skin Laxity
Carboxytherapy refers to the transcutaneous administration of high-purity medicinal carbon dioxide (CO2) for therapeutic purposes. This administration is considered safe. Among the therapeutic indications for CO2 are vascular, cardiac, metabolic, and rheumatic diseases, cellulite, chronic wounds, localized fat deposits, migraines, stretch marks, wrinkles, unsightly scars, and skin laxity.
Looking for facial rejuvenation with PRP or Carboxytherapy?
The efficacy of this treatment lies in its ability to increase the amount of oxygen and blood flow in the treated tissue, as well as increasing tissue collagen formation and remodeling. Therefore, CO2 administration results in increased skin thickness and blood flow. These effects translate into improved skin function and rejuvenation.
Application of Botulinum Toxin Type A (Botox)
Botulinum toxin type A, produced by the bacterium Clostridium botulinum, prevents the release of the neurotransmitter acetylcholine, causing paralysis of the muscle into which it is injected. Its effect is temporary, with full muscle function restored after 3 to 6 months.
Although this approach does not interfere with the aging process, it corrects expression wrinkles without a real effect on skin texture. Adverse effects from botulinum toxin application are mild, the most common being pain at the injection site, swelling, and ptosis.
Visible Light Devices
Intense Pulsed Light (IPL)
Skin aging, which encompasses both photoaging and intrinsic aging, is clinically characterized not only by wrinkles but also by pigmentary alterations, skin thinning, and telangiectasias. Today, several non-ablative techniques exist for facial rejuvenation, including intense pulsed light (IPL), CO2 laser, and radiofrequency.
Intense pulsed light is based on devices that emit non-coherent polychromatic light in high-intensity pulses with a specific wavelength spectrum, fluence, and pulse duration. These light pulses interact more or less specifically with intrinsic chromophores such as melanin, hemoglobin, and water, allowing selective thermal damage.
Effects of IPL include increased type 1 and 3 collagen, better disposition of elastin fibers (though reduced in number), increased fibroblast activity, among others. The combination of these effects results in an objective improvement in skin texture and wrinkles — in other words, tissue rejuvenation.
CO2 Laser
Lasers generate light energy in the form of a photon beam emitted from the laser medium, which usually determines the laser’s name and the wavelength produced. Different laser media exist, with CO2 being one of them. The CO2 laser uses carbon dioxide as its medium and emits energy at 10,600 nm.
Regarding lasers, the combination of collimation (the beam is more or less parallel), phase (photons are precisely in temporal and spatial step), and monochromaticity (photons are identical, all of one color) determine its coherence, a property that gives the laser beam its exceptionally high photonic intensity and allows the beam to be focused on very small points.
The main biological targets — blood, melanin, and water — absorb light energy differently and have optimal absorption spectra depending on the wavelength of the incident photon energy. For visible light lasers and some near-infrared spectrum lasers, the main chromophores are hemoglobin and melanin; the former is found in vascular lesions and the latter in melanocytic lesions. In the case of the CO2 laser, its only chromophore is water.
The use of lasers in medicine and surgery, especially for removing any type of pigment, is based on the principle of selective photothermolysis, which means using laser energy at high maximum powers and short pulse durations to destroy only the intended lesion while inflicting minimal damage to surrounding tissue. To comply with this principle, chromophores must absorb light energy at a specific wavelength not found in surrounding tissue, and high maximum powers with short pulse durations must be used.
Considering a laser treatment?
The CO2 laser does not comply with the principle of selective photothermolysis, since its chromophore, water, is uniformly present in soft tissues, not only in the treatment area. The advantage is that this laser is not selective for pigments; therefore, it can be used to treat both pigmented and non-pigmented skin lesions.
CO2 laser technology produces ablation of the entire epidermal surface, stimulating dermal collagen formation, extensive remodeling, and cell regeneration. This procedure leads to reactive synthesis of additional collagen in the papillary and reticular dermis, as well as an increased number of fibroblasts. However, among the disadvantages of this technique are prolonged recovery time and adverse effects such as erythema, hyperpigmentation, hypopigmentation, infections, and scarring risk.
Radiofrequency (RF)
Radiofrequency (RF) has emerged as a non-invasive treatment for facial rejuvenation. Its mechanism is the use of resistive heating within the skin layers and subcutaneous tissue to transform radiofrequency into thermal energy. This energy induces a dermal lesion, which stimulates the selective tissue repair response and coagulation. This results in tissue contraction and remodeling. In simple terms, RF produces an electrical current that generates heat through resistance in the dermis, which in turn generates contraction and increased collagen fiber production, with the consequent rejuvenating effect.
Unlike other modalities, RF produces an electrical current that results in tissue damage with minimal changes in melanin, making it safe for all skin types.
Molecular and histopathological studies have shown that RF triggers upregulation of cytokines and growth factors, remodeling and reorientation of collagen and elastin fibers, with increased papillary dermis thickness. These changes produce skin tightening with a tensor effect and reduction of scars and wrinkles. Finally, the thermal shock response induced by RF activates adipocyte cell death pathways, with the consequent fat reduction.
Most studies have demonstrated the efficacy of RF for treating acne, scars, and facial wrinkles. Objective assessments have identified reduction of acne and scar appearance, a tensor (lifting) effect, improved skin elasticity, collagen production, as well as volumetric changes in fat and wrinkle reduction.
Skin Esthetic Pearls on Skin Rejuvenation
From the 16th century to today, the pursuit of a beautiful and healthy appearance has been constant, with notable advances in Aesthetic Medicine.
Skin aging is linked to decreased collagen production, hormonal changes, genetic factors, and environmental exposure. The text discusses intrinsic factors such as hormonal and genetic changes, as well as extrinsic factors, for example sun exposure, smoking, and poor nutrition, which contribute to skin aging.
Here is a summary of various anti-aging therapies, from cosmetic use to more advanced treatments such as carboxytherapy, chemical peels, and biorevitalization methods like mesotherapy and platelet-rich plasma. Emphasis is placed on other methods such as hyaluronic acid use, botulinum toxin, CO2 laser, and radiofrequency as effective anti-aging therapies.
Before undergoing any aesthetic-medical treatment, it is important to verify its safety profile and efficacy, highlighting the need to understand risks and benefits before choosing a specific procedure.
In summary, this article provides a broad and detailed overview of available options for facial and body rejuvenation, from basic skin care measures to more advanced treatments, with an emphasis on understanding the factors that contribute to skin aging and selecting appropriate treatment options.
Clínica Skin Esthetic
Aesthetic medicine performed in unauthorized centers by personnel lacking proper training and qualification poses a serious risk to patient health. At Skin Esthetic, we are an Advanced Aesthetic Medicine Clinic. We perform aesthetic-medical procedures with high scientific rigor, by a duly qualified team, always focused on preserving the natural look that only you can have. Remember, at Skin Esthetic we work so that your only concern is thinking:
Why didn’t I do this sooner…?