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Blepharoplasty Lady

PST 021: Wrinkle — Read the Transcript

August 20, 2018

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Hello and welcome. Dr. Steven Mulholland here at SpaMedica in Toronto, Canada with Plastic Surgery Talk and our latest podcast today is on wrinkles. What are the actual causes of wrinkles? Seems like a simple question, but the actual pathophysiology is not so simple. The treatments are broken into the causes. If you think of a wrinkle, it’s a fissure, a permanent fissure created in the skin by repetitive action, repetitive action of facial muscles. So, you have a muscle doing this, like an accordion, and over time, and as skin ages, you get defects in the dermis, the under-carpet of the skin gets weaker and it starts to form lines. Over time, the lines may get deeper, and with falling, sagging flesh, the line may become a furrow or a furrow may become a fold.

What is a wrinkle? It’s a defect or a fissure or a break in the skin that leads to a line. Usually 90 degrees to muscles that act against it and there’s a loss of volume that helps make it deeper and support it. So, the treatments, as we’ll find out later in the podcast, reflect the activity that causes a wrinkle. How do we soften the muscles that cause the fissure? And how do we plump up the loss of soft tissue that led to the fissure and the furrow or the fold?

A question I get a lot, especially from some younger patients, or patients who’ve had facial cosmetic surgery for aging and they want to protect their investment, “Can we stop wrinkles in their tracks? Can we delay their onset?” And the answer is: absolutely yes. “How do we do that?” Well, think of the causality and treat the cause before you get the problem. And so, if you’ve got muscles that are constantly doing this, like an accordion, your frown lines, your squint lines, your worry lines, your lip lines, your smoker lines. These are the muscles that are actively compressing your skin, causing that accordion effect. Eventually, you’re going to get a fissure, a break, a weakness and a defect, and you’re going to get lines, and lines become wrinkles, and wrinkles become deep crevices.

How to stop that cycle? Soften and relax the unwanted muscle activity. So, start using Botox Injectable at a relatively early age, early on after your cosmetic surgery, to stop the wrinkles from forming. And in reality, you can stop wrinkles forever. If you start Botox Injectable at a 30, 35, 40-year-old age, you will never, ever get the wrinkles and lines you might have had. We know that from some fascinating twin studies where we got identical twins, separated at birth, to have a reunion. One was in Eastern Europe, low socioeconomic opportunities, one was in Western Europe, had all the opportunities that luxury affords. The wealthier twin had Botox Injectable and the other twin didn’t. These are identical twins.

When they met up at age 70, totally different faces. They should be the same face, they have the same DNA, the only difference was the wealthier twin used Botox Injectable for 30 years, never got a line and a wrinkle. We know it works. Judicious use of Botox Injectable, prophylactically, in the muscles of adverse facial expression, the Number 11s, the frown lines, the crow’s feet, the worry lines, those are the big three, and followed by smoker lines, these can be stopped in their tracks. So, start young or start after your surgery to protect your investment and stop the line before it forms.

Let’s say you have a line, and it’s formed. You’re too late to stop it in its tracks. How do we reduce and eliminate a line once it’s there? Well, again, we go back to the cause and try to reverse the elements that led to that wrinkle. First of all, you still need Botox Injectable. The vast majority of lines and wrinkles are over-animated areas. We need to soften the fissuring of the skin, so, Botox Injectable. But that’s not going to help remove a line that’s fixed. It’ll soften the progression of that line. How do you treat a line that’s already fixed, where Botox Injectable softens it? You add a filler. If we have a fissure and a defect in the skin, we add a dermal filler under that wrinkle or in the wrinkle to plump and soften.

Quite often, combination therapy, filler and Botox Injectable, will eliminate a line and a wrinkle, where one or the other unto themselves wouldn’t work. The synergistic effect of both often does the trick. And finally, you can add, for fine lines in areas where there’s not an identified muscle or a muscle you need like the smile muscle. You can’t really eliminate that. And, you’ve got these cheek wrinkles or upper lip wrinkles where you can’t eliminate totally the motion, then, you bring in lasers. Lasers and energy devices. Laser fractional resurfacing, we have carbon dioxide lasers, erbium lasers or fractional radio frequency laser devices will provide the icing on the cake for wrinkle elimination on areas where you can’t eliminate total animation.

So, that combination or that trinity, that troika of opportunities, Botox Injectable, filler and fractional lasers and radio frequency devices should leave you able to remove 90% to 95% of all visible lines and wrinkles. How long can you expect your wrinkle reduction or elimination to last? Well, it depends upon your goals. If you’re using Botox Injectable and fillers and you stop and allow the wrinkle to fissure again, it will come back. So, it will last as long as your commitment to ongoing use of Botox Injectable and fillers. So, about once or twice a year for the filler, three times a year for Botox Injectable, and your number 11s will never show up.

Now, what if you’ve done a laser treatment, for a fixed, established deeper line and wrinkle? The collagen production you get from that fractional laser or fractional radio frequency device will provide collagen for some years. So, improvement of upper lip lines and cheek lines following aggressive fractional resurfacing should be years in duration. So, maintenance of Botox Injectable and filler, months. If you do it every six months, you’ll never get a line and wrinkle. Therefore, it lasts forever. For ablative fractional laser treatments you get years of improvement in the fine lines and textural improvements, we have done that fractionally surfacing.

So, now in this podcast that we’ve discussed in-depth the management of a wrinkle, the cause of a wrinkle, the maintenance of a wrinkle becomes intuitive and obvious. You need Botox Injectable for unwanted over-crinkling animation effects two to three times a they’re. You need about once a year to re-inject with dermal fillers the fissure, to help support it. And for established, older wrinkles, you may need to do repeat fractional resurfacing every two or three years to bring back the collagen content that ongoing aging, degeneration and enzymatic degradation will induce, and so, between lasers, Botox Injectable and filler, you should be wrinkle-reduced and smooth for the rest of your life.

What’s the point of treating them if more will appear? Well, that’s the cognitive dissident theory of cosmetic surgery. Why do anything if you’re just going to get old and pass away? The goal is to look your best, to project the most confident, vital, smooth self that you can be, and yes, there will be more lines, more wrinkles. They will come back. The point is, why color your hair if it’s just going to go gray? Why put on some new clothes if they’re just going to get dirty? Because you’ll look your best.

We live in a culture where you’re often judged by how you look and how you project yourself, until people can dig in to see your great personality and your intellect. But the first thing people judge you on is the cover of the book, and old, dusty books don’t get read as much as new, shiny books. So, why do it? Because you can. Because the results last. Because they keep them away. Because you’ll look better. So, wrinkles, just like hair, just like skincare, and it’s just like clothing, needs preventative maintenance to always look sharp and project confident, self-assured and more vital, youthful version of yourself.

So, finally, and this is a very important question, what age should we really be starting all these anti-wrinkle, impressive but engaging and committed treatments? You can start at any age. Generally, when you start to see wrinkles. Sometimes I’ll see very young patients, young millennials in their 20s who come in and say, “I’m worried about looking like my mom. I know she’s going to get frown lines. I don’t have them yet, but I want to stop them now.” And I’ll say, you know, “It’s probably a little young.” We need to see the first evidence of that line or wrinkle, even the faintest hint of a shadow, but treating a beautiful, smooth baby face just because one day there’s going to be a wrinkle is probably not very ethical. And so, I believe that when you first start to see the earliest signs of subtle wrinkling, number 11s, worry lines, crow’s feet, that’s the time to come in and see your certified plastic surgeon or dermatologist and talk about baby Botox Injectable. Baby Botox Injectable to help prevent the lines and fissures that are starting to form.

The average age of onset for new Botox Injectable patients is now 30 years old. I have seen a 10-year reduction in the average age of first Botox Injectable administration, from 40 to 30, in the last 10 years. Why? Because young people are taking a more prophylactic stance. Why get the lines and wrinkles and treat them then, when I can stop them in their tracks? I just think you should wait until you start to see the first line and wrinkle, because you don’t really know when it’s going to show up. Maybe you’re never going to get them, or you think you would and you don’t need to waste money on Botox Injectable unnecessarily. So, once you see the first evidence of lines or wrinkles, start your Botox Injectable paradigm, and you’ll never get a wrinkle.

Thank you, again, for joining us here, Dr. Steven Mulholland at Plastic Surgery Talk, for another installment of our podcast series. This one was on Wrinkles. If you found this interesting, educational, entertaining, please share this on your social media channels, and join us again, really soon, for our next podcast on Plastic Surgery Talk.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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