Anti-aging: many paths lead to the goal

Aesthetic rejuvenation treatments are increasingly in demand. There is a wide range of methods which have proven to be effective. With regard to patient satisfaction, techniques that can be performed on an outpatient basis and have few side effects are advantageous, and the positive effects should be as long-lasting as possible.

Collagen, like keratin and elastin, is one of the structurally important fibrillar proteins, which are present in high concentrations in the skin. Oxidation of these proteins during aging alters their spatial structure, which may lead to functional impairment and modification of proteolytic degradation [1]. Prof. Dr. Claudia Borelli, University Dermatological Clinic Tübingen (D), spoke at this year’s congress of the Swiss Society for Medical Laser Applications (SGML) in Zurich about dermatological possibilities for promoting collagen synthesis in the context of anti-aging [2]. Skin aging is a complex, multifactorial process due to intrinsic factors (e.g. genetic disposition) and extrinsic factors (e.g. UV radiation, nicotine consumption). As a consequence of the skin aging process, wrinkling and a loss of elasticity [3], among others, occur, which is accompanied by phenotypic changes of cutaneous cells and structural and functional modifications of extracellular matrix components such as collagen and elastin.

Pollutant exposure also promotes extrinsic skin aging

In the context of intrinsic skin aging, epidermal senescence leads to a reduction of cell proliferation in the stratum basale as well as to a thinning of the epidermis [3]. UV radiation, a major extrinsic skin aging factor, reduces the expression of collagen type VII in keratinocytes. This subtype of this important structural protein is a linker of the dermal epidermal junctional zone. Due to the weakened connection between the epidermis and dermis, wrinkles form. In addition, photoaged skin is characterized by a decrease in collagen type I, which involves matrix metalloproteases and serine proteases, among others. That pollutants in the air are among extrinsic factors with negative effects on skin aging has also been empirically proven. For example, a positive correlation between _NO2 exposure and lentigines could be demonstrated [4]. Nutritional factors can also have an influence on (skin) aging processes. Mediterranean diet has been shown to be associated with a reduction in inflammatory parameters [5].

Wide range of combinable methods

There is an increasing need for aesthetic treatments to delay the skin aging process. The speaker showed that there is a great variety of methods to influence age-related changes in the skin. These include: Microneedling, hyaluronic acid injections, PRP, fractional laser, radiofrequency, ablative laser, chemical peels [2]. That the combined use of several of these and other techniques is a promising approach is supported in the consensus recommendations of Carruthers et al. clearly [6].

The speaker feels it is important to educate patients in one of the first consultations about what the maximum achievable outcome is and what interventions are required to achieve it. It can be blepharoplasty, deep chemical peels or lasers, but also a combination of these and other options. Especially when patients opt for non-surgical and non-invasive treatments, a combination of different techniques is purposeful. For two techniques, which are also carried out in her department, the speaker explained in detail what to pay attention to in order to achieve the best possible result. Both microneedling and hyaluronic acid treatments are associated with high patient satisfaction, he said. These are forms of treatment that can also be combined as part of a sequential therapy regimen.

Microneedling: Prof. Borelli mostly uses needles of 1.5 mm length. Patients are anesthetized for one hour by pretreatment with ^Emla®. The standard procedure includes 4 sessions, which are performed 6-8 weeks apart. Regarding the intensity of the treatment, the lecturer points out that the skin should bleed (important: sterile treatment). Combination with dermocosmetics is possible. Empirical findings show that aesthetic microneedling leads to microchannels in the skin, improving skin permeability to platelet-rich plasma (PRP) and various cosmetic substances. This method proved to be an effective treatment strategy as monotherapy or combined with other techniques [7]. For local anesthesia, Prof. Borelli recommends the following products, among others: Emla ^Cream® 5×5 g (lidocaine 25 mg per g, prilocaine 25 mg per g); ^Pliaglis® Cream 70 mg/g (lidocaine and tetracaine).

Hyaluronic acid: Hyaluronic acid injection treatment is an established minimally invasive anti-aging intervention with evidence-based efficacy [8]. The speaker referred to a publication by Reuther et al, in which a possible procedure using ^Restylane® Skin booster™ was well described [9,10]. The authors recommend three sessions, each four weeks apart. Prof. Borelli applies a somewhat modified treatment regimen: two treatments at intervals of 6-8 weeks, the subsequent treatment then after about half a year resp. depending on the skin condition (box).

Source: SGML Zurich

Literature:

Yim MB, et al: Protein glycation: creation of catalytic sites for free radical generation. Ann N Y Acad Sci 2001; 928: 48-53.
Borelli C: Collagen synthesis. Slide presentation. Prof. Dr. Claudia Borelli, Unit for Aesthetic Dermatology and Laser of the University Dermatological Clinic Tübingen (D). SGML Zurich, 16.01.2020.
Zhang S, Duan E: Fighting against Skin Aging: The Way from Bench to Bedside. Cell Transplant 2018; 27(5): 729-738.
Hüls A, et al: Traffic-Related Air Pollution Contributes to Development of Facial Lentigines: Further Epidemiological Evidence from Caucasians and Asians. J Invest Dermatol 2016; 136(5): 1053-1056.
Ostan R, et al.: Impact of diet and nutraceutical supplementation on inflammation in elderly people. Results from the RISTOMED study, an open-label randomized control trial. Clin Nutr 2016; 35(4): 812-818.
Carruthers J, et al: Consensus Recommendations for Combined Aesthetic Interventions in the Face using Botulinum Toxin, Fillers and Energy-based devices. Dermatol Surg 2016; 42(5): 586-597.
Sasaki GH: Micro-Needling Depth Penetration, Presence of Pigment Particles, and Fluorescein-Stained Platelets: Clinical Usage for Aesthetic Concerns. Aesthet Surg J 2017; 37(1): 71-83.
Ogilvie A, et al: ^Restylane® Skinboosters to improve skin quality – results of a consensus meeting. Journal of Applied Aesthetics, www.kosmetischemedizin-online.de
Reuther T, Bayrhammer J, Kerscher M: Effects of a three-session skin rejuvenation treatment using stabilized hyaluronic acid-based gel of non-animal origin on skin elasticity: a pilot study. Arch Dermatol Res 2010; 302(1): 37-45.
Kerscher M, et al: Restylane Skinbooster TM for the improvement of the skin quality. Cosmetic Medicine 2017: 28.