Average life expectancy has increased from 22 years in ancient Rome to 76 years in the 1980s, to 85 years today. This extended life span increases the time individuals spend productively in society.
What is skin aging? What are the factors affecting aging?
Aging is a process that develops differently in each person with genes, in other words hereditary characteristics, environment and lifestyles. Our skin ages like all organs. The only difference is that everyone sees this process. The skin is the largest organ of our body and its window to the outside, as well as the biggest indicator of our physical health.
With skin aging, the number of cells, volume and functions of the skin decrease. This situation occurs at different rates in everyone. Skin aging is a complex, irreversible biological and chemical condition. Many factors play a role.. Skin aging can be divided into two. One is internal aging, which increases depending on time, and the other is aging due to external factors (photoaging). With this process, cell renewal, protective functions, oil production, vitamin D production, hair and nail growth are slowed down. The earliest signs of aging appear on the skin and it is the first observation point we refer to for age prediction.
In chronological, that is, internal aging, the skin becomes thinner, elasticity decreases, fine wrinkles occur and expression deepens. This type of skin aging constitutes 20% of all aging and is inevitable.
Photoaging due to external factors constitutes 80% of skin aging. This type of aging has a chance to prevent and replace it. The most important environmental factor is the sun. 50-75% of sun exposure occurs in the first 20 years of life with the formation of substances called free radicals.
What are the methods used in non-surgical approaches to prevent or correct skin aging?
Creams
Botox
fillers
Chemical peeling (skin peeling)
Laser applications
Creams:
The sun causes skin color changes, thickening and thinning, roughness, vascular enlargement, sagging and coarsening, wrinkles and skin cancer.
Estrogen plays a key role in maintaining the youthfulness of the skin. With the decrease of estrogen, the skin becomes thinner, its elasticity decreases, sagging and wrinkles increase. All these changes are due to the decrease of a protein-like substance called collagen in the skin. The most significant loss of skin occurs in the first 2 years of menopause and continues with the decrease of 30% of collagen in the fifth year of menopause. Sun, smoking, stress, sleep disorder, alcohol use, malnutrition, weight changes, gravity, mimics are the most important factors affecting skin aging together with heredity. In this case, sun protection is the most important and cheapest “anti-aging” method in the prevention of skin aging.
What are the types and effects of sunscreens?
The negative effects of the sun on the skin depend on the duration of sun exposure and skin color and type.
Sunscreens are of two types, “chemical filters” and “physical sealers”. When physical sealants are applied to the skin, they usually form a visible layer. These act by reflecting the sun’s rays. They are suitable for the protection of the facial area in infants and adults. Chemical filters, on the other hand, absorb (absorb) the sun’s rays and prevent them from reaching the bottom. Such preservatives are suitable for the protection of body skin. The numbers indicated on the sunscreens as SPF (Sun Protecting Factor) or GKF (Sun Protection Factor) indicate how much the sun exposure time increases.
SPF 15 protects from the sun 92%, SPF 30 94%, SPF 50 97%. In other words, very high protection factors are not required for protection from the sun. However, for this protection, creams must be used under appropriate conditions.
These creams or lotions should be applied at least 20 minutes before going out in the sun and used in sufficient quantities. To be truly effective, 2 mg/cm2 should be administered (30 ml for the whole body), repeated every 2 hours.
What is antioxidant? What is its importance in the treatment of skin aging?
Antioxidants are substances that destroy the harmful effects of free radicals that are harmful to the body. Free radicals are the general name of substances that are formed during biological events that ensure the continuation of normal vital activities in our body, or under the influence of environmental factors such as cigarettes, air pollution and sun, and that damage body cells. They disrupt the structure of cells, have a negative effect on many body systems and meanwhile on the skin structure. Antioxidants destroy the harmful effects of free radicals. They can be produced by the body or taken from the outside. With age, antioxidant production decreases and the body’s ability to destroy free radicals is also affected.
While free radicals play an important role in skin aging, antioxidants prevent the attack of free radicals.
We can list the antioxidants effective on the skin as follows:
Retinoids: They are derivatives of vitamin A. It smoothes the skin surface, opens fine wrinkles, lightens brown spots and plumps the skin. They must be used for at least 10-15 months to be effective. It is effective in skin aging due to both internal and external factors.
Vitamin EThe effect of (alpha tocopherol) is controversial.
C vitaminRepairs collagen damage and brightens the skin.
Alpha lipoic acid and coenzyme Q10effects have not been proven.
Green teaContains growth factors and increases cell regeneration.
Gingkobiloba, ginseng, aloe vera, seaweed, grape seed, wheat protein, soy protein, zinc and selenium have no proven positive effects on skin aging.
What is Botox?
Botox is a toxin, a kind of poison, secreted by the bacterium Clostridium botulinum. Botulinum toxin-A (BTX-A) was first isolated in 1928 by Herman Sommer. In 1944, Dr. Purification studies were started by Edward Schantz et al., crystal form was obtained in 1946.
In 1949, Dr. The discovery by Vermon Brook that the toxin blocks movement-related nerve endings forms the basis of its use in medicine.
BTX-A, which was first used in the treatment of strabismus in 1978, was discovered by chance. In 1987, ophthalmologist (ophthalmologist) Jean Carruthers observed improvement of frown lines in his patient, and shared this observation with his dermatologist wife, Alastair Carruthers.
Since 1990, BTX-A has been used successfully in the treatment of approximately 200 diseases such as strabismus, stuttering, migraine, swallowing difficulties, as well as in the treatment of wrinkles and excessive sweating due to muscle contraction.
What is the role of Botox in removing wrinkles?
Increasing life expectancy and prolonging life expectancy increase the amount of time individuals spend productively in society. The prolongation of the active time in professional and social life has an impact on people’s desire to look and feel more fit, healthy and young. This expectation is seriously increasing with the effect of written and visual media.
The area that most reflects the aging and wear process that begins with birth is our face. The facial area is the focus of rejuvenation processes. Although the surgeries defined for facial rejuvenation are finding increasing number of applications, they are interventions that are hesitant because of the need for a healing process, the scars they leave behind and the undesirable risks they carry.
For this reason, the popularity of simple interventions applied for both facial rejuvenation and changing facial features is increasing rapidly. BTX-A injections are the most applied method all over the world since the first years of use.
Changes in bone, muscle, fat and skin tissue appear as the aging process and cause wrinkles as a symptom. Wrinkles that occur on the face are divided into two: Dynamic and Static Wrinkles.
Dynamic Wrinkles: These types of wrinkles appear as a result of the contraction of facial mimic muscles and they gradually increase from the age of 20. Their formation increases depending on the facial features of the person and turns into static wrinkles with the permanent changes they create over time.
The most prominent of the dynamic wrinkles are the horizontal lines on the forehead, the frown lines between the eyebrows and the crow’s feet at the corners of the eyes.
Since muscle activity is responsible for dynamic wrinkles, methods such as BTX that change or stop muscle movements are successful in the treatment of this type of wrinkles.
Static Wrinkles: These are wrinkles that can be seen even when the face is at rest. Depending on the place of residence, they can become even more prominent with mimics. Laugh lines around the mouth and wrinkles on the lower eyelid known as the tear trough are the most common static wrinkles. BTX alone is not enough to correct static wrinkles. Soft tissue fillings or surgical methods are preferred.
How does Botox work and how long does it last?
Botox stops the release of a substance from the nerve endings and stops the movement of the muscle affected by that nerve. This effect starts slowly 2 days after the application, develops fully in the 2nd week and continues for 3 months. After the 3rd month, the substance whose release is stopped starts to be released again and it completely returns to the beginning in the 6th month.
The longer the total number of applications, the longer the clinical effect. The effect around the eyes is usually shorter than in other areas.
When BTX injection is first started, after 3 applications every 3 months in a row, the desired cosmetic effect can be maintained with an application usually every 6 months thereafter.
Who should apply Botox?
Appropriate injection technique and success depend on a good knowledge of the anatomical positions and characteristics of the muscle structures in the application areas. The anatomy of the application area must be known in detail by the practitioner, otherwise undesirable complications may be encountered.
Although the outlines are clear in the determination of injection points, individual changes require that each patient’s decision be made according to the individual muscle amount, activity and position to be analyzed in detail. The experience period of the person who applies it will also increase his skill.
Cleaning the area to be applied before the injection and applying cold reduce the side effects such as infection, bruising and pain.
Who is Botox not applied to?
Those who are allergic to any component of the Botox preparation
Those with muscle disease
During pregnancy and lactation
Those with bleeding disorders
Those with an infection-inflammatory condition at the injection site
It should not be used in those who use certain drugs: Aminoglycoside, cyclosporine, D-penicillamine, muscle relaxants, quinine and calcium channel blockers, magnesium sulfate and lincosamide.
In addition, those who need to use facial expressions in business life (eg actors and actresses, politicians) should avoid botox applications.
What should be considered after Botox application?
Water, make-up and cream should not be applied to the area for 2 hours following the application. After the application, horizontal position for 4 hours and air travel within 24 hours is not recommended.
After the application, the applied muscles are operated for 2 hours, allowing the effect to start early.
What are the undesirable effects that may develop due to Botox application?
Botox application shows a very safe profile when it is done by a specialist physician who knows his job.
Since much lower doses are used in cosmetic applications compared to medical treatment applications, side effects are also less: Headache, flu-like symptoms, allergic reaction, eyebrow asymmetry, double vision, eyelid drooping, asymmetric smile, dry eye, pain, bruising are quite common. They are rare complications due to application errors.
What are Fillers? How are applications made?
Fillers are substances that are used for the treatment of deep and superficial wrinkles and loss of volume caused by aging or diseases under the skin, and are substances that are injected under the skin to regain the lost volume.
For many years, researchers and clinicians have been working to develop the ideal soft tissue filler. The first filler application dates back more than 100 years. Paraffin injections were made as a filler for the first time, but the result was unsuccessful due to the undesirable side effects, namely complications. It was used for the first time in 1893 for the purpose of filling the fat taken from the person (autologous fat transfer). In the following years, synthetic fillers such as liquid silicone were tried, but were abandoned due to undesirable side effects.
In the early 1970s, the first studies on injectable collagen started, and in 1984, collagen was approved as a filler.
Due to the tissue reactions and side effects seen especially in permanent fillers, which have been developed for many years, the application of these substances has been almost completely abandoned.
In parallel with the increasing interest in fillers and the developments in technology, great progress has been made in recent years in the development of fillers that have longer persistence, less reaction and more volume.
How many types of fillers are there?
Natural fillers (collagen and hyaluronic acid)
autologous oil
Liquid fillers (acrylamides and liquid silicone)
Non-absorbable microspheres (polymethylmethacrylate)
Particulate materials (calcium hydroxylapatite)
Permanent implants (polytetrafluoroethylene)
“Hyaluronic Acid” is one of the most commonly used fillers and has the least complications.
Hyaluronic Acid (HA)
It is the most widely applied filler, which is found in our country’s market with different names. Hyaluronic acid is a substance found in the normal structure of the young and elastic subcutaneous matrix (tissue). It is found in the body at an average rate of 200 mg/kg. The body of a 70 kg adult contains an average of 14 g of HA. It is found in the connective tissue and skin of the body. It is a substance with a high water holding capacity and has important effects such as bulking, moisturizing and cell proliferation. With aging, there is a loss of HA in the skin and joints. It has been used for many years in joint diseases with intra-articular injections.
HA was first produced from animal origin in 1989, but its half-life was found to be less than 24 hours. Then, the HA produced from bacterial origin had to be stabilized by cross-linking. Different molecular size preparations of HA have been produced as filler material. While small molecular weight preparations are applied superficially to correct fine wrinkles, medium and large molecular weight preparations are applied deeper and used to fill deep wrinkles.
Fillers containing HA produced with recombinant DNA technology (ie using special genetic methods) can be applied to any surface of soft tissues. The rate of unwanted side effects is very low and it has no toxic or harmful effects. They are used successfully in the grooves on the nose and cheeks, rim depressions, wrinkles between the eyebrows, filling the lips, and correcting acne scars and incision marks. HA injections persist for 6-9 months.
Anesthesia can be easily provided with creams before HA application. In recent years, pain during injection can be prevented by adding local anesthetic to HA preparations.
What is the Chemical Peeling Process?
The history of peeling, which is done to remove the spots and fine lines that appear on the skin due to the intersection of genes, environmental conditions and lifestyles, and to make them look younger, dates back to Cleopatra in ancient Egypt. Today, it is possible to go down to the desired depth by chemical methods. Peels are in a wide range from simple types that can be applied by the patient at home to deep peelings made with a serious operation.
Before having peeling, it is necessary to know very well the basic concepts, peeling types and selection, and the side effects that we do not want to have.
The chemical peeling process, as a result of the application of one or more chemical (acidic and basic) agents on the skin, creates a controlled damage on a part of the skin and ensures a younger and healthier appearance of the skin. The aim is to cause damage to the desired depth in the skin layers and to provide the treatment of unwanted spots, formations and fine wrinkles on the skin by taking advantage of wound healing during repair. As the wound heals, epidermal repair and the formation of new dermal connective tissue create a younger appearance on the skin.
Chemical peeling, according to the damage depth of the peeling solution; It is classified as very superficial, superficial, medium and deep.
The result of the transaction; different in different solutions, it varies according to some factors such as the concentration of the solution used, the acidity value, the duration of stay on the skin, the application technique, the applied area, the number of layers of the acid used, the pre-preparation of the skin, and the skin type.
A chemical solution can cause peeling at different depths under different conditions in different people at the same concentration. During and after the procedure, the patient’s compliance, healing process, complication development rate and results vary according to the depth of the chemical peeling.
In a successful chemical peeling process; There are many factors such as appropriate patient selection, properties of the peeling solution, application technique, and experience of the practicing physician.
Appropriate patient selection is important for optimal results. Before the procedure, the general health status of the patients, the drugs they use, smoking, past cosmetic procedures, viral infections called herpes, keloid, that is, excessively thickened scar formation, should be questioned. Skin type (chronologically (in terms of time) and photoaging) should be evaluated and graded. The patient’s lifestyle and expectations should be well evaluated; should be informed in detail about the procedure to be applied, all possibilities that may occur during the application, and what needs to be followed after the procedure.
Laser and Light Systems in Dermatology
The word “Laser” consists of the initials of the phrase Light Amplification by the Stimulated Emission of Radiation. The theory of absorption of stimulated light was first introduced by Albert Einstein in 1917 as part of his quantum theory. About 40 years after this theory, scientists developed the laser in line with this view.
Theodore Maiman developed the ruby laser, the first red color laser, in 1959. Later, Nedymium : Yytrium-Aluminum-Garnet (Nd-YAG) laser was developed by Johnson in 1961, Argon laser was developed by Bennet in 1962 and CO2 laser was developed by Patel in 1964.
In the laser system, the beam emanating from the light source is deposited in a certain cavity, strengthened and directed to a certain point. Laser light is a unidirectional, single-phase, monochromatic light that travels parallel to each other without scattering.
When the laser light is selectively absorbed in the tissue, the energy of the beam turns into heat and provides an effect.
What are the Uses of Laser in Dermatology?
Laser in the treatment of vascular structures : In this type of laser, the target tissue is the vessel wall. It is used in the treatment of sometimes congenital pink-red-purple colored spots that occur as a result of vascular expansion and proliferation. Argon laser, argon sourced tunable laser, copper vapor / bromide laser, Nd:YAG laser, KTP laser, krypton laser and pulsed dye lasers are effective in the treatment of such structures.
Laser in the treatment of pigmented (dark brown) spots: In this type of laser, the target tissue is melanin, which gives color to the skin. KTP laser, Q-switched alexandrite and diode lasers are effective in the treatment of such structures.
laser in tattoo treatment : Q-switched ruby and Q-switched Nd-YAG laser for blue and black tattoos; Q-switched ruby and Q-switched alexandrite lasers are used for green tattoos, and KTP, pulsed dye laser and Nd:YAG laser are used for red tattoos.
Laser in hair removal: In this process, it is the melanin substance that gives color to the target hair. In one phase of the hair growth cycle, it contains more melanin than the surrounding. The laser applied during this period allows the hair to burn. Alexandrite, diode and Nd:YAG lasers and IPL are the main lasers used for this purpose. Laser should be selected according to skin color, type and hair structure. The type of hair that each one is effective on is different.
Laser in skin rejuvenation: Treatment of aged skin basically includes the treatment of the outer 200 mm of the skin. For this purpose, ablative CO2 and Er:YAG lasers are used to peel the skin. They are effective by removing the upper layers of the skin and allowing the skin to regenerate. In applications where collagenase and fibroplasia are stimulated without peeling the skin, Mid-IR Nd:YAG laser, Mir-IR diode laser, Er:Glass laser, Q-switched Nd:YAG laser, IPL and radio-frequency are used. These rejuvenate the skin by stimulating certain enzymes.
Who decides on the laser and who should apply it?
Lasers are devices that require expertise. Dermatology and Plastic Surgery specialists are the experts who know these structures best. Selecting and applying the appropriate laser is not a simple process. It is unacceptable that the application is made by a person other than the doctor.
With the wrong selection and use of lasers, untreatable side effects (burns, scars and spots) may develop.
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