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Your laughter lines, signifying too much of a good time or the normal ageing process? Your face tells a story.

What are wrinkles?

I asked several of my patients what they understood by wrinkles. They said:

“They are laughter lines that show that you enjoy a good life”.

“Cosmetic fine striations which people see”.

“They are unwanted lines between the eyebrows which make you look angry”.

“Lines appearing when you are above a certain age”.

“Sun caused wrinkles that make you look worn and prematurely old”.

“Heavier people with fuller faces have fewer wrinkles”.

“If plenty of fat, less likely wrinkles”.

“Skinny people are often more wrinkly”.

Wrinkles and lines are caused by thinner skin and reduced facial volume with ageing, exacerbated by facial expressions and sun damage. Your face shows the footprint of your life, with the lines and wrinkles representing the smiles, worries, diet, history of smoking, skin exposure outdoors and, of course, your genetics. Wrinkles provide the richness and interest of your face but can also make you look tired and older than you feel, especially if associated with deeper lines and hollows around the eyes, lips and cheeks.

Wrinkles affect both men and women and when unwanted, requests to sort wrinkles come equally from both. At Clinica London, we treat wrinkles in patients from ages around 30 years up to 80 years old. Firstly, we assess the concern then plan a treatment regime. There are several different approaches to wrinkles that can be used together or by selecting just one.

Wrinkle prevention and treatments

At home:

  • SPF 50 Plus UVA and UVB protection are used daily.
  • Medical prescription cream Tretinoin is used regularly to reduce wrinkles and skin blemishes.

At Clinica:

  • Botox and similar injections around the eyes and forehead to reduce dynamic lines and wrinkles.
  • ProfHilo to lift and smooth the mid and lower face, known as the “liquid moisturiser”.
  • Sculptra biostimulation deep collagen to increase the mid-facial volume.
  • Fillers with Hyaluronate (HA) gel to increase under eye, lip, cheek and facial volume, e.g. Restylane and Juvederm HA.
  • Ultherapy non-surgical facelift to tighten and smooth the neck and lower face, as well as around the eyes.

The Clinica treatments are outpatient-based under local anaesthetic, done by the Oculoplastic Surgeon Ms Jane Olver and Dermatologist Dr Angela Tewari. Each treatment lasts a defined amount of time before needing redoing or topping up. The treatments are aimed at improving skin quality and appearance and addressing underlying volume loss.

 

Eyelid Surgery at Clinica

 

Ms Jane Olver does day-case blepharoplasty surgery to remove excess wrinkly and hooded upper eyelid skin and baggy eyelids. Eyelid surgery is carried out under local anaesthetic, often with light sedation if requested.

Read more about Out-Patient Aesthetic Treatments for Wrinkles

Botox

Anti-wrinkle injections with Botox for men and women are done by Miss Jane Olver and Dr Angela Tewari.

Botox was initially used medically in the early 1990s for blepharospasm and even for correcting double vision and strabismus (squint) when used in tiny amounts. By the mid-1990s Botox began to be used cosmetically. It was realised that Botox antiwrinkle treatment had a beneficial effect on the facial appearance, particularly for the deep angry-looking glabella lines, deep crow´s feet lines, and forehead lines. It also made people feel better by taking away the strained effect of their stressful lives. It started to be used for migraine treatment.

The aesthetic benefits of Botox treatment are felt by men and women. It is mainly used around the eyes to enhance their beauty and give a relaxed but natural appearance.
Before having your first Botox anti-wrinkle treatment we invite you to have an aesthetic consultation to discuss your face and particularly your wrinkles. I will assess the angry glabella muscles, test the forehead muscles and the muscles around the eyes plus on the side of the nose. Botox is even used as a medical brow lift, called the Botox Browlift.

The main thing is that I should only treat what the patient is concerned about. Some men are just concerned about their very strong smile lines called crow´s feet, whereas more women want to get rid of the eleven´s lines, the two-deep lines between the eyebrows. The art of the injector is being able to match the requirements of the patient, yet giving them a very natural look, not totally paralysed, and that fits in harmoniously with the rest of their face.

ProfHilo

This is a lightly cross-linked HA filler injected superficially in the face and neck which acts to lift and moisturise the face, making the whole facial appearance plumper, better hydrated and younger. It is particularly good in the lower face around the mouth and chin, and in the mid and upper cheek area. ProfHilo requires a treatment course with initial treatment, then 4 weeks later than 6 months and again at a year. Often used as a stand-alone treatment, it can be used to complement Botox and deeper HA fillers and Sculptra volumisation. Since ProfHilo became available a couple of years ago, many patients have found the treatment natural-looking and effective, and are returning regularly.

Sculptra

Sculptra is strictly not a filler, but a collagen stimulator that stimulates your deep collagen in the cheeks and aids midface fullness, thus smoothing out the wrinkles. Sculptra gives a very natural appearance without the risk of Tindel effect (blueness) or puffiness which can sometimes accompany certain HA fillers. Sculptra is poly-L-lactic acid, which is administered deep into the cheek by cannula using a one or two-port entry, entirely as an outpatient under local anaesthetic. The treatment course consists of two vials to start with, then two vials 8 weeks later, which stimulates the deep collagen and new volume within 4 to 6 months. The beneficial effect lasts up to two years.

HA Fillers

Although many different substances have been used as fillers over the last 50 years, the cross-linked hyaluronate (HA) gel fillers are regarded as the safest because they are reversible with time and can be reversed with an enzyme if required. HA fillers help correct loss of facial volume with loosening of the folds of skin and loss of natural fat over time.
Different HAs are used in different parts of the face, to give support, fullness, softness, subtle volume augmentation.

HA fillers are used for under eye dark circles and hollows, facial volume loss and malar bags, thin lips, poorly defined chin and jowls. At Clinica, we use a variety of different HAs including Restylane, Juvederm, Boletero etc, with specific brands and types preferred for lips, for under the eyes as tear trough fillers, and in the cheeks.

HA filler treatment is often by cannula under local anaesthetic, done as an out-patient in two stages in order to avoid over-filling. Hence it is often better to split the treatment into two treatments if more than one or two vials are likely to be needed, to get an optimal natural appearance. HA fillers can last 6 to 18 months, often much longer.

Ultherapy

Ultherapy is micro-focused ultrasonically guided thermocoagulation and is FDA approved for a non-surgical facelift. It is done as an outpatient under local anaesthetic and stimulates the deep dermis of the chin, under-mandible jowls and neck to produce new collagen and hence lift and tighten. It can also be used selectively around the eyes. The lower face and upper neck is the most popular Ultherapy treatment. It stimulates the patients to own natural collagen which is seen from 8 weeks after treatment and lasts 18 to 24 months. It does not cause any downtime or significant redness of the skin because the energy applied to the deep dermis is focused. Therefore, the person can go straight back to work and it is truly a day case outpatient treatment. There is an hours preparation with the topical anaesthetic cream, the treatment takes 60 to 90 minutes, then the patient can go straight home.

Day Case Eyelid surgery

Blepharoplasty surgery for drooping heavy wrinkly or hooded upper eyelids. The main age range of patients undergoing blepharoplasty surgery is 55 to 75 years, with a smaller number requiring surgery at a younger or older age.

Upper eyelid blepharoplasty surgery is done under local anaesthetic as a day case by the Clinica Oculoplastic Surgeons to remove the thin excess wrinkly skin which often overhangs the skin creases and upper eyelid, making it difficult to put on make-up and even interfering with the field of vision. Upper eyelid blepharoplasty to remove hooded excess skin and eyebags will help open the eyes so that the periocular area appears less wrinkly.

At Clinica, I do several blepharoplasty operations every week, in our small comfortable operating theatre, with recovery in our aesthetic room. This is always under local anaesthetic, though oral sedation can be added. I always aim to give the patient natural looking refreshed eyelids with blepharoplasty, which maintain their essential appearance and rebalance their face where the eyelids have aged more than the rest of the face.

More people request upper eyelid surgery, with a smaller number requesting or indeed requiring lower eyelid surgery. Although the skin in the lower eyelids can be wrinkly and loose, it can often be addressed with medical-grade skincare and HA fillers. Fatty bags are the main complaint in the lower eyelids, which are removed from the inside of the eyelid, without necessarily removing any lower eyelid skin or visible stitches.

If you have wrinkles:

No need to have a surgical facelift as there are many much less invasive out-patient treatments for unwanted wrinkles, to help you look as natural as possible, including Botox, ProfHilo, Sculptra, HA fillers and Ultherapy.

For wrinkly and baggy eyelids, day case blepharoplasty surgery compliments other peri-orbital rejuvenation treatments and helps redress the balance of the ageing face.

Let´s look good, and feel good for the end of 2021 and to welcome in 2022!

Miss Jane Olver

Consultant Ophthalmic Surgeon
Oculoplastic (Eyelid) & Lacrimal Specialist
Medical Director

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