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3Jul 2019

What's New in Anti-Ageing?

 What is the best anti-ageing treatment?

A question that is asked by as many patients as many dermatologists. A question difficult to answer accurately as a wide range of anti ageing treatments from lotions and potions to peels to laser to Botox and fillers to face-lifts are intrinsically not comparable.

So how do the answer this?

To unravel this, we need to first look at what makes us look Older-ie what are the changes of ageing and then we need to look at what treatment can reverse the same.

Our skin undergoes a lot of changes at different levels as we grow older. 

The changes that we see are brought about by a lot of changes at different layers of skin.

Main Changes in the skin as we age:
1. Epidermis:

The top layer of skin becomes thinner as we age, rate of regeneration reduces, and surface become uneven and feels rough.

 2. Dermis:

Degeneration of collagen ( the building block or main support of dermis) Far exits its regeneration. Elasticfibers too degenerate and as a result of these two changes

  • Skin is thrown in wrinkles and lines
  • pores widen
  • skin becomes slack and lax
  • easy bruisability sets in and blood vessels become more visible
3. Skin pigment

Solar Lentigines or Sun spots dueto cumulative  UV damage existing pigment changes are accentuated.

4. Skin Growths: 

Seborrheic Keratosis / DPN’s, Actinic Keratosis, Skin tags, Angiomas etc develop in people with genetic pre-disposition

Main changes under the skin as we age:
1. Loss of fat

Commonly below the skin in cheeks, temples ,chin, nose and eye area- resulting in further loosening of skin, creation of grooves and folds, sunken eyes and later, even a skeletal appearance.

2. Bone loss: 

This happens commonly after 60’S and is seen mainly around the mouth and chin

3. Cartilage loss:

May happen in the nose leading to dropping of the tip of nose accentuation of bony structures.

4. Increase in tone and thickness of facial muscles due to overuse

Leading to dynamic and then static wrinkles and grooves.

How do we treat these Ageing changes:

While there are variety of treatments that will treat each of these individual changes of aging there is no single treatment that will take care of all the changes. Hence we need a combination approach depending on which changes are we looking at treating.

 Let's start from the least aggressive and go on to the most aggressive treatments and which will work at what level. 

1. Over the counter (OTC) anti ageing creams:  

Touted as miraculous and being able to reverse ageing changes within a few days. Now if you look at ingredients, closely, the primary contain good moisturizers- In addition sum of the claims would contain peeling agent- a variant of alpha-hdroxy-acids or retinols. A few do contain small quantities of other ingredients that are claimed to repair and rebuild elastic fibres like Matrixyl complex and equivalent peptides.

 The promises and claims of speedy changes in otc creams typically rely on micronized particles the temporally fill spaces in the skin surface along with deep moisturizing effect that makes wrinkles appear lesser( due to hydration of (epidermis) rather than long term regeneration

So are they useful at all?

Yes,   they do have a place in anti ageing treatments and  can  serve as  good adjuvant home care, as long as the expectation of results is not superlative.


Some of the creams may cause irritation of skin and interact with various other treatments being done at the clinic. It is important to know the ingredients of all the creams being used by our patients when you start their treatments

2. Prescription Anti- ageing creams:

The prescription anti ageing cream contain higher concentration of the active ingredients like  retinol derivatives or AHA’s etc., and hence  would have a better long term anti -ageing effect compared to OTC brands. But the prescription creams are usually not cosmetically elegant and have a higher chance of irritation and reactions.


These creams need to be stopped a few days prior to the treatment sessions and can be restarted a few days later depending on the type and intensity of treatment being carried out.

3. Treatments for epidermal regeneration Treatments:

These include a range of exfoliative treatments from low- intensity microdermabrasion to superficial, medium depth and deep peels to other exfoliative systems like water jet peel etc.


These treatments work very well at epidermal level, improve texture and superficial hyper pigmentation and give a smoother, clearer skin tone. They also work well as preventive treatment to delay the ageing changes. Of course, the deeper the peel, the better the regeneration. However, one needs to be cautious going in too deep as that increases the adverse effects.

 At times, we need to combine skin peels with Q-switched Nd YAG laser treatments for improvement of hyper pigmentation.


Excessive and frequent exfoliation can increase skin sensitivity and it is important to have appropriate spacing between sessions depending on the skin type up and depth of peeling.

4. Treatment for dynamic wrinkles


One of the most widely known words in anti-ageing- “Botox” or Botulinum Toxin effectively “relaxes” the muscle by preventing transmission of nerve impulse to contract the muscle. This treatment is a very effective when the wrinkles are caused by overuse of the muscles.


Relaxation of muscle cause visible reduction in wrinkles and configured tightening of skin over the wrinkles. This effect is seen in dynamic wrinkles and is not very visible when there is significant skin laxity. Very useful in treatment of upper face wrinkles like forehead lines, frown lines, crow’s feet, bunny lines etc. Can be used by advanced users in a variety of other indications on the lower face as well.


Special training and Anatomical knowledge is necessary to ensure the targeting of correct muscle and to avoid adverse effects.

Thus,each of the above treatments has a unique face in anti- ageing. And the “best anti ageing treatment “needs to be customized to meet our patient individual needs, timeline and budget.