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Improving Skin Surface & Texture

Once wrinkles and facial contours are addressed, the 'third column' of Cosmetic Dermatology aims to improve the skin surface and texture. Achieving an overall better 'skin quality' is equally important as fixing lines and wrinkles to the overall appearance of the skin. In one very interesting study, subjects were able to predict accurately a person's age from photographs which showed only a small area of their skin surface, but did not show the whole face. It has also been shown that irregular pigmentation not only makes others see you as older and less attractive, but surprisingly as less healthy, too. All this demonstrates the major difference that treating the skin surface and texture can make. However, we have to understand that despite its importance, improving skin surface and texture, does not create the instant 'wow' effect that for example fillers and 'botox' offer. It is a gradual process with subtle effects, yet absolutely essential.

We use different methods of treatment to improve fine lines and crêpy skin on the face, soften acne scars and shrink pores.

Bio-revitalisation

Bio-revitalisation is a great treatment for improving skin quality, texture and hydration. It is particularly suitable for finer lines, criss-cross lines, crinkling of the skin and overall loss of elasticity, for example on the cheeks.

Our bio-revitalisation treatments are very different from traditional 'mesotherapy'. We use high-dose, stabilised hyaluronic acid (Restylane Vital or Restylane Vital Light) with a proven efficiency and safety record. Scientific studies have proved that stabilised hyaluronic acid not only enhances the visible appearance of the skin, but can also improve its elasticity, hydration and surface roughness. It is more effective than non-stabilised hyaluronic acid and studies have also shown that is has antioxidant effects and the ability to induce collagen production.

Skin revitalisation with stabilised hyaluronic acid is done as a course of three to six sessions at three to four weekly intervals. We perform the treatment after application of an effective numbing cream as pain prevention.

For even better results, bio-revitalisation can be combined with medical micro-needling. (See 'Gel Needling lift', below).

Magnified view of the skin surface before (left) and after (right) bio-revitalisation treatment.

Costs:
Bio-revitalisation treatment (per session) - £420

Medical needling ('collagen induction therapy')

Medical micro-needling is a great, very natural anti-ageing treatment that 'helps the skin to help itself'. Instead of injecting substances into the skin, this treatment only involves a sterile roller ('dermaroller') equipped with hundreds of ultra-fine needles.

Medical needling mechanically mimics the effects of fractionated laser technologies (such as Fraxel) by creating microscopically small punctures in the dermis. This intentional injury induces thousands of tiny, controlled wound-healing responses in this deep layer of the skin. Consequently, growth factors and fibroblasts are stimulated into synthesising new skin matrix, including collagen. In time, this will lead to a firmer, more elastic skin. As we get older, our skin gets 'lazy' and collagen production slows down. With medical needling, we give the skin a gentle nudge to remind it to keep making fresh collagen.

The great thing about medical needling is that we can induce effects in the deeper layer of the skin (the dermis) without having to fully strip the protective outer layer (the epidermis). Why is it so important to stimulate the dermis? Dr Stefanie calls the dermis the 'backbone' of the skin - the layer of collagen-containing connective tissue where the most prominent skin ageing processes takes place. With needling we can reach the dermis without significantly damaging the skin surface. The superficial punctures close again quickly, which is important since the epidermis protects our body from water loss and environmental damage.

Medical needling also helps with enlarged pores and acne scaring. However, the acne has to be successfully treated before this can be started. If a patient has been taking Isotretinoin (Roaccutane^®), we usually need to wait for six months before starting a minimal invasive procedure like this. We can also treat localised skin depressions, such as acne scars or chickenpox scars, with contained medical needling using a 'needle stamp' ('dermastamp').

Medical needling is not a single treatment, but has to be done in a course of three to six sessions at six to eight weekly intervals. The procedure is performed after application of an effective numbing cream as pain relief. For even better results, medical needling can be combined with a hyaluronic acid bio-revitalisation (see 'Gel Needling Lift', below).

You may have heard of needle-rollers for use at home. The highest quality, sterile titanium micro-needle dermal rollers that we use in clinic are more than five times as long (1.5 to 3mm versus 0.2 to 0.3mm). Not surprisingly, they're much more effective than home rollers in all respects. However, home rollers greatly enhance penetration of topically applied cosmetics and are thus a useful adjunct.

Costs:
Med. Needling with Dermatologist (per session) - £450
Med. Needling with Medical Cosmetician (per session) - £325

'Gel Needling Lift'

Here in our clinic, we pioneered the technique of combining bio-revitalisation using stabilised hyaluronic acid gel, with medical needling. What we have found is that due to their synergistic effects, these treatments work more powerfully in combination than when performed alone. We have called our exciting new procedure the 'Gel Needling Lift'.

A 'Gel Needling lift' works well to improve overall skin 'quality' and combat loss of facial skin elasticty and fine crinkling lines. It also helps to gently add definition to the jaw line, shrink enlarged pores and improve depressed acne scaring.

We are also able to treat small, isolated depressed lesions such as chickenpox scars with a small 'needle stamp' instead of the roller, but otherwise the procedure is very similar.

Costs:
'Gel needling lift' - full face (per session) - £530
'Gel needling' - localised lesion (per session) - £430

Chemical peels

In our clinic we perform TCA (Trichloroacetic acid) and glycolic acid peels. A TCA peel is a highly effective peel, which is always performed by our Dermatologist. A TCA peel reduces sun damage with wrinkling and irregular pigmentation, and improves skin surface and texture.

There are different TCA strengths on the market. High strength TCA peels are performed as a one off treatment. They are very effective, but have considerable downtime and potential side effects. In our clinic we use a gentler TCA peel, which needs to be repeated four times, each at weekly intervals. After completing this course, you will achieve the same end result as with the higher strengths TCAs, while having less downtime and a lower risk of side effects. TCA peels work particularly well for more mature patients with sun damaged skin.

Glycolic peels are milder compared to TCAs, so may be more appropriate for younger patients or for patients who don't want any visible flaking after the treatment. Glycolic peels are also great for patients with comedones ('blackheads and whiteheads') and a tendency for breakouts. You will achieve a more refined skin surface with a fresher, more vibrant appearance and skin tone. The effects are much better than all home use peels on offer. Our glycolic peels are usually performed weekly for six weeks.

Costs:
Course of four TCA peels with our Dermatologist - £1350
Glycolic Peel with Medical Cosmetician (per session) - £130

Improving irregular pigmentation, brown spots & freckles

In clinic, we see many patients with patchy facial pigmentation (melasma / chloasma) or mottled pigmentation due to sun-related skin ageing. While pigmentation is a stubborn problem that certainly won't disappear overnight and takes persistence and patience to treat, we can prescribe effective skin-lightening creams to tackle these issues. Topical treatments are particularly effective when combined with a special in-clinic Pigment regulating treatment every ten days (see 'Pigment Facial'). A Pigment Facial brightens irregular pigmentation while giving your complexion a wonderfully fresh glow.

It is also extremely important to combine any treatment for pigmentation with a broad-spectrum sun protection product of
SPF 50-90. Remember - a single day of excess sun can undo months of treatment!

'Age spots' (lentigines) on face and hands can be gently 'frozen' by our Dermatologist in clinic, treated with topical skin lightening products at home or approached with a special chemical peel. 'Freezing' (cryotherapy) in particular is very effective, but may leave some redness lasting around four to six weeks after treatment.

Melasma before (left) and after (right) Pigment Balancing Peel

Costs:
'Freezing' of 'age spots' (in addition to consultation fee) - £30
Pigment Facial with Medical Cosmetician - £130 (per session)