The story about quest for eternal youth and beauty, is a tale as old as time. In olden days the fountain of youth was believed to be a natural spring, which gave everlasting youth and beauty to people who drank or bathed in it’s water. These stories originated from legends that are thousands of years old. One of the earliest mention of this is in writings of the ancient Greek Historian – Herodotus, who lived in 5th century BC and is also considered as the founding father of History. It also finds mention in various legendary stories involving Alexander, the great and literally known as – Alexander Romance, which mentions that even the great emperor may have been searching for a river/spring which turns back the clock of time, for the person who drinks from it.
The stories took a realistic turn, when the famous Spanish explorer of 16th century Juan Ponce de Leon who was a pioneer explorer credited with many discoveries in the continent of America, spent a great part of his life, searching for this fabled spring, which was mentioned to be true, according to the natives he met. He searched in many islands of Caribbean and also in modern day Florida (of USA) for the fabled spring. It was during one of such explorations, that his group encountered a violent group of Native American warriors and Ponce de Leon sustained an arrow injury, which later caused his death. The 2011 Hollywood fantasy film – Pirates of the Caribbean: on stranger tides, is also based on the plot of competition between the Spanish & English explorers to find the fountain of youth, and the name of Juan Ponce de Leon, is also mentioned in passing.
Unfortunately in spite of all the efforts of the explorers of those times, the fountain of youth was never found. But the efforts of scientists and medical professionals have bore fruit and manifests itself as the many options provided by Aesthetic plastic Surgeons/ Cosmetic surgeons and other therapeutic beauty treatments of the modern era. With these interventions it has been indeed possible to prolong the period of youth and turn back the clock significantly, if not forever. Let us examine these fountain of youth -- of the modern world, which would give your face a young and radiant look; and try to examine, how they work in real life-- going from the cheapest & easiest way to the most complicated.
This is a procedure, where certain chemical solutions are applied in a very dilute concentrations to skin (mostly in face, neck and hands) to cause a controlled superficial wound (a chemical burn, restricted to superficial layers of skin). The outermost layers of skin are thus removed. As the natural healing process, repairs the damaged skin, new skin layers are formed from deeper layers of dermis. This improves the texture of the skin as the newer skin formed is smoother and has less wrinkle than before. The new skin gets a radiant glow, compared to it’s previous status.
Chemical peels was introduced in the later part of 19th century by the founder of Vienna school of dermatology, Dr Ferdinand Ritter Von Hebra. He used chemicals like - phenol, nitric acid, croton oil in different concentrations. He pioneered the use of these agents, for resurfacing and the restoring the skin, as well as to correct freckles and skin irregularities like small scars and marks.
Since the time of Dr Ferdinand, the knowledge regarding chemical peels has also increased as well as the invention/discovery of the new products. Different kinds of compounds have been made available, which have different depth of penetration, hence causing differential skin damage and skin remodelling . So the kind of skin peel to be used depends on the problem concerned.
Peels are categorised into 3 different categories, depending on the depth of penetration. The first category is - Superficial peels, which are used to treat problems, which are localised to the epidermis, the most superficial layer of skin. Glycolic acid & Salicylic acid are the common examples. The second category is – Medium peels, which reaches the superficial layers of dermis, which is the layer below epidermis. Trichloroacetic acid(and sometimes Glycolic acid peel too) is a commonly used example. The third category is – Deep peels, which reaches, the deeper layer of dermis. Phenol is a good example of this category. The depth of penetration depends on the chemical used, it’s concentration in the solution and also the duration of contact of the chemical solution, with the skin of an individual.
It is used for improvement in – Fine wrinkles under/around the eyes and around the mouth, uneven pigmentation, superficial small scars, actinic keratosis ( crusty, scaly growth in skin of fair people, due to excessive sun exposure), hyper pigmentation due to pregnancy & birth control pills and sometimes also in acne. As mentioned previously, it helps in resurfacing and restoring the skin to a previous smoother state, thereby improving the look and feel of skin.
Quite often additional supportive treatment is started alongside chemical peeling. These involve application of tretinoin cream before starting Peel Therapy. Precautionary antiviral medications should be started on people susceptible to Herpes simplex infection. After deep peel, patient may require some kind of pain killers. Sunscreens above SPF 30, should be used both before and after peeling in addition to measures like avoiding the sun.
Although these chemical peels are used quite frequently, in beauty clinics with patient wide awake-- but like any medical/surgical procedure, these also can cause possible complications. Pregnant & breast feeding women, or patients suffering from Psoriasis/Dermatitis/Eczema are not suitable for peeling procedure. People who have suffered from keloids or cold sores(Herpes) should inform their doctors before treatment.
The type of Peel used also depends on the pathology and ethnicity of the person involved. These peels are much more safer in fair skinned – Caucasians, but wrong judgement in Asian & African races can cause colour mismatch, in post peel recovery period. The deeper peel are more dangerous in this regard. Phenomenon like redness and scaling, with the older skin layer being replaced is normal recovery process. The other complications may manifest as burning sensation, scarring, infection and irregular skin tone. So these procedures, though very simple – should not be taken lightly and should only be done under supervision of a registered qualified Dermatologist (Skin Specialist).
Dermabrasion is a procedure, where mechanically the epidermis(most superficial layer of skin) and upper portion of the dermis (the layer below epidermis) is abraded(exfoliated) using a rotating instrument. This ensures that the epidermis is totally destroyed and upper part of dermis is partially removed. When the new skin reappears, it is of better quality than the previous one.
The procedure is done in dermatologist’s office as outpatient procedure. For this procedure a hand held dermabrader, which is motor driven, is used. Different kind of burrs (on tip of the dermabrader) are used for this superficial abrasion, which differs in their shape/size/coarseness. The area chosen for wrinkle removal is marked before infiltrating local anaesthesia. The dermabrader is kept on moving on the concerned area, with application of very little pressure on the skin. This slowly removes the superficial layer of skin.
The physician doing the procedure, can determine the depth reached by the dermabrader by noting the colour of the area and noting the nature of the bleeding (which is minimal in amount). After the desired level is reached, the whole area is covered by gauze dipped in haemostatic- local anaesthetic solution, this provides pain relief as well as stops the bleeding. Finally after stoppage of bleeding, an ointment is applied and the area covered by medicinal dressing or rarely, may be left uncovered (depending on treating dermatologist’s decision). Initially the skin is pink & swollen and there may be burning and tingling. It may take a couple of months for total recovery & disappearance of pink colour.
In general dermabrasion is used for improving the skin texture, mostly in face. Some of it’s important uses are in – acne scars, fine wrinkles, uneven skin tones, areas of sun damage, rhinophyma ( large bulbous nose), facial scars and tattoos in arms & legs.
If a person is on medications, those should be mentioned to the dermatologist. Intake of blood thinners & isotretinoin may effect the procedure. A smoker should withhold smoking as, it impairs the healing process. Sun exposure before the procedure should also be avoided as it may cause skin discolouration.
Like chemical peel, people undergoing dermabrasion also need an antiviral cover, if there is a suspicion of Herpes. Sometimes antibiotic cover is also advised for prevention of infection .Use of sunscreen (after healing) along with avoidance of Sun is also advised. On the hands of experienced dermatologists complications are rare, but untrained & under qualified beauticians may cause possible complications like -- hyperpigmentation, scarring, uneven skin tone and milia. Under treatment will give unsatisfactory results & overtreatment can cause hypopigmentation and scarring.
Laser is also used for the resurfacing of the skin. The mechanism of action is like the previously discussed chemical peel (laser treatment produces change in cellular level, same as that of phenol chemical peel) and dermabrasion, it is just the means of achieving the final goal is laser in this case, in place of peel or dermabrader. Many times dermabrasion and peel achieve the same result at a lower price, but the public’s fascination with high tech therapy created a high demand for laser. Lasers that are commonly used for aesthetic/beauty purpose by skin resurfacing, are – CO2 and erbium: YAG lasers. Sometimes depending on need – Pulsed Dye Laser, Fractional laser and IPL are also used.
Like the the previous two methods, Lasers also remove epidermis of the skin along with the superficial layer of the underlying dermis, and encourages formation of new collagen and healthy and new superficial skin layers. At the time of laser application, the depth targeted for removal is papillary dermis of pink colour. Below that is yellow coloured reticular dermis, which is left intact. Multiple sittings produces dermal collagen contraction, which further enhances the effect by, skin tightening. Unlike dermabrasion, there is no bleeding seen, as heat of the laser coagulates the dermal vessels.
To avoid eye damage, both the doctor & patient should take eye protection. Some doctors advice analgesics and local anaesthetics, for mild pain that some patient may experience. If the procedure is done by a non qualified person, it may be ineffective and even dangerous. Complications like Infections, burns, scarring and alteration of skin pigmentation may also rarely occur.
Many dermatologist advice, application of retinoic acid and hydroquinone cream for 1 month before the laser treatment, as these are believed to promote faster healing and helps in preventing hyperpigmentation after therapy. Antiviral medications are also advised, for prevention of herpes. Smoking should be stopped previously, so as not to impair wound healing.
It takes almost two weeks for re- epithelialization and healing of skin, but sometimes the redness persists for longer duration specially if the CO2 Laser was used. Erbium : YAG laser can cause faster healing and less post procedure redness, but the use of this laser is limited because, of it’s less effectiveness – as it penetrates to less depth. Newer methods of using erbium : YAG laser more aggressively & with longer pulses can achieve results comparable to CO2 Lasers. In some cases the treated areas may be covered by the concerned doctor and afterwards ointments may be advised. Protection from sun and use of sunscreen with SPF above 30, is mandatory. Some clinics even advice their patients for procedure, during winters for the same reason.
Lasers find utility in treatment of wide range of skin conditions. Some of the important one’s other than skin rejuvenation (giving youthful skin, removing wrinkles & skin tightening) are for removal of – Haemangiomas, Capillary Vascular Malformations, Venous & Lymphatic Malformations, Spider veins and acne scars. Many young males also prefer Laser for tattoo removal & young females for Hair removal.
Injections of botulinum toxin A( Commercially sold as Botox) is one of the most frequently performed cosmetic procedure in the world. Before we go into details of it’s use, a brief description of it’s origin & mechanism would be helpful. The bacteria -- Clostridium botulinum, secretes 8 different kind of exotoxins. The most potent of these is – Type A neurotoxin (neurotoxic protein). It prevents release of neurotransmitter at the nerve muscle junction, thereby causing paralysis of the concerned muscle.
The toxin is commercially marketed for treatment of many medicinal problems, besides treatment in Aesthetic/Cosmetic procedures. In fact, the use of this toxin in humans was pioneered by – Dr Alan Scott, an Ophthalmologist (Eye Doctor), as it was used in eye problems, like blepharospasm (involuntary tight closure of the eyelids) and strabismus (the condition of having a squint).
For cosmetology procedures, it is injected into the facial muscles, where nerve endings are present thereby paralysing them. Although the term –‘Paralysis’ may scare normal people but it is this subtle action on fine muscles, that causes pleasing aesthetic effects like disappearance of wrinkles & younger facial looks.
The injection has been used in almost whole of the face. The part of forehead above and between the eyebrows (Glabella), was the first area to be cosmetically treated with Botox. Since then many other facial areas have been included for the injection to remove wrinkles. These areas are Forehead wrinkles, wrinkles on the outer corner of eyes & lower eyelids, nasolabial fold, wrinkles around the mouth and neck area. It can also be used in non surgical brow elevation. It has also non cosmetic uses in – muscle spasticity, chronic migraine headache, hyperhidrosis (extreme and excessive sweating) and neurogenic pain.
It is very important that Botox injection should be given only by qualified dermatologists & Plastic Surgeons, well versed with it’s effects. Side effects in cosmetic procedures generally occur when the injection is given in the wrong muscle group or it spreads from injection site to nearby areas causing unintentional paralysis of different muscles. This can happen when the injection is given by a non medical personal, who does not have the knowledge of correct anatomy. Unintentional side effects due to muscle paralysis can cause difficulty in chewing and swallowing, difficulty in closing the eyes and partial facial paralysis. Other side effects not directly related to it’s action are – headache, flu like symptoms and allergic reactions. In it’s most extreme form – respiratory arrest, heart attack and death can also occur, when the injection is given by non medical personnel.
Cosmetic fillers are chemical/natural compounds which are injected in humans - in areas like face, to fill up depressions like wrinkles (of skin) thereby restoring a younger-smoother skin contour. The duration of action of these materials are variable, but all of them are gradually reabsorbed by body over time, with majority staying around 6 months.
The materials used for filler injections have evolved much in recent years, that is due to the increased understanding of human anatomy & experience of filler use. Different varieties are available. Example of Biosynthetic polymers are – Calcium hydroxyapatite, polylactic acid and polymethacrylate ; or biological molecules like – Collagens and Hyaluronic acids obtained from Cows or Pigs can also be used. The most recent addition to these category is the human fat, which is harvested from the person concerned, by liposuction -- which is very useful when a huge amount of filler material has to be used – as it reduces the cost & does not cause any allergy.
As mentioned earlier, filler fills up the spaces – where it is injected. This property is used, for cosmetic corrections of defects in the human body. Some of these are – Filling fine lines and deep creases (used to correct wrinkles & scars), Filling hollow cheeks and ill defined lips (where it gives lips more prominence & gives it a pout) and filling out hollow areas of body – such as in areas of fat loss in HIV patients.
Injection of fillers may appear to be very elementary, but in unskilled hands, the chances of complications and side effects increases tremendously. Some of these are – pain, itching, redness, infections and allergic reactions. Very rarely, Injection close to areas close around eyes can cause blindness.
The Technique
This technique involves, collection of small amount of blood from a person, which is then centrifuged. This separates the different components of the blood. Further manual separation of cells from the plasma ( remaining clear liquid) is done. Now this Plasma, has a higher proportion of platelets, than the normal blood, hence it is called Platelet Rich Plasma. This liquid is injected into skin in different parts of the body, where improvement is required.
This PRP containing higher amounts of Platelets is injected into different areas of skin, which promotes collagen formation and hence helps in regenerating tissues. This tightens the skin and makes it smooth. So the final end result is smoother skin texture and tone with decrease of previous wrinkles, giving youthful glowing skin. Filler injections can be used with PRP, as they supplement each other and give a better result in form of youthful looking face.
As PRP is prepared from the blood of the same individual, there is no allergic effects, which can occur rarely with other Filler injections. Some dermatologist use this for injection in scalp, which promotes hair growth in bald people. It is also believed to help in -- tighten open pores in face, reverse skin damage caused by sun, rejuvenate under eye areas, erase acne scars and decrease prominent stretch marks in the body. It has also found use in treating sports injuries and tendinitis in- Knee/Shoulder & Elbow. This procedure is quick and relatively painless and the person involved can go back to his daily activities, soon after the procedure. Results can be seen after 1 month of the procedure and gradually improves over time.
The procedure should be done only by a Plastic surgeon or a Dermatologists, who knows what he/she is doing. Mild bruising, redness and swelling improves within a few days. Local anaesthetic creams may have to be applied for people who are very sensitive to pain. If aseptic precautions is not observed, chance of infection is present. Multiple sessions (at least 3) in gap of 1 to 2 months are advised to get the best effects. If done by unqualified people- no improvement in condition may occur.
The excess body fat derived from Liposuction, always made the Plastic Surgeons ponder – if it could be used for any better function than simply throwing away. The first consequence of this thinking resulted in, use of Fat as filler material, which could be used to decrease wrinkles and scars present in face and other parts of human body. Further research showed that, it was possible to concentrate stem cells from fat obtained, which could give miraculous changes in the site of injection. By this technique, not only fine lines, wrinkles and scars can be removed but it also improves the texture and the colour of the skin.
The regenerative properties of the stem cells present in the fat, is responsible for giving rejuvenation to the skin. This can be used with the traditional fat grafting to fill up hollow areas. This can also reverse the -- sun damage effects, improve acne scars and dark circles under the eyes. Sometimes the visible effects improve tremendously, if this is combined with Chemical Peels & Lasers use.
This is an experimental attempt to turn back the clock of ageing for the elderly population. In the latest and most controversial procedure to look young, the super rich get blood transfusion, of blood taken from people of younger age group ,solely for the purpose of looking young.
The component of the blood used in this procedure is Plasma. Plasma is the clear straw coloured liquid part of blood that remains, after the other cells( red blood cells, white blood cell, platelets and other cellular component) have been removed. In the clinical trials, 100 people over 60 years, have been transfused with 2.5 litres of Plasma, in an institute in San Francisco. The procedure costs approximately $ 8,000 .
The authorities of the clinic believe, that it can prevent and improve certain conditions, that have been associated with ageing. The conditions which may improve have been identified as – Diabetes, Heart function, improvement in memory and physical appearance. The initial results have been mentioned as encouraging.
Parabiosis by definition means as union of two living animals/ people naturally or experimentally by means of shared blood circulation. This kind of research has been going on for last couple of decades, where researchers have joined the circulatory system ( blood circulation system) between old and young mice. The researchers showed that organs, muscles and stem cells were rejuvenated in the older mice. Similar results were obtained when plasma from young humans were transfused into older mice.
The history of humanity is full of anecdotes about counterclaims made for each scientific breakthrough. The treatment of blood/plasma transfusion for turning back age also has faced similar concerns, some with very valid reasons. Lots of scientists believe that there is no clinical support to prove benefits of this kind of therapy in human beings. The opponents to this therapy believe that, people undergoing this treatment are unnecessarily being exposed to all the side effects of blood transfusion. These can be – itching, chills, flushing of skin, fever, back pain, flank pain, dark urine, dizziness & fainting, shortness of breath, multiple infections and rarely even death.
Many from scientific community observe that Parabiosis, is an enigmatic issue even in animals like mice, where it is not yet fully understood, as how the older mice can look younger. Using a scientific principle that is still under research in humans is not something that can be encouraged; is a sentiment, supported by many opposed to this therapy.
The last but not the least issue involves the ethics behind this whole scenario. The blood for this kind of therapy/ experimental use comes by buying blood, that may have been donated by young people, who believed that they were donating blood to save life of a person in dire need, suffering from some grave life threatening cause like – Road traffic accidents/ Severe Burns/ Haemorrhagic blood loss. Using their blood for trifling elementary matter like turning back the clock for rich people, would be betraying their trust and is against medical ethics. But supporters of the treatment believe that results are obvious even after a single treatment . They further claim, that it would be wrong to deny people - youth and better health (for those who can afford it) – which is an integral part of Aesthetic medicine/ Plastic Surgery.
So it is a pretty clear that battle lines have been clearly drawn as far as this latest form of aesthetic treatment is concerned. As these trials are at very early stage, with dubious results; it is very difficult to predict at this point what will eventually happen. Paradoxically the final outcome will only be decided by time; for whose reversal, this treatment has been devised.
It is very obvious by now, that the proverbial fountain of youth, for which multiple European sailors set sail in era of discovery, does not exist in form of some magical fountain. But science of modern era has created some magical effects, from new inventions and scientific discoveries – which has made possible for beauty in an individual to last for a very long time, if not for ever.