Facial rejuvenation treatments

A woman in her thirties sits down in the chair and says, a little apologetically: "I know it's too early, but…". It is not too early. It is one of the most frequent sentences I hear in my office — and almost always an untrue one.

The skin starts to age after your 25th birthday. Not after forty, not after menopause. After twenty-five. And roughly every ten years its needs change — and with them what makes sense in the treatment room.

What happens underneath before anything shows

In some people the signs of ageing show up earlier, in others later. But deep in the skin the same thing happens to everyone.

There is a gradual fall in the production of collagen and elastin. The skin loses firmness, wrinkles appear. On top of that, cell division and growth slow down — which means the skin regenerates less and less effectively.

For a long time there are no worrying signs. And then they start appearing all at once. That is exactly why it is worth stepping in at the right moment.

And what if you miss that moment? Nothing terrible. You will simply have to reach for stronger tools.

One caveat up front: the division into decades below is a convention. It does not replace a consultation with an aesthetic medicine doctor, which is the most important step before any course of treatment.

After 30 — the skin still forgives

At this stage we most often notice the first visible changes. Tiredness shows on the face more and more clearly.

Stress, life on the run, too little sleep. The skin regenerates more slowly, becomes dull and dry. The first expression lines may appear.

And for now that is the only problem — and one that is easy to solve.

Moisturise, not repair

At this age, getting rid of fine lines takes nothing more than moisturising the skin well.

Needle mesotherapy deals with the first wrinkles quickly. Similar results come from microneedling, that is microneedle mesotherapy: a series of punctures delivers tailored cocktails based on hyaluronic acid, vitamins and amino acids into the deeper layers of the skin. They moisturise, regenerate and nourish.

Does it hurt? No more than a mosquito bite. After the treatment slight swelling may appear, which usually disappears within a few hours.

The best results come from a series of 2–6 treatments every 1–4 weeks. Afterwards the skin has a healthy tone and looks fresh. In short — younger.

If you cannot stand needles

That leaves chemical peels. Among others, I recommend a treatment with retinol and vitamin C — a comprehensive anti-ageing therapy.

Retinol strongly stimulates the deeper layers of the skin: it prompts fibroblasts to produce more collagen and elastin. Vitamin C and antioxidants do the rest. The result is rejuvenated, moisturised and nourished skin. The treatment is intended for skin with imperfections and signs of ageing.

There is also GeneO — a treatment that at the same time oxygenates the skin, exfoliates dead epidermis and helps revitalising substances absorb.

It feels a little like a massage performed with a special handpiece. A rejuvenating or brightening-and-nourishing gel is applied to the face, where it combines with a capsule based on sodium bicarbonate and citric acid. A chemical reaction takes place, known as the Bohr effect — carbon dioxide bubbles form and, bursting on the surface of the skin, deliver oxygen to it. Microgranules from the capsule instantly exfoliate the stratum corneum and remove accumulated impurities.

Cleansed and oxygenated skin absorbs the active substances from the gel in no time — among them azelaic, kojic and hyaluronic acid. The face looks fresh straight away, and the results last about 3 months.

If you are pregnant or breastfeeding, we do not perform a retinol peel — retinoids are not used at that time, not even topically. That does not mean you are left without options: some moisturising treatments and exfoliation with very gentle acids can be planned then as well. Mention the pregnancy at the consultation, before we start choosing a course of treatment.

Botox after thirty — no need to panic

For the first expression lines I use the most effective rejuvenating treatment there is: botulinum toxin injections.

Young women associate Botox with a motionless, expressionless face. Let me reassure you: a small amount of toxin, skilfully administered, is completely invisible. The only thing it blocks is the formation and setting of the first wrinkles.

I suggest this treatment to women with very lively facial expressions, whose muscles work hard. Botox holds back excessive movement and delays the formation of wrinkles around the eyes, around the mouth and on the forehead.

What does it look like? After local anaesthesia I introduce the product with a needle into the muscles just under the skin. Does it hurt? Practically not. Short-lived swelling may appear at the puncture sites, and very rarely bruising, which disappears within a few days.

You go back to normal activity straight away. For 24 hours avoid physical exertion, and for two weeks avoid the sauna, the solarium and heating the injected area.

New neuromuscular endings form over a period of 3 to 6 months — and that is when the effect of Botox gradually weakens. With expression lines the effect usually lasts 3–4 months, so the treatment is repeated several times a year rather than once a year.

Botulinum toxin is not for everyone. We do not administer it during pregnancy and breastfeeding, in neuromuscular diseases (myasthenia, for example) or in case of allergy to the ingredients of the preparation — which is why at the consultation I ask about medications and chronic conditions. The most common side effect is temporary drooping of the eyelid or brow; it passes on its own once the product stops working.

What to do at home after thirty

The most important thing is protection against solar radiation and free radicals. Creams with antioxidants — vitamin C, vitamin E, ferulic acid, pomegranate extract. A day cream must have a filter, at least SPF 30.

After 40 — when the V turns into a W

Forty is regarded as a turning point, but the skin is still coping quite well. Collagen and elastin production is falling, yet with proper care up to that point it is not yet visible on the face.

It is worse if nobody took care of prevention in time. Then after 40 you can usually see that the nasolabial folds have deepened, the cheeks have lost volume, and the corners of the eyes and mouth have started to droop.

The pace of change depends on lifestyle, diet, genes, hormone fluctuations, skincare and the environment. But sooner or later everyone's skin becomes lax — and the shape of the face that used to resemble the letter V gradually turns into a W.

The good news: this is not an irreversible process.

First, wake up your own regeneration

This is a good moment to boost the natural repair processes, which clearly weaken at this age. That is why I most often recommend platelet-rich plasma mesotherapy to women in their forties — the so-called vampire lift.

The procedure starts with taking blood from a vein in the crook of the elbow. The tubes go into a centrifuge, which separates erythrocytes and leukocytes from the plasma containing platelets, or isolates plasma with fibrin. It is precisely this preparation that is injected into the skin — with very fine needles, point by point as in classic mesotherapy, or in lines along the wrinkles.

Full results take time, until the collagen fibres, the skin's "scaffolding", have been rebuilt. That can take three to six weeks.

Why does it work? Growth factors released from the platelets are responsible for the division and multiplication of stem cells. These in turn stimulate tissues to regenerate, and can themselves turn into new, healthy tissue. In the skin they stimulate the production of new epidermal cells, renewal processes and the formation of new collagen fibres and blood vessels.

No risk of a reaction to foreign material — plasma is one of the most natural materials aesthetic medicine has at its disposal, because it comes from your own blood. As with any treatment involving a needle, you have to expect redness, swelling and small bruises.

Then lift the contour

Treatments after forty work on two fronts: they repair what has already changed, and they preventively protect against further changes. I most often reach for two of them.

Fractional microneedle radiofrequency

A special handpiece at the same time punctures the skin with very fine needles and emits a radio wave that heats the tissue around them. This controlled overheating stimulates the skin to renew itself and produce collagen.

The treatment is performed under local anaesthesia and takes about 30 minutes. Right afterwards the skin may be red — it usually returns to normal after a few hours.

Regeneration takes time, which is why the results are best visible after 4–6 weeks, and the final result of the series after about 3 months. I recommend a series of 3–4 treatments every 2–4 weeks. That is enough to lift the facial contour — the improvement is visible for as long as a year.

Infrared thermal lifting

A treatment performed with a handpiece emitting infrared radiation of a specific wavelength. Heating the collagen fibres makes them contract immediately, which means better skin tension and a lifted contour — visible right after the treatment.

But that is not all. Controlled heating also triggers the rebuilding of the skin's scaffolding and the formation of new collagen fibres, that is neocollagenesis. It lasts from 1 to 6 months and it is what gives natural results for years.

For the improvement of the contour to be visible and lasting, the treatment is best performed in a series of 3–6 sessions.

What to do at home after forty

Communication between cells becomes the most important thing. The main role is played by fibroblasts — the cells that produce collagen fibres. When they work efficiently, the skin is dense and firm. With age their performance falls, but it can be stimulated.

This is the mechanism behind cosmetics containing peptides. These short protein molecules can slow down glycation, vividly called caramelisation: sugar molecules stick to collagen fibres and crystallise, turning fibres that were elastic until then stiff and brittle. Preventing this is now the main goal of daily skincare.

After 60 — it is never too late

At this time oestrogen levels drop sharply. It is oestrogens that stimulate the receptors on cells, and those send a signal to regenerate deep into the skin. If low hormone levels persist for a long time, the receptors start to disappear.

At the same time the division and growth of skin cells slow down. This mechanism makes sense — it protects against damaged cells dividing too quickly, and therefore against the development of cancer. But it also has a side effect: the skin becomes thinner, loses firmness and elasticity, and wrinkles deepen.

For patients over 60 I have two pieces of news.

The good one: it is never too late for an aesthetic medicine treatment.

The slightly worse one: it now has to be more invasive, which often means breaking the continuity of the epidermis.

There is nothing to be afraid of, though. Modern rejuvenating treatments have nothing in common with a surgical facelift under general anaesthesia. None of them requires convalescence or leaves scars on the skin. And the results can be impressive.

The wrinkles are deep — time for a laser

At this age wrinkles are already pronounced, which is why excellent results come from laser facial rejuvenation. And the good news: a laser treatment no longer has to mean several days off or stepping out of everyday activity.

Usually, however, we use combined techniques. A single treatment — even the most expensive one — is not enough, because wrinkles are not the only problem. The facial contour changes noticeably too.

Three ways to work on the contour

Facial volumetry with the hyaluronic thread technique

It starts with anaesthesia — usually a cream applied to the skin, and for patients more sensitive to pain I additionally administer dental anaesthesia.

There is one thing worth knowing before you decide on any filler. Very rarely the product can enter a blood vessel and block it — the skin then turns pale, hurts more than it should, and after a few hours a bluish, marbled pattern appears. This is an urgent situation: hours count, not days. That is why the treatment is performed by a doctor, and why hyaluronic acid has an antidote — hyaluronidase, an enzyme that dissolves it. If you notice such symptoms, call the clinic straight away.

Then, with special needles — so-called microcannulas with rounded tips, which minimise unpleasant sensations — I inject a hyaluronic acid product in the form of linear threads. Hyaluronic acid binds water molecules and fills the areas that have lost firmness and volume. The contour lifts.

The results last for more than a year, although a lot depends on lifestyle.

PDO lifting threads

Like every medical procedure, it is preceded by a thorough medical consultation. The treatment itself is simple: very fine needles implant threads of polydioxanone into the skin — a synthetic fibre that gradually dissolves in the tissue, stimulating the production of collagen and fibroblasts and the formation of new blood vessels.

As a result the skin is tighter, firmer, better oxygenated and better nourished.

There are many types of threads. Biorevitalising ones are extremely fine. Lifting ones have barbs that make it possible to pull the skin up and visibly improve the contour. Realistically, the durability of the effect is estimated at a little over a year — there simply are no studies with longer follow-up. After the treatment you have to expect a few days of swelling, and sometimes small dimples in the skin or a thread you can feel; these things usually resolve on their own within a few weeks.

Calcium hydroxyapatite

A filler with a dense, gel-like consistency based on calcium. Injected into the places that need filling, it stimulates the development of natural collagen fibres and improves skin tension — and therefore the contour.

The product is administered with a microneedle or a microcannula. A few minutes earlier I apply an anaesthetic cream, and the syringe also contains an additional anaesthetic ingredient. The treatment is therefore painless. The results are visible immediately and last on average from 12 to 18 months.

What to do at home after sixty

The skin no longer produces building substances on its own — they have to be replenished. Most cosmetics for mature skin contain hyaluronic acid, which penetrates the skin and attracts moisture. But the most important ingredients of 70+ creams are calcium and oils and butters rich in lipids, ceramides and unsaturated fatty acids.

Everything in one table

What we do in our clinics — from the gentlest methods to the strongest:

• Needle mesotherapy — A cocktail of hyaluronic acid, vitamins and amino acids delivered straight into the skin · Dry, dull skin, first fine lines · A series of 2–6 treatments every 1–4 weeks.
• Microneedling (microneedle mesotherapy) — A series of punctures delivers the products into the deeper layers of the skin · As above — an alternative to classic mesotherapy · A series of 2–6 treatments every 1–4 weeks.
• Peel with retinol and vitamin C — Retinol prompts fibroblasts to produce collagen and elastin · Skin with imperfections and signs of ageing; for those who cannot stand needles · Gradually, after the course of treatment.
• GeneO — Exfoliates the epidermis, oxygenates the skin (the Bohr effect), delivers active substances · Grey, tired skin, before an important occasion · Straight away; lasts about 3 months.
• Botulinum toxin (Botox) — Holds back the work of the mimic muscles · Expression lines — forehead, around the eyes and mouth; very lively facial expressions · Usually repeated every 3–4 months (that is how long the effect on the mimic muscles lasts).
• Platelet-rich plasma mesotherapy — Growth factors from your own blood stimulate regeneration and collagen production · Weakened skin in need of rebuilding; people who avoid foreign products · Full effect after 3–6 weeks.
• Fractional microneedle radiofrequency — Microneedles + radio wave; controlled overheating stimulates collagen production · Drooping contour, loss of tension · Visible after 4–6 weeks, final after about 3 months; improvement for as long as a year.
• Infrared thermal lifting — Infrared contracts the collagen fibres and triggers neocollagenesis · Laxity, drooping contour, no convalescence period · Tension straight away; neocollagenesis lasts 1–6 months; a series of 3–6 treatments.
• Laser facial rejuvenation — Controlled skin renewal with a laser beam · Deep, pronounced wrinkles · Depending on the type of laser and the intensity.
• Volumetry with hyaluronic threads — Hyaluronic acid in the form of linear threads rebuilds lost volume · Hollow cheeks, blurred contour · Straight away; lasts more than a year.
• PDO threads — Polydioxanone tightens the skin and stimulates collagen production · Drooping contour — lifting threads; skin in need of rebuilding — biorevitalising threads · A dozen or so months; there are no studies with longer follow-up.
• Calcium hydroxyapatite — Fills and at the same time stimulates your own collagen · Lost volume, poor skin tension · Immediately; lasts on average 12–18 months.
• Polylactic acid — A biostimulator — prompts the skin to produce its own collagen · Skin that needs stronger stimulation · Gradually, after the series.

Age on paper is not everything

When choosing a course of treatment I always take into account not only age, but above all the appearance and condition of the skin — and these sometimes do not match the date of birth. Genes, skincare, lifestyle and hormone levels all have an influence.

In theory the more powerful treatments — polylactic acid, calcium hydroxyapatite, PDO threads — I perform only on women over 40.

But once I was visited by a 37-year-old with the skin of a 57-year-old. I reached for one of them without hesitation. It turned out that her ovarian function had failed prematurely and she had entered menopause back in her thirties. She had not been given hormone replacement therapy, so her skin began to age rapidly and lose firmness. A powerful treatment took off the 20 years that premature menopause had added.

How to choose for yourself

There is no single best treatment. There is, however, a fairly simple logic:

• Does your skin look tired but still hold its shape? Start with moisturising and biostimulation — mesotherapy, microneedling, a peel, GeneO.
• Are specific expression lines bothering you? That is a job for botulinum toxin.
• Has your facial contour started to droop? Then tightening and stimulating methods come into play: microneedle radiofrequency, thermal lifting, threads.
• Has your face lost volume? It needs to be rebuilt — with volumetry, calcium hydroxyapatite or biostimulators.

And the most important thing: the sooner you start taking care of your skin, the less there will be to repair later. But even if you are starting late — you are starting at a good moment. Always.

What specifically makes sense in your case is decided at a consultation, not on the internet.

Where to start in practice? Most often with a consultation and two pillars: botulinum toxin for expression lines and volumetry where the face has lost volume.

This article was prepared by Aneta Bembenek, MD — ophthalmologist and aesthetic medicine doctor specialising in the correction and revitalisation of the most delicate areas of the body: the face, including the eye area, the neck and the décolletage.