Tag: hyaluronic acid

Whether day skin care, serum or gel, hyaluronic acid is lauded as THE miracle weapon in the field of anti-aging. It is purported to cushion the skin, smooth wrinkles and balance roughness. But is the praise really justified?

The body’s own natural substance

Hyaluronic acid (HA for short) is, at least, not foreign to the body. Chemically speaking, it is a polysaccharide, i.e. a multiple sugar, and thus an important component of various types of connective tissue. It is the main component of our synovial fluid and lubricates the joints. The largest proportion of HA, about 50 percent, is stored in the skin. Its task is to bind enormous amounts of water – up to six liters per gram. Unfortunately, the body’s own production also decreases with age, starting from around the age of 25. At 50, the water reservoirs are only half full and this begins to become noticeable in the outside appearance: Fine lines and wrinkles, sunken cheeks, crow’s feet or a deepening of the nasolabial fold are classic signs of hyaluronic acid deficiency. The elasticity of one’s own skin, the so-called skin turgor, can be measured easily: one raises a skin fold on the hand with two fingers and releases it. Depending on the moisture content, the wrinkle remains or restores itself elastically. By the way, cracking joints are also an indication that hyaluronic acid is decreasng in the synovial fluid.

Chain reaction

The empty depots cannot be filled as easily as one might imagine, and certainly not with an externally applied cream. Whether this has an effect and what that effect may be is mainly due to the size of the HA molecules. Simone Presto, physician and expert for the Eucerin HyaluronPlus series, confirms this: “The long-chain (high-molecular) hyaluronic acid is a very large molecule which remains on the skin. The medium-chain hyaluronic acid penetrates a little deeper into the superficial skin layers through the epidermis, up to about the middle of the 12 epidermal layers. The short-chain (low-molecular) hyaluronic acid can penetrate more deeply.” But, as the doctor admits, there is a limit here as well. Even the smallest HA molecules cannot break through the basal membrane, the bottom layer of the epidermis, where cells are constantly produced. No innovative cosmetic can overcome this. The short-chain hyaluronic acid is deposited there and swells up because it binds water from the tissue. In this way, it can not only ensure that wrinkles become flatter, but also that cell communication is maintained. Ultimately, it supports the physiological processes of the skin. The basic prerequisite, however, is that enough moisture is already present in the tissue. Simone Presto also stresses: “This is why it is so important to drink enough fluid. After all, it is up to me to provide the skin with moisture from below, which can then be bound above.”

Nerd knowledge

Strictly scientifically, Hyaluronic acid has been called Hyaluronan for several years. Until the end of the 90s it was extracted from cockscombs, today it is obtained from yeast or grain by fermentation, a vegan alternative which is much more tolerable. The molecular mass is measured in Dalton (kd stands for kilodalton and is named after the English natural scientist John Dalton, who studied atomic theory). High-molecular hyaluronic acid has 1,500 kD, medium-chain 100 kD and short-chain 50 kD or less. Incidentally, when ingredients are indicated on cosmetic products, the so-called INCI, all variants are called sodium hyaluronates. If you want more information about what your cream contains, you should contact the manufacturer. If the aim of a cosmetic product is to moisten more than just the surface, both long- and short-chain molecules must be present in high concentrations. Even if the industry would like to convince you of the contrary, no care product can lift facial contours, enlarge the lips or iron out deep wrinkles. Only hyaluronan injections given by your beauty practitioner can build up targeted volume on individual facial areas. These can penetrate to deeper skin layers and thus achieve more intensive and long-term effects.

Continuous operation

For hyaluronic acid to really have an effect, it must be used long-term. Simone Presto: “The skin’s own enzymes, the hyaluronidases, break down hyaluronic acid. In the case of a care product, this is usually within 12 hours. That’s why cream should be applied twice a day to maintain the effect.” If the skin barrier is weak, this will only help to a limited extent. Strengthening the barrier layer is necessary for long-term moisture penetration. The outermost layer of the epidermis, the so-called horny layer (stratum corneum), maintains the actual protection of the skin against the environment and prevents excessive moisture loss. Urea, vitamins and ceramides are among the most important active substances that strengthen the barrier function.

Foto: @up_n_co

Decreasing volume causes the face to sag. The once narrow, defined chin area becomes wider and slack. Aesthetic goal: to rebuild facial harmony.

From about the age of 25, gravity begins to constantly pull on the contours of the body. The aging process in the face becomes particularly clear when the so-called triangle of beauty is reversed. The youthful face has high cheekbones with full cheeks and a well-defined contour with a narrow chin where the imaginary triangle converges. When skin density and volume distribution change, the triangle is turned upside down. The broader part now lies in the lower area of the face with a widened, slacker chin contour and a sagging cheek area. The overall impression is often seen as sad and stressed.

Unjustly neglected

“It is quite normal that during our aging process not only the tissue sags, but bone substance is lost as well. This gradually changes the shape of the face and, in particular, the chin and jaw area suffer from the aging process. The reconstruction of this area to attain facial harmony was unduly neglected in aesthetic medicine for years,” confirms Dr. Gerhard Sattler, co-founder of the Bellari Institutes and Medical Director of the Rosenpark Klinik.

Deep Tissue build-up

To rebuild the chin and jaw area special fillers or, more precisely, injectable implants such as the new Juvéderm Volux, are required, which can be inserted deeper into the tissue. In contrast to superficial hyaluronic acid injections to combat wrinkles and fine lines, the tissue must be built up from below. The Vycross technology was developed for this purpose. It combines hyaluronic acid molecules of low and high molecular weight to form a tightly cross-linked gel. In the skin, this implant has a long duration of action and low water absorption. In this way, the effect is maintained for up to 24 months.

Determination of width

In the treatment of the chin, a series of injections is first placed directly on the mentum, the bone at the chin. Five to seven injection points are required for this width determination. Subsequently, three to five points of volume are injected into the chin (pogonion), directly under the muscle. First of all, the chin is extended and its width determined, then the volume or the actual chin is formed. The fold above the chin can also be optimally compensated with Volux. Since Volux is combined with the anesthetic Lidocaine, the patient feels almost nothing from the injection. A slight reddening and some swelling may occur, but these can be easily concealed. Except in special cases, such as a genetically caused strongly receding chin for example, a single treatment is enough.

Chewing makes the muscles grow

A jaw area which is optically too wide can be caused by genetic predisposition or by a shift in volume due to gravity and the loss of support structures in the cheek region. But a widening by an overactive chewing muscle can be the cause of so-called sagging cheeks as well. How can the muscle (masseter) grow in this way? There are several possible causes: predisposition and excessive strain due to nocturnal grinding of the teeth as well as jaw clenching play a definite role, as does the over-consumption of chewing gum. The lower jaw and face then appear wider and more angular than would normally be the case.

Shaping with Botulinum

Botulinum is used to slim down the masseter muscle and prevent it from overly. Three to four punctures directly into the muscle are enough and the effect occurs after about seven weeks. Since the muscle is not exercised as much, it slowly loses substance and the volume decreases. However, it can take up to four weeks for the face to look narrower, especially at the back of the lower jaw. If the effect is to be permanent, it is advisable to repeat the injection every six months. Another advantage: nightly teeth grinding (bruxism) can be treated in the same way.

Sponsored by Bellari

All Eyes on the Mouth

Lip augmentations are now more popular than ever

The mouth is not only our most beautiful tool for speaking and kissing. Our lips convey emotions. They express what we’re thinking and feeling right at this moment. They influence how our environment perceives us. With a radiant smile we appear more friendly while drooping corners of the mouth make us look sad and ill-tempered. Whether it be in conversations with friends or with the boss, on a date or in the duckface pose for the next Selfie.

The ideal lip shape

But what does the most attractive lip shape actually look like? First of all: It is definitely not the ubiquitous pout, seen every day on numerous Instagram feeds. In a US study published by researchers on the Jama Facial Plastic Surgery platform, 428 people were presented with 100 portraits of women. The outcome was that the ideal is not the full, evenly-shaped lip. Which shape then? Optimally, the lower lip should be twice the size of the upper lip and occupy about 10 percent of the lower third of the face. At first glance, this may sound rather disproportionate. But in actual fact, it’s not. The pleasing, natural lip shape of model Miranda Kerr comes quite close to the ideal. But not everyone is lucky enough to have this and some would like a little help.

Lip enlargement with hyaluronic acid

“Lip augmentation is a frequently desired treatment to enlarge inherently narrow lips, especially with our younger patients. But it also plays an important role with older age groups in order to optically rejuvenate the area around the mouth. The aim here is to rebuild lost volume,” says Dr. Sonja Sattler from the Bellari Institute in Frankfurt and Hamburg. The most important aspect of lip fillers is the use of high-quality hyaluronic acid products. Cheap suppliers often use non-crosslinked hyaluronic acids, which only have a short-term effect. “Products which claim ‘lasting’ results are strongly discouraged, as they can lead to inflammatory nodules and asymmetry, even years later,” says Dr. Sattler. And: Since small injury points are caused by the needles being repeatedly placed on and under the red of the lips during an injection, frequent injections can lead to minor scarring here. The product should not contain any additives but should consist of pure hyaluronan. Dr. Sonja Sattler: “Unfortunately, we frequently see patients who come to us in desperation after suffering serious permanent consequences (bumps, etc.) from an incorrectly performed lip injection”.

No duck lips

To prevent this from happening, it is important to know that the lips consist not only of the visible, dark red part, but of lip white as well. The common misunderstanding that the lips are only red can lead to unnatural results, especially with lip augmentation. These are often referred to as “duck lips”. Natural-looking lips require a holistic view of the mouth/chin region. Often too little volume in the lip red itself is not the problem and for this reason, the lip white should be primarily treated during an injection. In most cases, an injection into the red part of the lips is then no longer necessary.

Injection with the tower technique

Depending on requirements, deep injection points are placed in the white of the upper and lower lip. Hyaluronic turrets are then injected into the tissue (the so-called tower technique) and this cushions the lip white from the inside. As there is an increase in volume due to the padding of the lip white, the lip red appears larger as well. In this way, the naturalness is preserved.

Smoothing wrinkles

In order to smooth out the small wrinkles around the red of the lips which cause lipstick bleeding, this region can be additionally treated with a finely cross-linked hyaluronic acid preparation. The hyaluronan is injected superficially, mainly along the lip margin, thus smoothing small lines. The injection takes place via tiny punctures at the corner of the mouth. The cannula is then moved back and forth, continuously releasing the low-viscosity hyaluronan, until the wrinkles disappear.

Just a slight prick

Modern hyaluronic acid preparations ensure that the hyaluronan decomposes more slowly than usual. In addition, some products now contain the anesthetic lidocaine, which makes the treatment almost painless for the patient. Since the effect of the lidocaine is immediate, only the slight prick at the beginning of the treatment is felt. The lip treatment lasts about 30 minutes and does not require any subsequent downtime. It is helpful to cool the area directly after treatment which also prevents the formation of smaller bruises.

Sponsered by Bellari – Lead photo © Shutterstock/ Ekaterina Jurkova

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