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Sagging Skin Solutions – Dr. Nedic

Sagging Skin Solutions – Dr. Nedic


Dr. Nedic reports on the new aesthetic procedures which have been created to curb gravity and keep one looking younger for longer…



Sagging Skin Solutions

Dr Sly Nedic reports on the new aesthetic procedures which have been created to curb gravity and keep one looking younger for longer.

There are many signs that skin is ageing, including laxity (sagging), wrinkles, various signs of photo-ageing (redness and dyspigmentation), solar keratosis (abnormal growths) and poor texture. Sagging (laxity) is the one that drives the majority of ageing women into aesthetic practices, as they can’t cope with the jowls that they have developed over time. Collagen, which is situated in the deep dermis, is the main component responsible for giving skin its properties of strength, extensibility and elasticity. When it starts breaking with age, skin laxity occurs. The skin begins to irreversibly sag, creating that older look with visible jowls and flattening of the cheeks.

Collagen is a group of naturally occurring proteins found in connective tissue, and makes up about 35% of the body’s total protein content. That explains why sufficient protein intake is important to prevent skin sagging. The fibroblast is the most common cell that produces collagen, which is why any aesthetic procedure that enhances fibroblast function (like Mesotherapy or LED phototherapy) should be used to prevent skin sagging, and for maintenance after aesthetic procedures that tighten skin laxity.

All types of collagen are a triple helix structure, which means that they require Vitamin C for their synthesis, especially the production of pro-collagen. As detailed in medical literature: “Prolonged exposure of cultures of human connective tissue cells to ascorbate (Vitamin C) induces an eight fold increase in the synthesis of collagen” (Morrat et al.,1981). So supplementation with Vitamin C is an essential part of the holistic approach to treating sagging skin.

There are 28 types of collagen in the body, and their production is genetically determined, but the most important ones for skin functions are type I and III. In fact, aesthetic devices like RF (radio frequency) are used to enhance collagen type III – the collagen of granular tissue, which is produced quickly by young fibroblasts before the tighter type collagen I is synthesised.

The RF treatments usually used for this
purpose are:

  • Monopolar RF for face and body like Thermage™
  • Bi-polar radio frequency for the body like Velashape
  • Tri-polar radio frequency for the body and face like Tripollar®

A similar effect is also achieved using tailored infrared light called Titan™. These aesthetic procedures help the new production of collagen over six months, leading to the best end-results only after this period of time. The patient needs to understand that while this collagen production is awaited, factors leading to breaking of collagen must be diminished. These are stress, hormonal ageing and sun exposure. Sun exposure is the one that many patients think that they are keeping in control by using good sunblock. The problem is that even the best sunblock will only control UVA and UVB rays responsible for photo-ageing, but will not stop the infrared spectrum (it os though, available in the European market). Infrared radiation, which accounts for 54% of the sun’s radiation, penetrates much deeper into the layer where collagen is situated, increasing expression of the MMP 1 endopeptidase, which breaks down collagen type I rapidly. This infrared radiation (mainly type A) is responsible for reduced firmness and increased sagginess due to sun exposure. Luckily nowadays we have skin products that can decrease MMP 1 activity and reduce dangerous IR(A) effects.

Procedures that simulate lifting but not targeting collagen Knowing that sagging skin is a product of damaged collagen structure, the holistic approach would be to build a new structure externally with aesthetic procedures and internally with supplements, stop further breaking by addressing stress, hormone replacement and sun exposure. That would be the ultimate goal in achieving that lifting effect.

Sometimes we use treatments that simulate the lifting effect, but don’t truly increase collagen production. These procedures are 3D facial remodelling with Voluma-Juviderm filler, which can simulate lifting, Liquid Facelift using Botox and fillers that can give a lifting effect. In more advanced cases a facelift would be used, which usually involves the removal of excess facial skin. These procedures simulate the lifting of sagging skin but they don’t directly enhance collagen production.

Dr Nedic use the following holistic protocol
for sagging skin for a patient aged 45 – 50

  1. Thermage or Titan to enhance collagen production on the face or Tripollar®, Velashape or Thermage™ for body sagging
  2. Vitamin C (Double Vit C by Solal), good protein intake (Metagenics Whey protein) and Metagenics Collagenics, a collagen supplement
  3. Bio-identical hormone replacement and stress control supplements.
  4. MMP 1 control by using Skinceuticals, a Dermogenetic test to check MMP 1 expression and control of Infrared A radiation.
  5. Voluma and Liquid Facelift for instantaneous results while waiting for long-term collagen production.