It is common knowledge that healthy skin is rich in the protein called collagen.
It’s generally well understood that collagen in the skin progressively diminishes with
age.
This of course has created a lot of opportunity for businesses to sell products and procedures
to restore collagen in your skin.
The marketing of creams, supplements, and devices has created many misconceptions about
collagen.
I’ll discuss some basic principles about collagen and how I help my patients with their
skin in my practice.
I’m Dr Amiya Prasad.
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Facial skin rejuvenation has been an important part of my practice throughout my career.
In fact one of the first injectable products I used was Zyderm and Zyplast, which were
referred to as collagen injections.
It is routine for me to perform rejuvenation procedures such as facelifts, eyelid surgery,
and implant placement.
Whether it is part of a surgical rejuvenation or an office procedure, I routinely perform
various treatments to stimulate collagen including lasers, radiofrequency technology, microneedling,
skin boosting, and platelet-rich plasma or PRP.
Where does collagen actually exists in the skin?
Most people I see in my practice are familiar with the layers of the skin called the epidermis
and the dermis.
On the face, the skin is about 2 mm in thickness with the eyelid skin being only about half
a millimeter in thickness.
The dermis is the deeper layer and is the foundation.
You can think of collagen as cables of protein, which support the skin’s foundation.
As mentioned earlier, a natural cause of progressive loss of collagen is aging.
It is generally accepted rule of thumb in the medical community that you lose 1% of
your collagen in your skin every year after the age of 20.
There are other factors, which can further decrease the collagen in your skin.
These include smoking, excess sun exposure, in door tanning, many medical conditions particularly
those associated with systemic inflammation, nutritional deficiencies, and environmental
toxins.
The take home message is to first focus on ways you can prevent the acceleration of collagen
loss.
Understanding that collagen is a protein which is made inside the body should be a guiding
principle to address 2 common things people do which is not productive.
The first is the application of creams, which are often very expensive which claim to contain
and thus deliver collagen to your skin.
These creams may be decent moisturizers but they cannot deliver collagen into the dermis.
Fine lines may appear to improve instantly after application due to the moisturizers
and concealers in the product.
Most over the counter creams are cosmetics, not pharmaceuticals.
They are sold with slick marketing and attractive packaging.
Put these same products in no frills containers and all you have are generic moisturizers.
A similar concept is the sale of collagen capsules as supplements.
The claim is that by ingesting collagen in capsule or pill form, the collagen will find
it’s way to your skin.
As mentioned earlier, collagen is a protein.
A protein is made up of amino acids.
As is the case with any protein you eat, your digestive system breaks down the protein into
amino acids therefore there is no advantage in taking collagen capsules over any other
protein source with comparable amino acid composition.
It is a common belief is that facial aging is limited to the skin.
This belief has been reinforced by decades of cosmetics advertising.
This is not the case.
The most significant effects of facial aging is found at the bone structure level.
This has been well established in the medical literature.
This volume loss contributes significantly to the appearance of your skin.
With this understanding, I approach facial rejuvenation from the inside out.
For example, I routinely perform a procedure where I place long lasting hyaluronic acid
fillers at the bone level.
This is essentially using the principles of facial implant surgery to the placement of
fillers.
We refer to this as structural volumizing.
When volume is restored, the skin looks better and facial balance is restored.
Youthful skin is characterized by even color, smooth texture and luster.
Once again, thinking about skin from the inside out, it’s important to understand that the
soft and youthful appearance of younger skin is not just a function of the epidermis and
dermis but also the layer of fat and blood supply under the skin called the subdermis.
A healthy subdermis is critical for healthy skin.
It’s a common perception that skin is a simple covering for your body when actually
your skin is a structure with nerves and a blood supply.
It’s a living organ.
This means that your general health and your lifestyle has a direct effect on your skin
the same way as it would on your heart and your lungs.
Simply, your skin benefits from stress management, exercise, healthy diet, and avoidance of cigarette
smoking and excess sun exposure.
In my practice, I help my patients with the subdermis using PRP or platelet rich plasma.
PRP or Platelet rich plasma is a concentration of the wound healing and growth factors in
your blood, which are recruited for injury repair such as when you have a cut.
This results in improvement in the blood supply to the skin as well as the quality of the
fat cells that are directly below the dermis.
When you look at someone whose young, the skin has a soft and lustrous quality, which
is often referred to as “baby fat”.
With this understood, it makes sense to strategically use PRP to enhance the quality of your skin
from the subdermis level.
The level of the epidermis and dermis which is in total about 2 mm in thickness or essentially
what we all see from the outside is where the cosmetics industry, the injectables manufacturers,
the laser and related technology industries and of course the professional medical retailers
are all claiming to have the ultimate solution for this 2 mm thick structure.
This is where the collagen induction strategies are all focused.
Whether it’s microneedling, dermabrasion, laser, ultrasound, or radiofrequency, the
goal of any given procedure is to induce your skin to produce collagen.
This is based on the skin’s ability to produce collagen as a response to an injury.
I’ve observed from seeing patients who’ve had one very aggressive treatment such as
an ultrasound, which heats the skin to a high temperature, described as very painful that
the patient’s skin actually looks thin.
These same patients feel that they look older after this treatment.
The same description is applicable to people who’ve had multiple different lasers done
by multiple different practitioners.
When each technology creates an injury to the skin to stimulate collagen production,
does anyone ask the question, is there capacity for the skin to respond effectively to the
treatment?
It looks like that question doesn’t get asked and there’s more of a hope and see
what happens attitude.
In states like New York where I practice, there is no law requiring only licensed professionals
like doctors to perform these types of procedures.
This has resulted in many non-physicians being either delegated or working independently
without the benefit of an experienced MD overseeing directly onsite the patient’s treatment.
So how do I help my patients who want more collagen in their skin in my practice?
I perform a thorough history and physical examination as well as take high resolution
digital photos including using techniques such as backlighting for people who have acne
scars.
Since a lot of devices are being marketed and claim to induce collagen to a level where
the face is lifted without surgery, I provide my patients with a full understanding of my
inside to outside approach.
This means understanding bone volume loss, loss of fat and volume in the subdermis and
the specific characteristics of the dermis and the epidermis.
When it comes to the skin being only 2 mm in thickness and the health of the subdermis
being very important, I look to create a treatment plan, which looks at the long term effects
and benefits.
In order to have a successful strategy, there are some key elements to treatment which every
patient I see needs:
1) There should be minimal discomfort 2) There should be minimal or no downtime
3) There should be a highly predictable outcome
In terms of the devices which improve skin quality through collagen induction and remodeling,
I use a radiofrequency technology as well as a long pulsed Nd:YAG laser technology.
These devices do apply progressive temperature elevation to induce collagen production and
remodeling resulting in skin tightening and when desired, fat reduction.
Both of these technologies are well tolerated and patients come back for additional treatment
without hesitation.
The dermis is the level of the skin, which provides a foundation for the epidermis.
When this foundation is weak, lines and wrinkles form.
I routinely use nonablative laser technology where the collagen remodeling is induced without
removing or creating holes in the top layer of the skin.
In addition, I use this technology to treat discolorations, which are often associated
with the fine lines and loss of collagen caused by excessive sun exposure.
There’s usually no downtime and I’m able to help my patients improve the skin thickness
and color.
We refer to this as laser skin toning.
In the spirit of avoiding overheating or over traumatizing the skin to induce more collagen,
I developed a process where I use micro channel technology to deliver PRP and Hyaluronic acid
directly to the dermis without any bleeding or bruising which we call skin boosting.
I’m inducing significant collagen production and improving skin quality with better circulation
without causing any injury to the skin.
In areas of the skin such as the eyelids, I often use laser technology such as long
pulsed Erbium laser and Fractional CO2 laser.
Closing: Throughout my career, I’ve observed a trend
where industry first influenced doctor’s purchasing of devices such as lasers by hiring
so called thought leaders in dermatology to peddle their lasers.
In the past several years, they’ve taken it to a new level where they create brands
of devices and market aggressively to consumers to create pressure on doctors to buy or lease
these devices.
This creates more of a business transaction focused attitude toward people who seek to
have these latest and greatest procedures.
Paid celebrities further create even more hype.
I see this as hijacking the judgment of the physician for profit and effectively forcing
practitioners to feel obliged to get these devices who then push their patients through
treatments to meet their financial obligations.
I look at things in a simple way.
If a laser or device is going to be useful, I don’t lease it.
I buy it outright.
I look at the technology as a tool, which I use when it’s appropriate, not because
it’s the literally “hot” treatment of the week.
For the medispa or any practice where surgery or other options are not available and that
“hot” treatment of the week is now a monthly expense, well, you know what the “best”
option for anyone who walks in will be.
As a surgeon focused on facial aging solutions, I provide my patients with a comprehensive
approach without any bias.
I look at achieving healthy skin the way I look at muscle building.
Apply safe and predictable approaches and always think long term.
I hope you found this information helpful...thank you for your question