Tag Archives: plastic surgery

What Can Different Types of Facial Wrinkles Tell Us?

Few people enjoy having wrinkles. Some people spend a lot of time, money and efforts trying to reduce the wrinkles on their face, while others simply appreciate them as something naturally occurs with aging. Regardless, wrinkles are always associated with aging. However, if we look into what different types of wrinkles are and how they form, we will find that not all wrinkles are bad. Not all wrinkles are caused by aging, and not all wrinkles should be treated the same way. Here, we introduce different types of facial wrinkles categorized by plastic surgeon and their corresponding treatment.

A person smiling that shows some wrinkles on her face.
The wrinkles created by the motion of smiling are dynamic wrinkles. They will disappear once the smile stops. Credit: Masterfile.

In general, there are two main types of wrinkles, dynamic wrinkles and static wrinkles. Dynamic wrinkles are the type of wrinkles that only appear when you make expressions such as smiling, laughing, or frowning. These wrinkles disappear once your expressions stop. The facial muscles have enough elasticity to return to their original positions. These are temporary wrinkles that everyone may have, even little kids!

Static wrinkles, on the other hand, are wrinkles that form when your muscles cannot return to their original position due to gravity and loss of collagen and elastin. These wrinkles cannot disappear like the dynamic wrinkles. When the collagen fibers become thinner, the skin loses elasticity and gets more wrinkles, whose width and height grow with age. (Lemperle, 2001) Lemperle et al. from the University of California put these wrinkles into three categories.

Three hand-drawn figures that show textures of different wrinkles.
Figures that show the textural change of skin experiencing (a) superficial wrinkles, (b) mimetic wrinkles, (c) folds. Source: A Classification of Facial Wrinkles.

The first type is superficial wrinkles. These are the less severe wrinkles that only involve textural changes of the skin surface. These wrinkles lines are separate lines at first but will gradually group together. (Arumugam, 2015) Common causes are aging, excessive exposure to UV light, and gravity. Superficial wrinkles, according to Lemperle, can be reduced or removed by chemical peeling (applying chemical solution on the face to peel off the top layer and then grow it back), or laser resurfacing. (Lemperle, 2001)

A figure with 2 side-by-side photos that show the effect of laser resurfacing before and after the treatment. The wrinkles of the person's face reduces.
Before and after laser resurfacing. Credit: Tahoe Aesthetic Medicine.

The second type is mimetic wrinkles. These are more severe and visible dermal creasing. Major causes include aging and repeated dramatic facial expression. (Arumugam, 2015) Because the facial creasing is deeper, the reduction methods include more complicated procedures such as muscle resection (cut out a portion of muscle and inserted the shortened muscle at the same place), botulinum toxin (a neurotoxic protein), or skin filler injection. (Lemperle, 2001)

The picture shows a person's lower half of the face with dash line indicating where the nasolabial line is. A needle is pointing at the dash line mimicking the process of skin filler injection.
Skin filler injection to reduce the effects of nasolabial lines. Credit: Filling in Wrinkles Safely

The last type is folds, the part of the face where droopy skin overlaps. Folds and mimetic wrinkles usually occur together. To correct the overlapping skin, tightening procedures such as blepharoplasty (surgery that repairs droopy eyelids), face lift, or skin excision are needed. (Kligman, 1985)

Noticeably, researchers have discovered that wrinkles formation may be different by gender, race, etc. For example, women in general have finer and less apparent wrinkles than men because their skin is thinner and softer. (Wu, 1995) Asian skin connects more firmly to the tissues underneath because of its thicker dermis and higher collagen density. Therefore, the repetitive pulling of the skin surface affects wrinkles on Asians and Caucasians differently. (Ahn, 1999)

Wrinkles are nothing horrible. They are something that everyone has or will have in the future. There is nothing wrong with wanting to reduce the wrinkles on your face, either. Just remember that there are many types of wrinkles and each of them requires a bit of a different treatment. Spending some time finding the appropriate treatment will most likely save you more time, money, and effort in the future.

Sources:

[1] Lemperle, Gottfried, et al. “A Classification of Facial Wrinkles.” Plastic and Reconstructive Surgery, vol. 108, no. 6, 2001, pp. 1751–1752., doi:10.1097/00006534-200111000-00050.

[2] Arumugam, P, et al. “Facial Forehead Wrinkles Detection using Colour based Skin Segmentation.” Advances in Natural and Applied Sciences, Aug. 2015, pp. 71–80., doi:10.22587/anas.

[3] Kligman, A.M., et al. “The Anatomy and Pathogenesis of Wrinkles.” British Journal of Dermatology, vol. 113, no. 1, 1985, pp. 37–42., doi:10.1111/j.1365-2133.1985.tb02042.x.

[4] Wu, Yin, et al. “A Dynamic Wrinkle Model in Facial Animation and Skin Ageing.” The Journal of Visualization and Computer Animation, vol. 6, no. 4, 1995, pp. 195–205., doi:10.1002/vis.4340060403.

[5] Ahn, Ki-Young, et al. “Botulinum Toxin A for the Treatment of Facial Hyperkinetic Wrinkle Lines in Koreans.” Plastic & Reconstructive Surgery, vol. 105, no. 2, 2000, pp. 778–784., doi:10.1097/00006534-200002000-00050.

This Toner Might Be More Expensive: 3-D Printing Artificial Organs

For most people in the United States who need an organ transplant, they will need to wait an average of three to five years on a list before they can get a lifesaving surgery. On average, 20 people die daily waiting on this list. There is a possibility of being able to bypass the wait time by manufacturing the required organs with 3D printing. This manufacturing technique was first used in the medical field for prosthetics and surgery practice models, with a goal to create fully functioning organs for those in need. Instead of using plastic or printer ink, the 3D printer uses cells to create biological constructions. 

A biological 3D printer making a small model of a human heart
Biological 3D Printing Market Update Photo

Traditional methods of artificial tissue and organ creation involve the use of stem cells, which are cells that do not have a designated purpose yet, to create a scaffold or frame for the organ. If cells for a desired organ are placed on the appropriate scaffold, they could multiply and grow into an artificial organ over time. If 3D printing is implemented using the same scaffold procedure, cells could be placed more precisely; the cell diameter can be better controlled, and the speed of the process can be controlled digitally. All of these aspects allow for better replication of the complex networks and structures found within biological tissues. A major advantage of the 3D printed organs are the customizations and variability that can be implemented with the method. Implants can be made to different sizes to suit each unique individual. If the original cells used for 3D printer material are from the intended recipient, the compatibility of the implant or artificial organ is nearly guaranteed. The risk of organ rejection is always present in the time following a transplant operation. 

A man who received 3D printed skull implants following deformation from a bicycle crash.
Xilloc Medical Before and After Photo

The 3D printing process is near perfect for certain medical uses, such as prosthetics, and dental implants, but more work needs to be done with the printing of tissues and organs. Small simple organs with thin walls can be done but printing larger organs such as hearts and kidneys requires integration of the vascular network, which cannot be done at this time. As printers become more precise and able to use a higher variety of cells, the creation of these vascular networks becomes more and more plausible. 

Scientists are currently investigating a new way to print these complex organs by combining organic material with mechanical chips. These chips are able to replicate certain biological stimuli, including fluid flow and chemical gradients, in order to achieve some degree of organ function within a much simpler biological structure. Using these chips will allow for better mass production of a variety of tissues and organs. This particular technology is being used to create tissues that will be used for testing pharmaceutical drugs. There is an opportunity for these tissues to be expanded to use in the human body, but the majority of companies using this technology are still in the startup phase. 

            While the use of 3D printing to create complex artificial organs is not completely viable today, the technology is improving rapidly. Within a few years, the waiting times and problems with organ transplants could be a thing of the past.