Collagen Supplements - Do They Really Work? What Does?



Old or young? The difference is collagen

I've had many patients come to me and say they take excellent care of their skin,with a regimen that includes regular beautician visits, expensive skincare and that latest must-have - collagen supplements. Usually available in a drink, and costing up to USD100 per bottle, these supplements are not cheap, but come with a lot of promises for prolonged beauty and general health.

 

Collagen - is it really so important?

Collagen is a natural protein component of the skin that acts like a scaffold and the main building block for cells, tissues and organs. About a third of the protein content in your body is made up of collagen, which is found in the bones, muscles, and tissues of the organs. Collagen, keratin and elastin give the skin its strength, elasticity and structure.

The body naturally produces the collagen that it needs, but this production is gradually disrupted as part of the natural aging process. Women produce less collagen than men, and this collagen is lost at a rate of about 1% per year. This means that a woman has naturally lost almost half of the collagen from her skin by the age of 50.

Collagen is also greatly affected by environmental stresses such as sun exposure, nutrition, skin damage, and exposure to toxins such as pollutants, cigarette smoke and recreational drugs. With decreased collagen, the skin loses its natural elasticity and firmness, and fine lines, wrinkles and sagging appear.

 Poor collagen levels also affect the bones, and this picture (right) shows how collagen loss affects facial shape in extreme age degeneration.

Here's to your youth - anti-aging drinks claim to deliver beauty in a bottle, but do they really work?

 

Collagen supplements claim to offer a range of benefits, including

• reducing wrinkles
• reversing age of skin
• tighter skin
• plumps up skin
• improves skin elasticity

The truth is, however, that there is little to no evidence that beauty supplements, pills and drinks can do what they claim. Collagen is a type of protein which when ingested, is broken down by the digestive system into individual amino acids to be recombined by cells according to their needs.  

So many companies have jumped on the collagen bandwagon that it is very hard for consumers to realise that there is actually no scientific proof that collagen supplements have any effects on skin health and appearance at all. There is no guarantee that drinking collagen drinks would be any more effective than any source of protein such as meat, cheese, eggs or beans at restoring the collagen in your skin.

So if you can't get collagen through a drink, what about collagen in skin care products? Most collagen molecules applied to the skin in lotion, cream or gel forms are far too large to be absorbed into the dermis - they merely lie on the surface and get washed or rubbed off. There are some companies that are selling micronized collagen which are meant to be small enough to be absorbed into the skin, but it is unlikely these micro molecules would be in any form useable by skin cells. It is also highly likely that any collagen that actually manages to penetrate the skin would be challenged by the body's immune system as a foreign body. They would either cause an allergic reaction or simply be destroyed by the white blood cells before they manage to be of any benefit to the skin whatsoever.

What really works?

The abundance of collagen supplements on the market tells us that many people are genuinely concerned about their skin health. So, based on the best dermatological and anti-aging expert advice, what can be done to ensure we show up at our 20-year school reunions with our best faces forward?

Reduce collagen degradation
To ensure sufficient collagen in the skin, first prevent loss of the collagen that you already have. If you are not already on a proper sun care regimen, that should be your first priority. Studies have shown that sun protection is one of the most important ways in which you can combat aging. Cigarette smoke, like sun exposure, has also been shown to greatly degenerate collagen, and there is also evidence that improper and insufficient sleep has a negative effect on skin health. Read more about tips for choosing a good sunscreen in this previous post.

A nutritious diet
Eating the right foods and getting good sources of antioxidants from fruits and vegetables is very important for collagen production. Brightly coloured produce such as tomatoes, grapefruit and watermelon contain the powerful antioxidant lycopene, which helps prevent collagen degeneration. Fruits such as oranges, strawberries and red peppers also contain Vitamin C, something that is key for the optimum condition of the skin. Vegetables such as broccoli, leafy greens and cauliflower provide our skin with glucosinolates, which fight the free radicals that attack our collagen. Also key to skin health is the omega-3 fatty acid known as eicosapentanoic acid or EPA, which has anti-oxidative and anti-inflammatory effects to help protect and heal the skin. Omega-3 is readily available from food sources such as oily fish and spirulina. Avoid starchy foods and sugary substances; this helps
reduce inflammation which interferes with the body's natural collagen production processes.

Proper skin care
The right skin care helps regulate the optimum skin condition so that it is protected from extreme stresses. What works? Regular exfoliation with a gentle exfoliator scrub, or with alphahydroxy acids (AHAs) can help to 'exercise' the skin, and ensure healthy cell renewal. Skin care products that have been proven to help combat aging include products that have antioxidant properties, examples of which include green tea extracts, coffeeberry and DHEA. Try products with retinol, a Vitamin A derivative, sometimes known as Retin-A, which works to both stop collagen degradation from the effects of UV exposure while boosting collagen production.


Collagen Stimulating Dermal Fillers
Hyaluronic acid, a natural water-binding component of the skin, helps to stimulate collagen production by surrounding fibroblasts - the skin cells that produce collagen  - with plenty of water. As the skin ages, this important component of the skin also suffers a decline. 
 
Researchers at the University of Michigan medical school found that Restylane injections (Restylane's key component is hyaluronic acid) not only stimulated the fibroblasts around them to increase collagen output, but also seemed to be protective of the existing collagen in the area as well. The two top hyaluronic acid dermal filler brands are Restylane and Juvederm, and they work by immediately filling the area to plump out lines and wrinkles. The effects of the filler are enhanced by the collagen stimulation, so patients tend to need repeat sessions less frequently. 

Just like hyaluronic acid, poly-L-lactic acid or PLLA, has been shown to stimulate collagen growth. PLLA is a major component in Sculptra dermal fillers, which are injected deep into the dermal layer in a three-session treatment program which lasts up to two years. Sculptra has been proven to correct both collagen loss and fat atrophy, and is also FDA approved for AIDS patients who have severe cheek lipoatrophy (fat loss).

Radiesse, which has calcium hydroxylapatite as its collagen stimulating active ingredient, is another dermal filler that works very effectively in restoring volume in patients with deep lines or sagging skin. The effects of the collagen stimulation allows the volumising effect of Radiesse to last for about 12 months or more. 

Laser and RF collagen stimulation
Collagen production slows with the aging process, but where the skin is injured, collagen production is increased as part of the skin healing process. Aesthetic equipment such as carbon dioxide and Fraxel lasers, and radiofrequency modalities such as Thermage and Ultherapy all work by subjecting the skin to controlled damage, so that collagen renewal can be stimulated. All of these methods work very well to tighten the skin and improve its appearance, although lasers are designed to stimulate regrowth on the surface and epidermal (top layer) areas, and radiofrequency skin tightening works in the deeper dermal areas for greater wrinkle and line rejuvenation.



- Cosmetic Medicine, MD


Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or drop him an email at cosmedmd@gmail.com  

How To Age Like A Celebrity And Look 30 Forever

There are some lucky people who never seem to face the ravages of time. Celebrities like Madonna, Tina Turner and Demi Moore are some examples, and despite being over 50, they manage look better than people 20 years their junior.

Christy Brinkley will celebrate her 58th birthday this year, but  her looks remain forever 30.

Aging is a process that is greatly affected by genes, environment, sleep habits and diet to name just a few factors, but since this is a cosmetic medicine blog, and my patients come to me to reverse the effects of time rather than prevent them, let's examine exactly how a face ages.

As the face ages, it undergoes significant and visibly identifiable changes

As the face ages, it undergoes significant and visibly identifiable changes. It begins with weathering of the skin, and changes to the texture, transluscence and variance in skin colour in the mid twenties. By the mid thirties, furrows and lines are visible in forehead and near the eyes. Loss of fat from the temples and upper cheeks may show by the age of forty, and the undereye area is one tell-tale sign of aging as the skin begins to sag and pouch. The neckline is also an age giveaway as it becomes loose and baggy during the fifties. By the sixties, the skin is noticeably lined and very loose and saggy as the cheek fat atrophies.

How to Turn Back The Clock

1. Loss of volume
Lipoatrophy, the loss of fat in the underlying facial structures means the facial skin begins to sag, the cheeks become sunken and gaunt, facial shadows become more pronounced and lips become flatter and thinner, jowls appear on the sides of the face, and the neckline is visibly looser.

The Fix: Thread lifting, fillers, Thermage

Thread lifting for jowls and sunken cheeks




Fillers for deep lines and for plumping cheeks, lips and sunken areas

Thermage for overall facial rejuvenation and collagen remodelling

2. Skin texture and pigmentation
Environmental effects such as sun exposure and air pollution, as well as hormonal changes and effects of diet all play a part in the appearance of the skin as we age. The skin also gets thinner and fine lines appear, while melanin deposits and surface damage all contribute to obscure the glow of healthy, young skin.

The Fix: Skin resurfacing

3. Wrinkles and lines
Wrinkles appear in forehead, eye, cheek and around the mouth, as a result of the loss of fat and also due to constant muscle movements.

The fix: Botulinum-A injections


There are many exciting techniques for holding back the ravages of time, and ensuring you look your best, even into your 50s and 60s. These treatments are best used in combination, for a natural look that is purely you, but just younger, brighter and refreshed, so you too, can look and feel like a star, no matter your age.

Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

Looking Younger without Surgery

Nobody enjoys the process of growing old, and it is especially distressful when external factors such as sun, pollution, stress, poor sleep habits and so forth cause premature aging of our skin. Fortunately science can lend a helping hand and erase or minimize the damage. From wrinkles, to lax skin, pigmentation and deepening lines, the signs of aging are thankfully very easily dealt with, even if you are hesitant to undergo surgery. If you're looking to improve the ravages of time on your complexion, here is a short list of some of the most popular non-surgical options available out there.

1. Botox
Botox is the most popular anti-aging treatment available, and for good reason. Just one session with your doctor will give you 6 - 9 months free of wrinkles and lines, and at about the same price as a set of branded anti-aging skin care products. It is quick, about as painful as a paper cut, and can make you look 5-10 years younger in a matter of days.
Botox has always suffered from a poor reputation as some people have had bad experiences, but in the hands of a trained professional, the results you get will amaze you. Some people are concerned about getting 'addicted' to Botox, but I find it comparable to a maintenance regime not unlike having a regular facial or haircut. Botox is also useful in the treatment of headaches, neck and back pain, muscle spasms and bladder disorders, which is always helpful when age starts to create more physical concerns in areas other than the face.


2. Fillers
Fillers and botox are almost like husband and wife; they complement each other and work together to create a harmonious effect. Botox works to relax muscles and smooth out wrinkles while fillers work by volumizing deep facial furrows such as the naso-labial folds and deep glabellar lines (frown lines). Fillers are also effective in increasing the fat pads on the cheeks and the sides of the forehead, to reverse the effects of gravity. Fillers can also be used to reduce lines around the lips, volumize the lips, plump up sunken under-eye areas, and have been used to replace lost fatty deposits in areas such as the breast and buttocks. There are too many filler brands to count, such as Radiesse, Juvederm, Restylane, Esthelis, Macrolane and many more. Different fillers are indicated for different uses, but in general are all very successful at volumizing lines, wrinkles and sunken areas. Sculptra is one that is especially designed for long-term re-volumizing, and helps to boost collagen production as well as fill in sunken areas.


3. Skin Tightening & Lifting Therapies
Skin tightening and lifting is important as gravity and collagen loss create the sunken areas and deep lines that are seen on aging faces. While a face-lift will always provide the most dramatic results, a range of non-surgical therapies such as Thermage, Ultherapy and Exilis are available.
Thermage burst onto the scene about 6 years ago with its promise of non-surgical, non-invasive skin tightening, with a single treatment, no less. Since then, Thermage has become a brand icon, and it has expanded its range from lifting skin on the face, neck and eyes to upper-arms, hands, abdomens, buttocks and thighs.
Thermage works by using radiofrequency waves to heat up the collagen in the skin and produce a rejuvenating, tightening effect. Results are not immediate, but the treatment gives a progressive uplifting effect as the collagen remodels over the next few months. Some patients report an improvement in their facial wrinkling and overall condition of the complexion as a pleasant side effect of the treatment.
Exilis is another therapy that utilizes radiofrequency (RF) to target collagen deposits and boost their production. Commonly used in the facial, neck, decolletage, abdomen, thighs and buttock areas, Exilis is also effective in spot fat reduction. A typical course is 4-6 sessions, and is a quick and painless way to more youthful, tighter skin.
Ultherapy uses ultrasound waves to similarly heat up and remodel collagen, helping to tighten brow lines, smoothen skin on the cheeks, lift sagging eyelids and refresh the overall look of the face, results which are visible from the second or third treatment.
While these skin tightening therapies are not indicated for the elderly where collagen is very minimal, or for those who are severely saggy due to extreme age or weight loss, they can restore youthful tone and give a refreshing uplift for those who are just starting to notice the ill-effects of aging and poor skin care.

4. Fractional Laser Resurfacing
Laser resurfacing modules work by damaging the top most layers of the skin to remove fine wrinkles, pigmentation and scars. Fractional laser resurfacing means that instead of treating all of the skin surface at once, only a fraction of the surface is treated, so pain is manageable and healing is faster. Examples of these treatments are Fraxel, Pixel, ProFractional and Mosaic, which all work in the same way to remove the top-most problematic layer, and allows the growth of younger, healthier skin in its place. A further benefit of this treatment is that skin texture and tone will also improve.

Fraxel - Before and After

5. Platelet Rich Plasma
Plaetelet Rich Plasma therapy involves the use of a patient's own blood, from which platelets are extracted and re-injected into facial areas to boost collagen production. Generally, treated areas include the cheeks, peri-ocular (around the eyes), neck, decolletage, jaw line and back of hands. Results include improved skin texture, tone and overall appearance. Platelet-rich plasma is an established medical procedure which has been used in long-term pain management, joint healing and a proven record in facilitating healing.

5. Stem Cell Therapy
As stem cells are the body's own healing components, stem cell therapy has been hailed for its ability to improve the body's overall condition. Promised results include a better complexion, thicker hair, brighter eyes, improved memory and libido, greater energy and stamina and a better general well-being. There are various methods used in stem cell therapies, from stem cells extracted from a patient's own fat or bone marrow, or in some procedures, using stem cells collected from human or even animal embryos.
While scientific evidence is still contentious as to the true value of such treatments, many are convinced of their anti-aging and medicinal value. This article on USAToday.com highlights just one such satisfied customer, a baseball player who amazed his fans with his brilliant sporting performance after undergoing stem cell therapy.

- CosMed, MD