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  

Instant Youth - Non-surgical and Minimally Painful Liquid Face Lifts

Most people know what a face lift is, and they know for sure what they are getting when they ask for one. But many don't realise that you can boost and lift your facial areas to give a youthful, refreshed look without surgery. With a liquid face lift, also known as an injectable face lift, you can see and vet the results as the procedure is being done, and the pain is barely worse than getting your pimples popped or brows tweezed at the beauty salon. And the best part is you can walk out of the doctor's office looking years younger in as little as 30 minutes.

A liquid face lift is a combination of botox and injectable dermal fillers and can be used in conjunction with newer techniques such as platelet-rich plasma or thread lifting for more dramatic results. Dermal fillers, specialised gel-like materials that a qualified physician injects to plump up sunken areas, fill in deep hollows and furrows, and can also be used to shape and sculpt facial contours to give you plumper lips, a higher nose or more youthful facial contours. Botox is then given to erase fine lines, relax tense muscles and correct imbalances in facial symmetry and contour.

There are many dermal fillers available on the market, most for specialised uses, and it is up to a skilled practitioner to know the best one for your intended result. Softer materials spread out over an area, but thicker, more viscous dermal fillers are more suitable for a more defined result - for a defined nasal bridge, perhaps.

To lift and enhance youthfulness of facial features, these are some commonly treated areas -

• Tear troughs - the tear trough deformity is a groove that extends from the cheekbone or zygoma and extends out towards the sides of the face. It is especially obvious in advanced age, as the skin is pulled downwards by gravity and fat pads atrophy due to aging. Fillers can easily plump out the line, restoring the look of fullness to the lower eye area.

Before and after tear trough fillers

• Fuller cheeks - a youthful face is characterized by full, rounded cheeks, that are high up on the face, with little to no bony areas obviously seen. As the face ages and sags the contours of the face are flattened and become lax and pouchy. This can be explained by what cosmetic doctors refer to as the triangle of youth and pyramid of aging -the uplifted contours of the firm cheeks of a youthful person forms a triangle, which becomes inverted, a pyramid shape, as the process of aging causes sagging and downwards mobility of facial fat to the lower jaw areas.

Fillers can greatly help to address the loss of volume in the upper facial area, and restore the appearance of youthful fullness to the cheek areas.

• Shadows and lines - We can recognise the youthfulness of a person's face at a single glance, as we subconsciously register the shadows and lines especially in the temple, lower eye and mouth areas. This picture shows how light reflects off a youthful face, areas that can be augmented by botox and  fillers to enhance the youthfulness of your looks. 

Light reflecting from the brows, nose, cheekbones, upper lip,  chin and earlobes is one way we subconsciously examine the age of a person's face

This woman's before picture shows deep under-eye hollows and reduced fat in the cheeks and temples. A liquid face lift has improved the light reflections so she has the facial profile of a younger person

• Erasing fine lines and correcting muscle tension - Cares and worries as well as the constant use of facial expressions over the years leave their mark on your face that is as telling as a yellowed birth certificate.  Botox owes its amazing popularity and success tot he fact that it is the quickest, simplest, most reliable way of immediately turning back the clock. The frown lines, crow's feet and brow lines are some of the most common areas that give the best instant results.

Some of the areas where botox can be used to best effect to restore a youthful look

This woman's frown lines, crow's feet and smile lines give her an aged appearance that can be effectively and nonsurgically treated with Botox and fillers 

For dramatic results, a surgical face lift is still the gold standard, especially for those of advanced age from 50 and above. Nonsurgical methods are a good alternative for those who aren't yet in need of a face lift, or who would like to have milder, less invasive procedures that improve in moderation, giving you results that are impossible to achieve in a bottle or facial. For the best of both worlds, a nonsurgical, liquid face lift can lighten and energize your look, and the results look natural, not overdone.  

- 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.