Wednesday, October 5, 2016

Rested and wrinkled? Oh, the irony

Are the facial wrinkles, lines and folds that happen with aging result purely from the expressions we make? While skin distortion from facial expressions causes many, if not most, of the wrinkles we see on our faces with age, a new study suggests there’s a wrinkle (ahem) in that line of thinking. It turns out, as many experts in facial aesthetics have long assumed, wrinkles also result from "mechanical distortion" during sleep.

Plastic surgeon and lead author Goesel Anson, M.D., clinical instructor of surgery at the School of Medicine, University of Nevada, Las Vegas, and colleagues report in the study published online June 21 in the Aesthetic Surgery Journal that compression, shear and stress force factors result in facial distortion when people sleep on their sides and stomach.

These sleep wrinkles tend to be perpendicular to expression lines and they don’t respond significantly to animation, according to Dr. Anson. Common sleep wrinkles include the lateral oblique forehead crease, radial orbital crease, lateral (vertical) malar crease, medial cheek crease, nasal/lip crease, corner lip crease, oblique marionette crease, preauricular crease and inferior vertical cheek crease, according to the study.

American Society for Aesthetic Plastic Surgery President Daniel C. Mills, M.D., a plastic surgeon in Laguna Beach, Calif., says he has long suggested to patients that some of their facial wrinkles come from sleep positions, especially when patients complain that they have more wrinkles on one side of the face than the other. He’ll ask them how they sleep at night, and often the light goes off in the patient’s mind that, yes, those wrinkles show up on the side of their favorite sleeping position, he says.

“So, these are things that we see on a daily basis, but it’s very nice for the doctors to have written an article about this, quantifying it,” Dr. Mills says.

The researchers not only looked at wrinkles from sleep, but also potential facial skin expansion. Based on available studies, they didn’t find a direct correlation between facial distortion during sleep and skin expansion, Dr. Anson says. However, it’s a logical conclusion to draw from basic science literature and more research needs to be done on the subject matter, she says.

The Science of Sleeping Positions

In order to get a sleep wrinkle, you have to have contact with a surface, Dr. Anson says.

“So, back sleeping should not cause these wrinkles. But if you sleep in a side position or on your stomach, then you likely cause compression, which will likely increase your risk of having sleep wrinkles,” she says.

However, physicians who recommend their patients sleep on their backs to avoid the wrinkles might end up with frustrated patients. Dr. Anson and colleagues report that while initial sleep positions tend to be conscious decisions, most people unconsciously change positions throughout the night.

While wrinkles from sleep tend to increase with age, they are also influenced by the amount of time spent in various positions. Interestingly, the number of position shifts per night decreases as we age — from 27 to 16 a night, with an average of 20 nightly position shifts, according to the research. As a result, the time spent in each position increases with age.

That’s bad news for those who sleep predominately on their sides and stomachs, which is most people. According to the study, the lateral sleep position is the most common in studies, averaging 65%, while an average 30% of sleep is spent supine and 5% prone.

Sleep Wrinkle Solutions

Neuromodulators, the go-to wrinkle reducers that cosmetic surgeons use to treat expression-caused facial wrinkles, don’t work on wrinkles that are due to sleep, Dr. Anson says.

Fillers might help temporarily. But if patients’ wrinkles are truly from compression during sleep and the mechanical distortion continues after filler treatment, the results are unlikely to last long at all, according to Dr. Anson.

Dr. Mills says that it’s also possible that newer noninvasive cosmetic surgery treatments designed to promote collagen formation, such as radiofrequency and ultrasound devices, could help to make skin more resilient to wrinkles from sleep. And microneedling, he says, could increase the penetration of newer products that may also help with wrinkles.

“Even IPL has been shown to add a little more collagen to the deep dermis,” Dr. Mills says.

The logical solution, Dr. Anson says, is to limit the cause — the mechanical compression that comes from smashing our faces into fluffy pillows.

“There are several specialty pillows available these days, which help to minimize distortion during sleep,” says Dr. Anson, who has developed and patented such a product, called the JuveRest pillow.

“We have a small amount of unpublished data comparing a standard pillow to the JuveRest pillow. We see a clear improvement in distortion and wrinkles immediately. How that relates to long-term improvement is much more difficult to study due to the length of time required for those studies and many variables in sleep position,” she says.

Dr. Anson says that while she can’t draw the conclusion that using the JuveRest or any other specialty pillow designed to limit distortion will prevent or change facial wrinkles in the long term, it seems logical that it would.

“The argument is that this is all logical,” she says.

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