Is an anti-wrinkle pillow the secret of this Hollywood star's beauty?

Avantika Bhuyan explores what 32-year-old star Mandy Moore's actions tell us about the tyranny of anti-ageing regimes.

Some time ago, the news of American actor-singer Mandy Moore buying an anti-wrinkle pillow rekindled the conversation about ageing. Barely 32, the actor of the popular show, This Is Us, was seen carrying an "age-defy pillow" that supposedly "fights wrinkles while you sleep".

After vitamin-infused day-and-night creams to products infused with everything -- from donkey milk and snail slime to animal placenta -- the skincare market now seems replete with satin-finish special pillows that can cost up to ₹30,000 a piece online.

The anti-ageing market's arsenal also includes devices that claim to smoothen wrinkles and tighten the skin.

Surf online and you're likely to stumble down a rabbit hole of products that claim to battle signs of ageing.

Handheld and home-friendly, somewhat like blow-dryers and electric shavers, they boast of ergonomic designs and also come in candy-pink colours. Touting everything from vibration massages and ultrasonic waves to radio frequency, these claim to tighten skin and boost collagen, promoting "youthfulness".

There are LED light therapies, face toning devices, wrinkle removers, micro-needles and electronic cocktails -- a little something for anyone besotted with looking young.

While they aren't as friendly on the pocket as they claim to be on the skin, these do-it-yourself therapies have their share of takers.

Smita Khurana (name changed on request), 35, for example, recently got botox and derma fillers (for filling creases and lines, and enhancing facial contours), and is now toying with the idea of doing collagen inductions (for thicker, firmer skin) at home.

Dermatologists and cosmetologists are also seeing increasingly younger people coming to them.

Rinky Kapoor, cosmetic dermatologist and dermato-surgeon at The Esthetic Clinics in Mumbai, says while 40- to 60-year-old men and women are known to seek these therapies, now 35-year-olds are also showing up at her clinic.

In fact, Kolkata-based dermatologist and dermato-surgeon Koushik Lahiri says, "I see girls and boys as young as 15 seriously concerned about wrinkles."

It is no wonder then that anti-agers registered a growth of 16 per cent in 2016, with sales of ₹5.6 billion in India, according to Euromonitor International, a market research provider.

The innovations the field has seen are mind boggling.

Anup Dhir, senior consultant (cosmetic surgery) at Apollo Hospital, New Delhi lists some: ablative laser rejuvenation, which helps with fine wrinkles, HIFU ultrasound treatments that take care of facial sagging, PRP injections to help renew skin and smoothen tone, fat injections to help refill the sagging face, and more.

People are also leaving aside the heat-labile Botox for the more stable Botulinum toxin to deal with dynamic lines.

"For skin rejuvenation and a youthful flow, there are fractional lasers -- notably the fractional carbon dioxide laser, the fractional erbium laser, also called Fraxel, ultherapy, microneedling and turborollers, mesotherapy and a wide range of cocktail solutions, platelet-rich plasma, and more," says Kapoor.

The thrust of the research is two-fold -- to improve the quality of the skin and to minimise the effect of gravity.

For the former, people earlier used creams and serums. But now, they are opting for percutaneous collagen inductions.

"One treatment that is really gaining popularity is the vampire lift," says Anil Behl, director, cosmetic reconstructive and plastic surgery, Fortis Memorial Research Institute.

"We take 40 ml to 50 ml blood from an individual, spin it around to take out fractions, say 6 ml-worth, which show greater growth factors. We return the remaining blood back to the body," he explains. "This 6 ml is then injected under the skin, which stimulates it to grow faster and makes it thicker."

So popular is this treatment that he does nearly two vampire lifts a week.

To suspend the gravity-induced sagging of the area around the cheeks, nose and neck, cogged threads are used from the scalp to the jawline to give an instant lifting effect and reposition the tissue.

"A facelift would earlier give a scar, this doesn't," says Behl.

While these treatments need professional help, there are now several over-the-counter products that are flooding the marketplace -- both online and offline.

"For instance, there are micro needles. The ones for home use are smaller, around 0.5 mm, while the prescription ones that we use are 1.5 mm," says Behl.

And, there are wrinkle remover machines -- handheld devices that tighten the skin, starting at ₹941.

Then there are the more complex, and expensive ones, priced at ₹34,000-plus, which use patented LED light therapy. The device emits UV-free rays that claim to energise the cells to regenerate them.

Devices that offer non-invasive facial lifts using microcurrent technology are priced between ₹39,000 and ₹50,000.

But how effective are these do-it-yourself solutions?

In a recent report by the British Broadcasting Service, The Truth About Looking Good, researchers from the University of Sheffield found that expensive anti-ageing creams make no difference in fighting signs of ageing.

Mukta Sachdev, consultant dermatologist at Manipal Hospital and medical director at MS Skin Centre and MS Clinical Research, Bengaluru, says these pillows and electronic devices are especially popular because of their "predictable efficacy, ease of use and relatively lower costs compared to in-office treatments".

In Sachdev's opinion, home-user, friendly anti-ageing devices can only work as "maintenance" therapy.

"A lot of these are companion products for in-office treatments and are often recommended to augment the benefits of professional treatments done in a dermatology office," she says.

Kapoor says it is important to ascertain the genuineness of these DIY products. There are no published studies documenting the degree of efficacy or safety of many of these products, she says. They may be used, at the most, for preventive rather than therapeutic purposes.

Consult a dermatologist before investing in these anti-ageing therapies, she advises.

Jaishree Sharad, the cosmetic dermatologist behind Mumbai-based Skinfiniti and author of Skin Talks, too feels the devices available online may not help as they cannot achieve the required heat in the first place.

These devices use the concept of activating collagen, but the results aren't as promised because in order to tighten collagen, the skin needs to be heated.

"Collagen will reach the needed 60 degrees for tightening only if you heat the skin to 40 to 45 degrees. That's high. When we do it, we use very refined radio frequency-enabled machines," she says.

Then there's the question of technique: there can be burns on the skin if one isn't careful, and the device should not be left to concentrate on one spot for too long either.

The reason why they are so easily available online, says Sachdev, is because most often they fall under the category of "home improvement", and not medical devices.

And then, of course, there is the anti-wrinkle pillow that is designed to prevent hair creasing and sleep wrinkles.

"Non-invasive therapies, such as a pillow claiming to fight ageing, is an attractive buy and there are always people ready to spend money on quick-fix treatments, even if it is not always a medically recommended therapy," says Sachdev.

But one wonders if a mere pillow, even if it is specially designed, can compete with the natural process of ageing.

"Take a picture and you'll see that one side of your face looks better than the other," says Sharad. "When you sleep on a particular side for years together, that side of your face does tend to sag a little more. It doesn't really affect wrinkles on the forehead or crow's feet, but your laugh lines on that side tend to be deeper," she explains.

It's understandable why Sharad often advises her patients to sleep on their backs as much as possible.

"You can't do much when the damage is already done, but you can prevent it from happening. When you cross 40, it seems like you've aged overnight, but really factors like your lifestyle and environment have been damaging your collagen and elastin fibres for a long time," she says.

If you train your mind to sleep flat on your back -- which, unfortunately, will make snorers snore more -- you needn't opt for these pillows.

"The makers of such pillows have just used the idea of what happens when you sleep on a side and come up with this. Let people who can afford it go for it, but it doesn't need to be that way," adds Sharad.

Lahiri, who is also the vice-president of the International Society of Dermatology, points out that there are only three factors responsible for signs of ageing: rest, genetics and race, and environment.

"In some families, even people who are in their 50s and 60s don't look their age."

One's genetic make-up and race is as significant as the life one leads, says Lahiri, adding how stress and smoking both make one age faster.

Flipping through sites on beauty, one stumbles on the immense popularity of Korean beauty regimes designed to fight the wrath of time.

"There creams and products are actually very good. There are better than the American and European ones," affirms Sharad.

In Sharad's yet-to-be-properly-tried kit is an under-eye patch with micro needles, a Korean product hawked as an anti-ageing weapon. The thought behind such patches is a takeaway from the microneedling techniques used for the whole face.

The idea is to "cause microscopic injury to the skin". Whenever there is an injury, there is repair; whenever there is repair, there is new collagen formation, explains Sharad.

"It was a little uncomfortable. I really didn't see a change when I tried it for 20 minutes," she says, adding how there still needs to be a lot of research to see if it really works.

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