Written by Andrew Proulx, MD
What exactly are wrinkles?
The unkind effects of aging on the skin include loss of elasticity, sagging (due to laxity and gravity effects), roughened texture, discoloration, and loss of hydration, all of which contribute to the most dreaded aging effect of all – wrinkles.
Wrinkles are creases or folds in the skin. They include lines (“mimetic” wrinkles) – which involve partial thickness of the skin – and furrows – which are full thickness. They can form anywhere on the body, as the skin ages, but they are usually most noticeable on the face, especially on the forehead, around the eyes (crow’s feet), and between the nose and mouth.
Causes of wrinkles
Wrinkles are multi-factorial, meaning that they are caused by a combination of factors, such as:
- Sun/UV light exposure (photo-aging)
- Facial expressions
- Internal factors (such as metabolism, and hormones).
There are a variety of wrinkle treatments available from physicians or specially licensed healthcare professionals, ranging from topical treatments, to injections, to cosmetic surgery. Options include:
- Prescription topical retinoids: These vitamin A derivatives can reduce fine lines, but not deep wrinkles. They work by neutralizing free radical oxidants, exfoliating old skin cells, and stimulating new collagen growth. An example is Retin-A cream.
- Botulinum toxin: Originally marketed under the brand name Botox Cosmetic, it is now available in a variety of brands such as Jeuveau, Xeomin Aesthetic, and Dysport injections.
- This is a synthetic version of a potent neurotoxin made by the bacteria Clostridium botulinum. Botulinum toxin relaxes muscles by blocking the nerves that cause them to tense up. It reduces wrinkles by paralyzing the muscles that pull on the skin. Injections usually last 3-4 months and then must be repeated to retain the effect
- Chemical peels: Formally known as “chemoexfoliation,” chemical peels are outpatient procedures involve applying caustic agents to the skin to ablate the skin to a desired depth in order to stimulate the regrowth of healthier, more youthful looking skin. There are a variety of different chemical peels available to choose from, based on the particular chemical agent used and the strength. Peels are classified based on the depth of penetration (superficial, medium, or deep)
- Dermabrasion and microdermabrasion: Dermabrasion” is a facial skin resurfacing technique that mechanically damages the skin by using a rotating brush to remove the top layer of skin, thereby stimulating skin regrowth. “Microdermabrasion” is similar, but gentler and more superficial, with less penetration than dermabrasion
- Laser resurfacing: With laser skin resurfacing, laser light energy is applied to damage the skin and stimulate new growth and collagen production. A variety of different types of lasers are in use, each with its own characteristics. There is usually significant downtime due to skin damage following these treatments
- Dermal fillers: These are injectable gels that reduce wrinkles by lifting up the skin, stimulating new collagen growth, and drawing in hydration. There are four types of dermal fillers available (hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate), available under a variety of brand names such as Restylane, Juvederm, Radiesse, and Sculptra. Each has its own characteristics and duration of action. Dermal fillers are temporary and need to be repeated a few times a year, depending on the type of filler used. There is generally very little down-time involved with these treatments
- Face-lift surgery: A face-lift (rhytidectomy) is a surgical procedure that removes the extra skin in the face and neck, and then the underlying connective tissue is pulled back in order to tighten the remaining skin. There is significant recovery time involved, but results can last up to 10 years.
At-home wrinkle treatments
At home wrinkle care is most effective when it comes to prevention. Since about 80% of the environmental cause of aging comes from UV exposure, the simple expedient of applying broad-spectrum sunscreen to the face and neck every day goes a long way in preventing the development and worsening of wrinkles.
Topical and oral antioxidants are likely to play a role in helping to slow the effects of aging. Some popular ingredients to look for include Retinol, vitamin C, green tea extract, licorice extract, kojic acid, arbutin, niacinamide, mandelic acid, and tranexamic acid.
Self-care remains the best approach to fighting wrinkles. Protecting yourself from UV light (avoiding tanning, and wearing sunscreen every day), quitting smoking, avoiding alcohol use, eating a healthful diet, and using a daily skin care routine that cleanses, moisturizes, and exfoliates are helpful.
Ready to take the next step?
To learn about your wrinkle treatment options, find a doctor in your local area.
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