Wrinkle Treatments

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. (1)

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. (2) 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: (3)

  • Genetics
  • Sun/UV light exposure (photo-aging)
  • Smoking
  • Facial expressions
  • Chewing
  • Internal factors (such as metabolism, and hormones).

Over time, people are exposed to sources of oxidative stress (when reactive oxygen atoms in the environment and in the body overwhelm the body’s ability to neutralize them), and this damages skin cells and impairs their ability to repair or renew themselves. As people age, the effects of the oxidative stress add up. (3) The greatest sources of oxidative stress in our environment are UV light, smoking, and air pollution.

As well, the skin is exposed to physical stress that repeatedly stretches and bends the skin – such as that which occurs with facial expressions, chewing, or even facial contact with a pillow during sleep (“sleep wrinkles”).

Physician-administered treatments

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: (4) 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:(5) originally marketed under the brand name Botox, this injectable wrinkle treatment is now available in a variety of brands such as Dysport, Xeomin, and Jeuveau. 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:(6) 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: (1) “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: (7) 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: (8) 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: (9) 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. (3)

As well, environmental and internal toxins and oxidants (free radicals) are a major cause of aging in general, including the aging effects on the skin. Topical and oral antioxidants are therefore likely to play a role in slowing the effects of aging. A number of topical antioxidants are available – such as creams or gels containing co-Q 10, or vitamins A and E – and oral antioxidants are contained in many healthy foods, particularly so-called “superfoods.” Green tea is believed to be especially beneficial for the skin. (3)

Over-the-counter wrinkle creams are available that contain the same compounds – most notably vitamin A derivatives and alpha-hydroxy acids – that are contained in the chemical peels used by health professionals, although in lower concentrations. While these compounds can improve wrinkles, the low concentrations can give only limited results.

Many home wrinkle treatment remedies on the market are unproven, do not work, or a downright scam. (10) Generally, any over-the-counter skin creams containing antioxidants, alpha-hydroxy acids, and/or collagen may be beneficial. Topical retinoids appear to have the most benefit. (10)

However, self-care is the best approach. 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. (11)

Ready to take the next step?

To learn about your wrinkle treatment options, find a doctor in your local area.