Wrinkles and Fine Lines
Factors that promote wrinkling include the following:
- Degree of natural skin pigmentation (more is better)
- Sun and ultraviolet exposure
- Heredity (some families wrinkle more)
- The loss of subcutaneous fat on a person’s body
Some of these factors are beyond our control. The main preventive measures we can take are to minimize sun exposure and not smoke. These measures can, at best, delay wrinkles.
Sun Protection factor SPF numbers on sunscreen labels refer to protection against UVB radiation. Higher SPF numbers (50) are better at protecting the skin than lower numbers. Broad-spectrum sunscreens offer protection against UVB and UVA radiation (longer-wave ultraviolet light). UVA rays are abundant in sunlight and produced by tanning salon light bulbs; they may not cause immediate sunburn but do produce aging and an increase skin cancer risk over time.
Medical Treatments for Wrinkles
- Vitamin A acid: This ingredient has the longest track record of success in treating aging skin and fine lines. They may produce redness and peeling at first, but people usually can minimize discomfort by lowering the retinoid cream’s concentration or applying it less often until the skin gets used to it.
- Alpha-hydroxy acids: These so-called “fruit acids” include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. They produce only subtle improvement though.
- Antioxidants: These include preparations that contain vitamin A, vitamin C, and vitamin E, as well as beta-carotene. There is very little compelling evidence that these sorts of creams produce a significant cosmetic improvement.
- Ordinary moisturizers: Creams that don’t contain any of the above substances can only moisturize the skin, making wrinkles look temporarily less prominent.
- Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.
- Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects such as long-lasting pigment changes and scarring.
- Microdermabrasion: This refers to “sanding the skin” with a machine containing aluminum crystals; many estheticians offer this service, usually in “packages” of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother.
- Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, Dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color.
- Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of Dermabrasion with greater reliability and precision. A medical professionals passes the laser several times over the area to be treated until the damage reaches the middle of the dermis, the skin’s second layer. This helps stimulate the body’s natural collagen synthesis (production), which plumps up sagging skin and wrinkles.
- Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less “downtime” afterward. Patients may need several treatments to achieve full benefit.
- Non-ablative laser resurfacing: Newer lasers attempt to stimulate collagen synthesis under the skin without damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward.
- Heat and Radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using Radiofrequency devices and infrared light sources. Techniques are still in development, but results to date suggest that such treatments are safe and can produce visible and lasting improvement.
- Thread lift: In this procedure, a barbed, medical professionals insert a stiff thread into facial skin in the appropriate direction and the tissue is pulled to catch on the barbs, producing a lifted appearance. Whether or not the effect is sustained is controversial, but there is no doubt that in the short term there can be a modest cosmetic benefit using only a local anesthetic associated with minimal downtime.
- Botox: Injection of botulinum toxin, the muscle poison, can paralyze facial muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months, and patients must have repeated injections to sustain improvement.
- Fillers: Medical professionals inject fillers into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, health care professionals use new filler substances such as hyaluronic acid, and autologous fat transplants because their effects can last six to nine months or even longer.