wrinkles treatment

Introduction to wrinkle treatment

Although wrinkles can signify wisdom or at least some level of maturity, there is no question that newly born infants also have wrinkles. The real concern that most of us have is that certain types of wrinkling is associated with aging. Aging in our current “pop” culture is not viewed positively. Generally, the treatment of normal skin aging that does not result in a functional abnormality is termed “cosmetic.” And most cosmetic procedures are not covered by health insurance.
Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce “the appearance of fine lines,” which means that they don’t reduce the lines themselves). Others can achieve a fair amount of success.
Although all of our skin ages, sun exposure dramatically enhances the rate at which this occurs. Changes brought on by sun damage (photoaging) include dryness (really roughness), sagginess, skin growths like keratoses, lentigos (“liver spots”), and wrinkles. Just compare the facial skin of a poorly pigmented farmer to the skin of his buttocks.
Most wrinkles associated with aging appear on the parts of the body where sun exposure is greatest. These sites are the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows that are related to muscular contraction. Some deep furrows are anatomical in nature and have little to do with aging. Generally, it is only the aging wrinkles that really bother people. There are two basic approaches to the amelioration of these signs of aging: prevention and treatment. Topical wrinkle treatments are, in general, much more effective for fine lines. Deeper creases may require more invasive techniques, such injection of fillers, local muscle paralysis, or plastic surgery. There is a special form of wrinkling called “cellulite” that produces a “cottage cheese-like” appearance to the skin. This is most commonly noted in the hips and buttocks of women and is due to fat deposition in certain anatomical areas in the dermis.

wrinkles treatment

What causes wrinkles?

There are many factors that contribute to the onset of wrinkles. The following are the most important:

  1. Aging
    Wrinkles are a natural by-product of the aging process. With age, skin cells divide more slowly. The inner layer of the skin, called the dermis, begins to thin. The network of elastin and collagen fibers, which support the outer layer, loosens and unravels. This process results in depressions on the skin surface. With aging, skin becomes more fragile. Also, oil-secreting glands are less efficient, making the skin less able to retain moisture and appear more wrinkled. All of these factors contribute to the development of
  2. wrinkles.
    Facial muscle contractions
    Lines between the eyebrows (“eleven” or frown lines) and lines coming out from the corner of the eyes (crow’s feet) are believed to develop because of the underlying muscle contractions. Smiling, frowning, squinting, and other habitual facial expressions cause these wrinkles to become more prominent with age. Over time the expressions, along with gravity and the loss of underlying bone and fat mass, contribute to the formation of jowls and drooping eyelids.
  3. Sun damage
    Excessive exposure to ultraviolet radiation (too much sun) can result in premature aging of the skin, also known as photoaging. The ultraviolet sunrays that cause photoaging damage collagen fibers (the major structural proteins in the skin) and elastin fibers (the protein that enable skin to stretch). Both of these fibers are important components of the skin’s connective tissue. Without them, the skin loses its strength and flexibility, leading to wrinkles. When ultraviolet light damages skin tissue, certain enzymes are produced. These enzymes create and reform collagen. During the process, however, some healthy collagen fibers are damaged, resulting in a disorganized formation of fibers called solar scars. Wrinkles develop when this rebuilding process occurs over and over.
  4. Smoking
    Healthy skin always regenerates. While old collagen is broken down and removed, new collagen is being produced and installed. Researchers have found that smoking tobacco products causes a reduction in the production of new collagen. A lack of new collagen results in the development of wrinkles. This may also be due to the lack of blood supply to the skin caused by smoking.
wrinkles treatment

What is Symptoms of wrinkles?

Wrinkles are the lines and creases that form in your skin. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.

What factors promote wrinkles?

Factors that promote wrinkling include the following:

  • Smoking
  • 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 (people with more subcutaneous fat have fewer wrinkles)

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.
SPF numbers on sunscreen labels refer to protection against UVB radiation (the “sunburn rays”). 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 are produced by tanning salon light bulbs; they may not cause immediate sunburn but do produce aging and an increase skin cancer risk over time. (Sorry, but there is no such thing as a “safe tan.”) Sunscreens that block UVA indicate this on the label and contain ingredients such as Parsol, Mexoryl, and benzophenones.

What treatments and procedures are available for wrinkles?

There are several medical (topical medicines and creams) and many invasive techniques available for ameliorating wrinkles. They are all effective to the degree that

  1. they change the nature of aging collagen,
  2. they stretch the skin,
  3. fill in the depressions in the skin, or
  4. they paralyze muscles that cause the skin to crease.

They include both medical and surgical methods:

Medical treatments for fine wrinkling

  • Vitamin A acid (tretinoin [Retin A, Renova]): This ingredient, available by prescription, has the longest track record of success in treating aging skin and fine lines. Creams containing tretinoin must be used on an ongoing basis. They may produce redness and peeling at first, but discomfort can usually be minimized by lowering the 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 the vitamins A, C, and 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 make wrinkles look temporarily less prominent (“reduce the appearance of fine lines“).

Procedural options

  • 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 (changes in the color of the skin) and scarring. Such peels may require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.
  • Microdermabrasion: This refers to “sanding the skin” with a machine containing silica or 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. Cosmetic products marketed as “home microdermabrasion” are just mild exfoliants — harmless but not likely to produce any meaningful change in wrinkles.
  • 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. The laser is passed 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. Some doctors perform laser resurfacing under “conscious sedation,” in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring.
  • 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. Several treatments are needed 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 being developed but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts.
  • Plastic surgical procedures: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
  • Botox: Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe; the muscle poison does not spread through the body to do damage elsewhere.
  • Fillers: Fillers are injected into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), lactic acid (Sculptra), and autologous fat transplants are being used because their effect can last six to nine months or even longer.
    Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

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