The skin is the body's largest organ, and is divided into 3 layers: the epidermis, the dermis, and the hypodermis (also known as the subcutis).
The epidermis is the outermost layer of skin and contains regenerative layers of skin cells. The dermis is the next layer and contains connective tissue (i.e. collagen) and other fibers that give the skin strength and elasticity. The deepest layer, known as the subcutis or hypodermis, is composed primarily of fat. The subcutis supports blood vessels and nerve fibers that feed the overlying dermis and epidermis.
As skin ages, the supportive components of the skin are gradually destroyed. For example, elastic fibers in the dermis break down and are permanently lost. Collagen fibers degrade and undergo chemical modifications that destroy their function. There is also gradual loss of hyaluronic acid, a substance that maintains the texture in the skin. Thus, the skin becomes stiffer, thinner, and sags. In addition, wrinkles also appear over facial muscles as they stiffen with age. Thus, areas subjected to repeated movements with facial expression, such as the forehead, and around the eyes and lips, become wrinkled. Finally, the normal healing processes and cellular repair are gradually diminished; leaving older skin less resilient to environmental insults. Excessive sun exposure (including tanning beds) and smoking can greatly accelerate the aging process.
The classification of wrinkles, also known as rhytids, is based on how deep into the skin the wrinkles extend. Fine lines are the result of changes in the upper dermis and may appear “etched” in the skin. Medium wrinkles reach the mid-dermis, and deep wrinkles (also known as furrows or folds) reach the deep dermis and subcutis.
While we cannot reverse every possible cause of wrinkling, there are steps we can take to minimize the aging process:
Avoid excessive sun exposure, including sun lamps and tanning beds. Ultraviolet exposure is greatest between 10am and 4pm. Use sunscreens in combination with other sun-protective measures.
Quit Smoking. Smoking not only increases perioral wrinkles (wrinkling around the mouth) but also places you at a higher risk for skin cancer.
Lead a healthy lifestyle. This includes a balanced healthy diet, daily exercise, and stress reduction.
Daily skin care should consist of mild cleansing of the face daily, application of a moisturizer, and daily sunscreen use.
Many commercial and prescription products are available topically for the treatment of wrinkles. Professional treatments for resurfacing or implantation of materials can also be used for wrinkle treatment. These include:
- Dermal fillers like Collagen, Restylane and Radiesse.
- Botox (Botulinum toxin)
- Laser Resurfacing
- Chemical Peel
- Topical antioxidants- Vitamins A, C, E, selenium, coenzyme Q10, and alpha-lipoic acid.
- Exfoliants- alpha hydroxy acids
- Vitamin A derivatives: Retin A, Renova, etc.
- FotoFacial and IPL Treatment may be used for fine lines
All photos courtesy of S. Zimmet, MD and P. Bitter Jr., MD