What causes wrinkles?
Wrinkles are a natural part of aging. Wrinkles form in part because the supportive components of the skin (such as elastin, collagen and hyaluronic acid) degrade as we get older. Although much research has been directed at understanding why this happens, it is still a mystery. Everyone ages at a different rate based on genetics, sun exposure, general health, and lifestyle choices (such a smoking and drinking). You can profoundly affect how rapidly you age by avoiding the sun and living a healthy lifestyle. For example, sunlight damages the natural layers of the skin and destroys collagen. For proof of this, examine parts of your skin with minimal sun exposure, such as the inner arms, inner thighs, or buttocks. Notice how soft and smooth the skin is compared to your forearms or face.
Is there an effective wrinkle treatment?
The best wrinkle treatment is prevention. By avoiding the sun (including tanning booths) and living a healthy lifestyle, your skin will look younger. However, there are many techniques in use today to treat wrinkles.
Nonprescription and Prescription Creams:
• What are they?
Available over the counter, most wrinkle creams essentially moisturize the skin. Some formulations (such as those with retinol, vitamin C, or glycolic acid) may improve the texture and color of the skin. Unfortunately, they typically do not have dramatic effects and can be quite expensive. Prescription creams, most notably synthetic derivatives of Vitamin A (retinoids), can provide better results in improving sun-damaged and aging skin.
• What are the risks?
Over the counter creams are usually well tolerated. However, retinoids can be irritating and some people are not able to use them. Also, they must be used continuously for continued benefit. Creams may not work for everyone and the risks and benefits need to be discussed with your physician.
Dermabrasion (Mechanical Resurfacing)
• What is it?
Mechanical resurfacing of the skin has been in use for about 30 years and involves the use of motorized abrasive tools to remove the outer layers of the skin in a controlled setting. A new layer of skin replaces what was removed and the new layer typically has a more youthful appearance.
• What are the risks?
Local anesthesia is required for pain control during the procedure. Dressings usually need be worn after the procedure and temporary facial swelling and pain is normal. Within 7-10 days, the skin has healed but is often very red. Complete healing may take up to one month and collagen remodeling may continue for months after the procedure. With the advent of newer, less destructive techniques, dermabrasion has become less popular. It is still used for acne scarring, however. Complications are rare but include infection, prolonged healing, abnormal discoloration, and scarring. Dermabrasion is not for everyone and the risks and benefits need to be discussed with your physician.
Microdermabrasion
• What is it?
Microdermabrasion is a fairly new and popular procedure and is classified as very superficial dermabrasion. This method employs aluminum oxide crystals which are propelled at the skin and then immediately vacuumed up. Although not scientifically proven to improve wrinkles, many patients report that their skin feels smoother after multiple treatments (7-10, spaced about one week apart).
• What are the risks?
Because microdermabrasion penetrates only the most superficial layers of the skin it is painless and requires no downtime. The cost is moderate and requires a series of treatments. Microdermabrasion is not for everyone and the risks and benefits need to be discussed with your physician.
Chemical Peels
• What are they?
Your physician can administer a peel using a variety of different chemicals to remove age spots, discoloration, wrinkles and fine lines. Chemical peels may smooth and firm the skin and may lighten age spots gradually. The superficial peels, such as a glycolic acid peel can be done during your lunch hour, and there is no recovery time. Deeper peels are more effective but require longer recovery. See more details under discussion chemical peels.
• What are the risks?
Different kinds of peels carry different risks. Superficial peels are usually quite safe. However, you may need a series of superficial peels (done approximately once a month) before you'll notice improvement. Costs can add up if you choose a series of peels. The risks and benefits vary depending on the kind of peel need to be discussed in detail with your physician.
Laser Resurfacing
• What is it?
Laser resurfacing is an in-office treatment where age spots, wrinkles and lines are “burned” off with a laser. Laser resurfacing usually removes most age spots, age related discoloration, and wrinkles, often in just one treatment. Some lasers, such as the CO2 laser are considered the gold standard in terms of facial rejuvenation. With good sun protection, the effects can last up to five years. See more details under discussion of lasers.
• What are the risks?
Lasers actually remove the outer portion of the skin- called the epidermis. Because of this, you may experience some pain as well as redness and peeling. You may even form scabs in the days after the procedure. Expect recovery time of at least a week. Laser therapy is also expensive. One treatment can cost anywhere from $1,000 to $5,000, depending on how much of your face is treated. The risks and benefits of laser resurfacing need to be discussed in detail with your physician.
Intense Pulsed Light Therapy (IPL)
• What is it?
IPL is one of the newer forms of facial rejuvenation. Unlike lasers, which use intense, focused light, IPL is intense broadband light. Although IPL delivers energy to both the superficial and deep layers of the skin, the epidermis is spared from damage. Thus, there is virtually no recovery time. In the studies that have been performed so far, IPL can smooth the skin and fade age spots, freckles, melasma, and even broken blood vessels. Improvements usually last for about a year with good sun protection.
• What are the risks?
IPL is safer than laser therapy because IPL does not damage the epidermis. There may be some pain during the procedure but no recovery time. Unlike laser therapy, however, you may need multiple treatments (average is 4-6, at three weeks intervals) to get the full benefit. The cost is variable, but is usually more expensive than peels and less expensive than lasers (300-600 dollars per treatment on average). The risks and benefits of IPL therapy need to be discussed in detail with your physician
Thermage
• What is it?
Thermage uses a technology that delivers a radiofrequency pulse deep into the skin. The thermage probe simultaneously cools the epidermis to protect it during treatment. The energy from the radiofrequency heats the collagen which immediately tightens the skin. Heating of the collagen may also stimulate the production of new collagen such that improvements may continue for up to six months. Thermage can be performed on all skin types.
• What are the risks?
Although relatively new, thermage appears to be safe with side effects reported in less than 1% of patients. Like IPL, thermage does not damage the epidermis. Thus, there is usually no recovery time. It can be painful, however, and your physician may offer you pain medication or topical anesthesia. Side effects include swelling, redness, bumps and blisters on or around the treated area. These side effects usually disappear in a few days or weeks. A rare (<0.2%) but longer lasting side effect described as a skin depression has also been reported. The risks and benefits of thermage need to be discussed in detail with your dermatologist.
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