What's the best way to get rid of wrinkles?

In reading that Colleen has already tried the creams and lotions that can be quite expensive and quite a lengthy process in achieving results, it would appear that she is in need of a treatment that goes beyond what these have to offer. Although Botox and fillers are a good place to start, it may be a better option to consider laser resurfacing first, followed by the injectables as a way to compliment her results.

Quite honestly, I'm not a big fan of microdermabrasion and fancy skin care products when an individual is in need of results that will not be addressed with these modalities. We hear a common story in our consultations wherein a patient was disappointed after much expense invested in a series of 10 or more microdermabrasions for facial wrinkles.

The idea is to treat laxity of the skin by using thermal (laser) energy to tighten the skin, stimulate collagen to improve the texture and appearance of wrinkles, and treat the surface of the skin to resolve discoloration. There are numerous good modalities that all claim to address these concerns, whether it is fractionated technology, radio frequency, deep dermal tissue heating, and more. Although most will agree that the CO2 laser is still the gold standard for laser resurfacing, we are pleased with our Erbium MicroLaserPeel and its ability to deliver consistent, predictable outcomes with far less risks and downtime involved as with the CO2 laser. Oftentimes, laser resurfacing is far less expensive when adding up all of the time and cost involved in treatments that are not designed to remedy the patient's concerns and goals.

Above all else, one should do their research and ask many questions during a consultation. An honest, open consultant will not hesitate to suggest to an individual that they may be better served by a consult with a plastic surgeon to discuss a more invasive approach. The consultation process should take into consideration what one has already tried, what their goals are and the time frame to meet these goals, skin type, whether or not downtime is an option, and what budget a person has.

You have multiple choices:

• Combination of Botox and Fillers
• Combination of Laser Treatments with Botox and Fillers
• Combination of Plasma PSR with Botox and Fillers

What I am really trying to get across is that there are a huge number of choices. Are you looking for a quick fix, are you looking for something more permanent, are you prepared to put up with some downtime? What is your budget? All this goes into a good consultation with your physician regarding what choices one makes for treatment.

The best way to get rid of wrinkles is Bridge Therapy. This uses a fractional CO2 laser and can combine ActiveFX with DeepFX treatments. The combination is called TotalFX. A study comparing 1 ActiveFX with 5 Fraxel treatments has shown 50% increased collagen with the single ActiveFX compared to 5 Fraxel treatments! The effect on dyschromia was the same. A great treatment to use WITH Bridge Therapy (TotalFX) is Thermage. Fillers can also be used when there is a "deflation" issue in the area. Botox can help avoid getting the wrinkles to begin with! Having fillers where needed can also help avoid experiencing this problem.

For superficial wrinkles:

• Polaris
• Fraxel
• Restylane
• Juvederm plus 

For facial creases and folds:

• Perlane
• Juvederm ultra plus
• Thermage
• Radiesse
• Sculptra
• ArteFill

For dynamic wrinkles:

• Botox

For deep wrinkles:

• Sciton Lasers
• Portrait Plasma
• Deep & medium chemical peels

I continually test new anti-wrinkle and anti-aging ingredients, always hoping to find something new and better than everything I already know and employ in my formulas. I test exotic herbs, roots, and flowers from distant lands, but I have to admit that few of these “newly discovered” ingredients ever deliver results that sweep me off my feet.

Here comes a short list of maybe not so trendy but very reliable wrinkle fighters:

• Vitamin A and its precursors carotenoids. I use pure isolated vitamin A but also red palm oil (the richest natural source of carotenoids, thirty times the amount found in carrots), and carrot seed oil.
• Active and stable forms of vitamin C
• Wheat protein
• Sea vegetables, such as kelp
• Cold-pressed avocado oil
• Organic unrefined peanut oil
• Rosemary
• Horsetail
• Comfrey
• Cold-pressed evening primrose oil
• Cold-pressed borage oil
• Rosewood
• All roses
• Geranium
• Soy lecithin

Superficial wrinkles and fine lines –
In addition to topical skin care with growth factor and antioxidant creams, a variety of non-invasive lasers have been found to be very helpful. These include the Affirm, CoolTouch, Fraxel, Active FX, Titan, and the like. Topical skin care takes at least 2 months to show an improvement. Depending on the type of laser, 1-6 treatments may be necessary to achieve the best effect. Topical skin care in addition to lasers works best.

Deep wrinkles, facial folds and creases –
Surgery, such as face-lifts and the many names doctors call it like the “life-style lift” or mini-facelifts, are all very similar. The more invasive the procedure, the better and longer-lasting the results. Only your dermatologic or cosmetic surgeon can advise you if surgery is necessary or if the use of filling substances, such as Sculptra, Fat, Radiesse, Juvederm, or Restylane, will be best for you. At times a variety of fillers are used in one session.

Dynamic wrinkles –
Botox or, when it is approved by the FDA in 2008, Reloxan are the only non-surgical methods for improving dynamic wrinkles. Endoscopic surgery may also work but is much more invasive.

I think if you really want to improve fine lines and wrinkles, you need to look at medical-level treatments.

Medical-grade home care products can help reduce fine lines and uneven texture on a superficial level, but they work best in conjunction with lasers and injectables. I have not found any over-the-counter treatments that work as well as medical treatments. 

It is not that there is one product that best minimizes the appearance of wrinkles, but that best results are achieved by using these treatments in conjunction with each other.

To determine which treatments to use, a client's skin type, stage of wrinkle, wrinkle type, and skin history must be taken in to account.

• For deep wrinkles and skin laxity: a combination of Titan, Sculptra, and Juvederm is often best.
• For more superficial wrinkles: a combination of Botox, Juvederm, and Pearl skin rejuvenation would be a great combination.
• For wrinkles that are only noticed with movement (dynamic wrinkles), such as between the eyes forehead, and crow's feet: Botox will often be the best choice to reduce these.

The first line of defense against wrinkles is prevention by staying out of the sun. It’s that 80 year-old who comes into the office and you just say “Oh my god, she’s a beautiful woman”. You can be 80, 70, or 20 to be beautiful, but you can tell that they’re the ones who have avoided the sun.

But once wrinkles are here, the simplest thing is to use a moisturizer because that is going to sort of plump and hydrate the skin, so to speak, and in so doing, will give the appearance of an improved line. So we all look better with a nice moisturizer and that speaks to, now I’m not an Anthelios salesperson, but that is a nice product because it does have a plumping affect. Again, moisturizer is a temporary effect, but it is still something you can do to soften wrinkles while preventing new lines from forming.

Now some lines are from the sun and some lines are from muscle movement, so when we frown or smile, that is where Restylane and Botox come into play. You can use all of the sunscreen you want but if you smile enough or frown enough, you’ll still get some lines.

Currently, conventional spas are leaning more towards combination treatments to get down to the root of wrinkle-causing dilemmas. Using AHA’s with Microdermabrasion, IPL’s, or light chemical peels. Baby-boomers and Yuppies are now seeing the damage they created back in the day when SPF was thought to be an acronym for a venereal disease.

At face to face nyc –day spa we have a variety of skincare treatments for serious facial aficionados from the Alchemy Treatment (micro current and microdermabrasion combo) to the Uptown Peel (light chemical peel).

The rituals I recommend include using Vitamin A with antioxidants, as well as doing in office treatments such as laser peels and Botox.

• Vitamin A is very similar to Retin-A and Renova, and is used to stimulate collagen and minimize fine lines and wrinkles.
• Botox and laser peels help with complexion blending, removing reds and browns from the skin, minimizing large pores, smoother skin texture, eliminating fine lines and wrinkles.

One of the basic treatments to reduce the visible signs of aging begins with professional skin care by a licensed esthetician. It is never too early to begin.

Also, there are many excellent treatments to reduce wrinkles, lines and creases.

• Dynamic line increases can be dramatically reduced by Botox when administered by a well-trained professional.

• There are also excellent filler materials to treat deeper lines and wrinkles that are more permanent. Most of these treatments are temporary and need to be utilized a couple of times a year.

The important thing is that none of these treatments will interfere with future procedures if someone decides to do something more permanent. There are many different options and these should be discussed with a board-certified professional.

The state-of-the-art way to soften the appearance of wrinkles is with fractional laser resurfacing (performed with a laser called Fraxel).

Fraxel Laser treatment produces thousands of tiny but deep columns of treatment in your skin, known as microthermal treatment zones. This treatment eliminates old epidermal pigmented cells. It also penetrates deep into the dermis.

Just as important, though, are the areas of skin the Fraxel laser leaves untouched. For every microthermal zone the laser targets and treats intensively, it leaves the surrounding tissue unaffected and intact. This "fractional" treatment allows the skin to heal much faster than if the entire area were treated at once, using the body's natural healing process to create new, healthy tighter tissue to replace skin wrinkles and imperfections.