Wrinkle Treatment Overview

Wrinkles are caused by sun damage, loss of volume, and progressive changes to the skin through continual muscle movement, like smiling!

There are two important substances of the skin that play a role in wrinkle formation, collagen and elastin. If you were to look at skin under a microscope, you could witness changes in the amount and organization of these substances over time. Aside from genetic predisposition and aging, factors like sun exposure, smoking, and perhaps even conditions such as air pollution can accelerate the loss of collagen and elastin.

Imagine a piece of paper that is folded back and forth many times, causing a crease to develop. Similarly, habitual use of facial muscles along with the decrease in skin volume and elasticity, causes wrinkles, fine lines or 'creases' in the face.

Getting rid of wrinkles may be the wrong goal

Skin experts emphasize that removing wrinkles is nearly impossible if you want to have a natural appearance. Few want frozen faces or skin that looks pulled back. "A face without expression lines looks odd," says Michael Law, a Raleigh-Durham plastic surgeon. A good anti-wrinkle goal is to rejuvenate the skin by softening lines and plumping up folds in the skin.

Consider a raisin. Due to sun and aging, a grape loses volume and becomes a raisin. Raisins obviously have a lot of wrinkles and folds. Removing the damage is similar to trying to get rid of facial wrinkles.

wrinkles form like a grape becoming a raisingrapes before wrinkles

The raisin can be plumped or skin could be removed, but it won't regain the look of the younger grape. We share this kind of irreversible change from aging. We simply can't revert to the young, supple skin we had as children and teens.

Wrinkle solutions recommended by doctors

Skin care experts suggest that you find a wrinkle solution that matches your type of wrinkle. There are 3 types most often referred to by dermatologists and doctors.

1) Superficial wrinkles and fine lines – less prominent facial lines or lip lines may be addressed with one or several nonsurgical treatments

  • Botox Cosmetic may be used to prevent a wrinkle caused by repetitive muscle movement from getting deeper.
  • Injectable fillers (e.g., Restylane, Juvederm) may be used to temporarily fill wrinkles. Volumizing the face can make a significant difference in making your lines disappear in a natural way. Once the face is volumized, a doctor may recommend you improve deeper lines with resurfacing such as lasers, chemical peels, or dermabrasion.
  • Lasers (e.g., carbon dioxide, erbium:YAG, Fraxel) may be used to resurface the skin to reduce lines.
  • Chemical peels and dermabrasion may also be used to resurface the skin.
       chemical peel before and after

Chemical peel before and after

2) Deep wrinkles - Reducing facial folds and deep creases depends on where the wrinkles are located. What works for nasolabial folds may not work for the forehead. In dealing with deep wrinkles, doctors may recommend one or several treatment options

  • Botox. Botox Cosmetic is indicated for 'temporary treatment of moderate to severe frown lines between the brows in people 18 to 65 years of age.' Botox works by paralyzing the muscle and as such is good for lines created with motion of muscle. 
  • Facial Fillers. Dermal fillers such as hyaluronic acid (Restylane, Juvederm, Perlane to name a few), collagen, Radiesse, and others aim to erase lines by filling in the underlying structures. These are temporary and at times cannot address deep wrinkles because it does not release the tethering that is creating the wrinkle.

Deep wrinkles may be treated with a filler (as shown)

*Treatment results may vary
  • Ablative Lasers - CO2 and erbium. These work on several levels. By taking off the outer layer of skin and promoting collagen tightening, ablative lasers can dramatically minimize wrinkles and produce a more youthful, even skin texture. The down side to these is the intensive after-care.
  • Cosmetic surgery - Deep wrinkles in the cheek and neck area may be best treated with a comprehensive facelift and neck lift. In general, the more invasive the procedure, the better and longer-lasting the results.

3) Dynamic wrinkles – Dynamic lines are wrinkles associated with animating the face, specifically smiling and squinting (or the dynamic portion of your lower eyelid). Often these lines are called crow's feet, vertical smoker lines, or eye wrinkles.

Wrinkle experts consider it impossible to eliminate completely these wrinkles, and any treatment will not prevent recurrence as long as the muscles are being used for smiling and squinting. Your goal is a slight softening of these lines for a natural look.

Eye wrinkles - before and afterBotox before and after for dynamic wrinkle

Botox is commonly used to treat dynamic lines and wrinkles. A direct competitor to Botox, called Dysport is also on the market. Yet, Botox or Dysport isn't for everyone, for personal or physical reason. You may fear needles, have safety concerns, or not want to take on the cost of routine Botox injections.

Some individuals may be considered poor candidates for Botox, such as those with very loose skin and soft tissue and bulging fat of the lower eyelid. Botox is not appropriate for the line that runs from the corner of the nose to the corner of the mouth. That line (the nasolabial fold) is better treated with a filler such as Juvederm. Also, small wrinkles in the middle of the cheek are not treatable with Botox, but may benefit from a topical resurfacing depending on how deep and how many lines are there.

At-home remedies for wrinkles

One of the fundamentals of all facial rejuvenation is a good skincare regimen and drinking water. Yes, you may be tired of getting this advice, but by providing hydration to the skin, some finer wrinkles can be erased. Similar to inflating a balloon, when skin is hydrated the cracks and crevices are eliminated.wrinkle creams serve as one way consumer try to reduce the appearance of wrinkles and lines

*Treatment results may vary

Good skincare includes using moisturizers, sunblocks, and usually Retin-A and/or agents to even skin tone. There are multiple skin product options available, including wrinkle creams containing retinoids (e.g. renova), potent antioxidants (e.g. Revale or Prevage), glycolic acid (Vivite) and a mixture of growth factors and antioxidants (SkinMedica TNS Recovery Complex).

Be cautious of cosmetic products that make big wrinkle removal claims. They are typically not as research-based as prescriptive medication and are often disappointing. Besides not delivering anti-wrinkle results, these products may dry out and irritate your skin, clog pores and cause acne or other skin disorders. Often, ingredients in the non-prescription wrinkle creams oxidize quickly and deteriorate a short time after they are applied, that is, before they can be absorbed by the skin.

Ask your dermatologist for prescription-based, medical antioxidants and anti-wrinkle creams. A dermatologist is likely to recommend products which are medical grade, such as Obagi or Nia-24. The skin care will usually improve fine lines, but will more importantly improve the long-term quality of the skin as well as make any subsequent procedure more effective.

More wrinkles information on RealSelf

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