I Have Aging Thin Sun Damaged Skin. What Can I Do to Fix Crinkly Fine Lines and Wrinkles on my Cheeks? (photo)

Thin skin can get dehydrated very easily. The lack of moisture in the skin will accentuate even the tiniest of lines.

I would recommend that you embark on a topical skin program first. Even if you decide to have laser procedures or peels, you'll need to pay attention to the moisture content in your skin.

There are over the counter lotions and creams which contain ceramides that would be helpful in moisture retention.

Most people forget that skin care can often mitigate many of the issues they have with their skin.

A further topical step might be retinoids - but with your skin fragility you may prefer to go with retinols instead of RX products as they are less irritating to sensitive skin.

Chemical peels or fractional laser might be the next step, but I would recommend a soft first step to see what kind of improvement you get with products.

 

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

The skin tends to thin out with age and and this is more obvious in individuals who have thinner, more delicate skin to begin with. To reduce the fine lines, you'd essentially need to plump and thicken your skin. I'd recommend stepping up your skin care by adding retinol in incremental steps and to protect your skin from UV exposure and also give up smoking if necessary/possible. Consider adding regular treatments that will help promote further collagen stimulation. Micro-needling, mesotherapy and platelet rich plasma treatments involve using fine needles and the down time is minimal. Laser treatment e.g. CO2 laser produces very good results but you need to allow up to a week for recovery.

Chemical peels have been a reliable mainstays of the cosmetic physician's toolbox for well over a century. The "Punctuated Phenol Peel"--a very recent advance in chemical peeling technique--is one that is sure to put chemical peeling squarely back on the map and in competition with the more expensive, more heavily hyped laser and light-based therapies currently intensively marketed to consumers. The technique works especially well for crepey and finely wrinkled skin.

The procedure is simple, requires no sedation, and has little or no downtime. Using 88% plain phenol, fine lines and crinkles are treated in punctuated (i.e. fractionated or pixelated)  fashion. Using a very finely pointed applicator, the chemical is applied in a serial spot fashion with each spot separated from surrounding treatment spots by approximately one-quarter inch. The use of serial spot coverage, rather than coverage of whole areas, allows for rapid recovery as healing takes place from the intervening non-treated areas. It is precisely the same rational for the use of fractional lasers.

The "Punctuated Phenol Peel" technique is a novel approach to rejuvenation that limits the overall potential for toxicity and downtime of traditional deep peels while constituting focal spots of more intense peeling. Wrinkle lines and crepeyness can be traced in this punctuated fashion, and treatment sessions can be repeated at monthly intervals if necessary until the desired result is obtained. (When appropriate, acne scarred areas may likewise be treated in a punctuated fashion.)

Consultation with and treatment by an aesthetic physician experienced in chemical peeling is an absolute must for determining  the appropriateness of this novel approach for any particular situation.

For fine wrinkles on cheeks, I would suggest addressing them from both the inside and the outside.  Address the inside with a filler such as Sculptra, Juvederm, Radiesse or Fat Grafting which will replace missing volume and give more support to the overlying dermis.  From the outside, address the fine lines and wrinkles with a combination of  laser resurfacing, daily Retin A (or equivalent use) and chemical peels.  You are right that these wrinkles cannot be treated with Botox and it will significantly affect the animation of your mid face and lips.  

 

Good Luck.

The wrinkles you see are a natural result of decreasing collagen and elastin that occurs as we age. Fillers and chemical peels do not address this fundamental problem.

Dermal heating stimulates the natural production of collagen, elastin and hyaluronic acid. This reduces wrinkles by treating their underlying cause. The result is truly younger skin at a molecular level with increased elasticity and thickness. I am consistently impressed by ePrime, which delivers fractionated radiofrequency to precisely heat the deep dermis. This approach would be perfect for you.

It's normal to start noticing the early signs of aging in your thirties and forties.   The best treatment for texture, pores and fine lines is the microablative fractionated CO2 laser like SmartSkin. This laser is very effective for wrinkles, acne scars, and improving skin texture.  You seem to have a fair skin complexion.  This laser treatment is very precise and predictable.  You will have two days of swelling, two days of peeling and two days of redness.  To maintain your result I would consider using SkinMedica TNS essential serum with growth factors.

Sun overexposure, cigarettes, alcohol, ill health, and select medications are just some of the contributing factors that can cause a premature aging of the skin. Before recommending a treatment, you’d have to be examined to identify the source of your problem. Based on the results of your examination, I might recommend a combination of treatments. However, I’d starting with Platelet Rich Plasma (PRP) therapy to revive the skin and reduce the appearance of those fine lines and wrinkles crisscrossing your cheeks. The treatment involves the injection of your own extracted blood platelets. The nutrients and growth factors can then repair the damaged tissue by jumpstarting the body's natural collagen and hyaluronic production.

Chemical Peels actually strengthen and thicken the skin.  A vital part of improving your skin though is your daily routine.  Some of the clinical products I would recommend are Vitamin C&E to neutralize free radical damage, a NIA 24 product which is designed to thicken and strengthen the skin, and Retin A or a Retinaldehyde to stimulate cellular turnover, therefore reducing the signs of aging.  That, coupled with Chemical Peels, Needling (along with PRP/Platelet Rich Plasma injections or topical infusion (no downtime)), would introduce you to a good program.  CO2 laser resurfacing is always an excellent choice as well, but it depends on whether you want to ease into the process or jump in!  Either way, you need an experienced and trusted clinician to advise and educate you as well as administer your treatment.

Fine wrinkles and pigmentation problems of facial skin is best treated with medical grade skin care followed by CO2 laser resurfacing. It also improves on the skin quality in general. Better color, better skin quality, long term results.

Recovery 2 weeks, then redness of the face for few weeks.