Wrinkles: preventing, removing or forgetting them

Wed. October 4, 2006 12:00 AM
by Omeed Memar, M.D.

One of the common complaints that I hear about are wrinkles and what treatments are available to help people look years younger.

Americans spend about $250 million a year on wrinkle fillers – a more-than-threefold increase in four years.

For prevention, wear sunscreen and don't smoke.

To reduce the appearance of wrinkles:

(a) Hydrate. Use a moisturizing soap to clean your face; then, apply an emollient moisturizer.

(b) Try the prescription antioxidant tretinoin (Retin-A) or an over-the-counter antioxidant product with reliable studies backing it up.

(c) Get an alpha-hydroxy acid peel, Botox and/or a filling agent.

Wrinkles are the result of many factors: sun exposure, facial expressions, genetics, environmental pollutants (such as smoking) and various lifestyle-related aspects, including sleeping on one side of the face.

There are basically two types of wrinkles:

1. Dynamic Wrinkles: These are caused by muscle contraction. When you’re younger, you can create wrinkles by doing things like smiling or furrowing your eyebrows. When you relax your face, the lines go away. Over time, though, those facial lines tend to become permanent.

2. Static lines: These are the ones most associated with changes to the skin itself as you become older, more mature. Damage from the sun, smoking, and your own aging are the predominant factors here.

To help slow down or stop wrinkles, apply sun screen. While most of the damaging sun exposure happens to occur before people turn 18, you must still integrate a sunscreen into your skin's regime every day.

Hydration is really the key to low key wrinkle fighting. Here you want to do several things in your every day regime:

(a) When washing your face use a gentle cleanser (name products). They have little, if any, detergents (which can strip away natural oils that provide hydration, lubrication and protection) and increased moisturizers.

(b) Gently pat your face dry and try and emollient moisturizer. This will seal in the moisture you’ve gained from the shower and provide some additional hydration. Some newer, technologically advanced emollients, such as CeraVe, contain superrich moisturizers called ceramides that provide ongoing moisturization throughout the day.

(c) In addition to hydrating, you may want to try an antioxidant. Topical antioxidants include Retin-A (by prescription) but there are over-the-counter choices too. While evidence is still out as to which of the over-the-counter ones are really effective. The most important thing is to understand whether the product has been fully tested. Call the company and request any clinical studies or trail. If they have none, avoid the product. If they are able to produce some evidence, have your dermatologist or primary-care doctor review them critically.

Some other minimally invasive wrinkle reduction options are:

(a) Alpha-hydroxy acid peels. These are often referred to as 'lunch-time peels.' These cause dead skin in your epidermis (the top layer) to slough off, revealing newer, brighter skin. They may also work in the dermis (the bottom layer) to increase the production of collagen, elastin and hyaluronic acid. To get the most effective response, have your dermatologist perform this peel – they can provide you with products that are best for your type of skin and have the most concentration of the product. Keep in mind that these peels make your skin much more sun-sensitive, so lather on the sunscreen.

(b) Microdermabrasion. This is an excellent form of exfoliation, making the skin feel and look fresher. While this can be helpful in removing superficial linees, it is not effective on long-term, significant lines. When used with other treatments it can offer subtle improvements.

(c) Thermage. This is a non-invasive treatment that delivers tighter skin, renewed facial contours and healthier collagen. (Collagen is the building block that provides structure to your skin.) The Thermage procedure is available only in the offices of qualified physicians who specialize in cosmetic procedures. The Thermage procedure employs a patented monopolar capacitive radiofrequency (CRF) technology called ThermaCool™. It has been clinically proven to tighten and gently lift skin to smooth out wrinkles and renew facial contours. The incision-free procedure is fast and easy, and requires no downtime from normal activities. Unlike lasers, the procedure can be performed on patients of all skin types. The ThermaCool device has been cleared by the FDA for the non-invasive treatment of wrinkles.

(d) Botox. We’ve all heard about this. It is a genetically engineered enzyme that causes muscle relaxation. Some facial lines, especially crow’s feet, smile lines, and lines on the forehead and between the eyebrows, come from muscular contraction. No topical crème or lotion will affect the muscles. Here is when Botox is the best option.

(e) Filling Agents. Hyaluronic acid products, like Restylane, can be effective when treating areas that are caused from a decrease in the skin's supporting substances or on wrinkles caused by muscle contraction. Restylane is synthetic (not derived from animals) and can last six to 12 months.