Wrinkles 101

For some people, having wrinkles could mean three things:

1. Wrinkles are the roadmap of your life.
2. Wrinkles signify wisdom.
3. Wrinkles show a level of maturity.

However, what concerns most people is that having wrinkles is generally associated with aging, and in this generation’s pop culture, “aging” is not viewed positively, thus the abundance of anti-aging products and treatments in the market.

Wrinkles are an after-effect of aging. Also known as rhytide, these are fold, ridges, or creases in the skin. As we age, skin cells divide more slowly, and the dermis (our skin’s inner layer), starts to thin, which makes the skin’s stretchiness and structure break. While the skin naturally ages all over the body, it does much more on the parts where sun exposure has been the greatest like in the hairless scalp, face, neck, the backs of the hands, and on top of the forearms.

According to the article by www.webmd.com entitled: Cosmetic Procedures and Wrinkles, the following are factors that contribute to the promotion of wrinkling:

• Smoking

-        Smoking limits the collagen production of our skin, which serves as a major part of our skin structure. The collagen deterioration gives way for wrinkles.

• Facial Muscle Contractions

-        Lines between your eyebrows (frown-lines) and lines jutting from the corner of your eyes (crow’s-feet) are thought to result from facial muscle contractions. Smiling, frowning, squinting and other habitual facial expressions cause these wrinkles to become more prominent. Over time, those expressions, plus gravity, contribute to the formation of jowls and drooping eyelids.

• Sun Damage

-        Getting too much sun damages your skin. That leads to wrinkles. To prevent them, stay out of the sun between 10am and 4pm, and get in the habit of wearing sunscreen every day, even when it's cloudy.

In this generation of technological advancement, there are now numerous treatments for wrinkles ranging from topical medicines and creams to invasive techniques. Its efficacy reaches to the extent that they change the nature of the aging collagen, they make the skin stretch, they fill in depressions in the skin, or they paralyze the muscles that make the skin develop creases.

In an article entitled Wrinkles at www.medicinenet.com by Gary W. Cole, MD, FAAD, a board-certified dermatologist from California, he listed down both medical and surgical methods of treating wrinkles:

Medical treatments

• Vitamin A Acid (tretinoin [Retin A, Renova]): This ingredient, available by prescription, has the longest track record of success in treating aging skin and fine lines. Creams containing tretinoin must be used on an ongoing basis. They may produce redness and peeling at first, but discomfort can usually be minimized by lowering the cream's concentration or applying it less often until the skin gets used to it.
• Alpha-hydroxy acids: These so-called "fruit acids" include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. They produce only subtle improvement though.
• Antioxidants: These include preparations that contain the vitamins A, C, and E, as well as beta-carotene. Such creams may provide a certain amount of sun protection as well as mild improvement of fine wrinkles.
• Ordinary moisturizers: Creams that don't contain any of the above substances can only make wrinkles look temporarily less prominent ("reduce the appearance of fine lines").

Cosmetic procedures

• Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.
• Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects, such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels do not require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.
• Microdermabrasion: This refers to "sanding the skin" with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in "packages" of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as "home microdermabrasion" are just mild exfoliants, harmless but not likely to produce any meaningful change in wrinkles.
• Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color.
• Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the peel reaches the middle of the dermis, the skin's second layer. This helps stimulate the body's natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some doctors perform laser resurfacing under "conscious sedation," in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring.
• Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less "downtime" afterward. Several treatments are needed to achieve full benefit.
• Non-ablative laser resurfacing: Newer lasers attempt to stimulate collagen synthesis under the skin without peeling or damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward.
• Heat and radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devises and infrared light sources. Techniques are still being developed but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts.
• Plastic surgical procedures: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
• Botox: Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the "frown lines" on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe; the muscle poison does not spread through the body to do damage elsewhere.
• Fillers: Fillers are injected into the skin to increase volume and flatten wrinkles and folds. For a long time, the most popular filler was collagen, whose effect only lasts a few months. More recently, new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse) have become popular because their effect can last six to nine months or even longer.

However, it is advisable that a person considering getting any of the above-listed treatments should consult a doctor who has experience in at least one of the mentioned techniques. It is important that the patient is fully informed of the potential risks and benefits before going through a chosen procedure.