Removing Facial Wrinkles

Written by: Alan Rockoff, M.D.
Edited by: William C. Schiel, M.D., FACP, FACR


Although wrinkles can be signs of experience and wisdom, most people would rather not have them.

People's desire to retain and regain youth is strong and universal. The eternal wish for a "fountain of youth" can be seen in the innumerable products and procedures advertised in books, magazines, and other media that promise "younger-looking skin." Many claims for such youth-enhancing methods are unfortunately overblown or entirely nonexistent. Let the buyer beware! Still, effective techniques for softening and even removing wrinkles do exist.

Skin ages all over the body, but much more so where there has been sun exposure. Changes brought on by sun damage (photoaging) include "dryness" (really roughness), sagginess, skin growths like keratoses ("liver spots"), and wrinkles.

Wrinkles in turn can be divided into two categories; fine, surface lines and deep furrows. Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques, such as plastic surgery.

Wrinkles are found primarily on the parts of the body where sun exposure is greatest. These areas especially include the face, neck, the backs of the hands, and the tops of the forearms.

What factors promote wrinkles?

Factors that promote wrinkling include:

Skin type (people with light-colored skin and blue eyes are more susceptible to sun damage)
Heredity (some families wrinkle more)
Hairstyle (depending on how much skin is covered by hair and protected from the sun)
Dress (again, by determining which skin is exposed)
Occupational and recreational sun exposure over the course of many years

Some of these factors are beyond our control. The main preventative measures we can take are to minimize sun exposure and not smoke.

SPF numbers on sunscreen labels refer to protection against UVB radiation (short-wave ultraviolet light, or the"sunburn rays"). Most sunscreens allow UVA (long-wave ultraviolet light) to penetrate the skin. These are the same rays used in suntan parlors. Although UVB is more energetic in producing wrinkles, there are about 10 times as many UVA rays in the atmosphere as there are UVB rays. It is therefore likely that using tanning parlors and spending lots of time outdoors--even with "maximum protection"--will contribute to the development of wrinkles. Some sunscreens contain ingredients (like Parsol 1789) that provide UVA protection, but these are only partially effective. For more, please read the articles, Sunburn and Sun Sensitizing Drugs and Sun Protection and Sunscreens.

What treatments are available for wrinkles?

So, what can be done to treat wrinkles? There are several medical (topical medicines and creams) and cosmetic techniques available for improving (minimizing) the appearance of wrinkles and even removing them. Below is a description of these methods and their potential outcomes and side effects.

Medical treatments:
Vitamin A Acid (tretinoin, Retin-A, Renova). Among medical treatments, this is by far the most proven and effective way of bettering many of the signs of aging, such as mottled pigmentation, roughness, and wrinkling. Creams containing this medication must be used on an ongoing basis. At first, they produce redness and peeling. Although this can be unpleasant for a while, it is essential to achieving improvement once the peeling stops.

Alpha-hydroxy acids. These are the so-called "fruit acids" and include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. The improvement they produce is, however, relatively subtle.

Antioxidants. These include preparations that contain the vitamins A, C, and E, as well as beta-carotene. These creams may provide a certain amount of sun protection as well as mild improvement of wrinkles.

Ordinary moisturizers. Regular creams, which don't contain any of the above substances, may make wrinkles look temporarily less prominent. This is what advertisers have in mind by products that "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. These deeper peels do a better job of smoothing fine lines. In general, however, the deeper the peel, the greater the risk of side effects, such as long-lasting pigment changes (changes in skin color) and scarring. Such peels do not require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.

Dermabrasion. Often performed under general anesthesia, this procedure involves the use of 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 or Ela-Max, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated once or twice at 6 to12 month intervals to maximize improvement. They are, however, associated with pain, lengthy healing times, and potential for permanent pigment changes and scarring.

Non-ablative laser resurfacing. Newer lasers attempt to stimulate collagen synthesis under the skin without peeling or damaging the epidermis. Data on their effectiveness are still preliminary at this point, but suggest that results for fine lines and wrinkles may approach those of invasive laser resurfacing. Treatment is almost painless and there is little or no redness, peeling, or "down-time" afterward. Noticeable improvement may involve several repeated procedures over a period of months.

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. Safety depends again on the experience of the physician. Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

Written by: Alan Rockoff, M.D.
Edited by: William C. Schiel, M.D., FACP, FACR

Disclaimer: this website is for informational purposes only, and is not intended to be a substitute for a professional medical diagnosis, opinion or suggested course of treatment. Please see your health care professional for a professional medical opinion, and refer to our Disclaimer regarding your use of this website.

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