Is there a Wrinkle Cure?

When I do a skin care consult, the most common concern people want to improve upon is wrinkles, wrinkles, and wrinkles. Wrinkles are associated with aging. No one wants to look older and wrinkles are definitely not attractive. The problem is that just about every product and brand claims to have something to prevent wrinkles and most of the time, only minimal changes are seen and maintained. Is there a wrinkle cure?

Well to understand wrinkles, let's talk in brief about why and how they occur. One reason why we wrinkle is that as we age, certain genes become turned off spontaneously, thereby causing us to form wrinkles. The genes that are turned off are the ones that produce collagen. The second phenomena is the constant exposure to free radicals. As described in a previous blog, free radicals are cells that are unstable and cause a vicious cycle of destruction when they try to become stable. We are exposed to free radicals every where. It comes from the air, solar radiation, ozone, and pollutants. Normal cell metabolism also cause free radicals to form. It is the accumulation of these free radicals that causes us to age. And lastly, there are natural decreased levels of anti-oxidants in the skin that decrease our ability to fight off the free radicals and accelerate the aging process.

There are two types of skin aging: Intrinsic Aging and Photoaging. In Intrinsic Aging, the natural collagen production will decrease by 1% per year throughout the adult life span. What we see is reduced collagen formation at the nuclear and cellular level. This produces the chronological changes we see with age. In Intrinsic aging the skin appears dry, dull, pale with fine wrinkles. There is some laxity to it and it is prone to benign skin growths. With Photogaing, this is aging related to sun exposure. The UV radiation causes direct damage to the DNA of the skin cell damaging its ability to repair itself as well as reproduce normal skin cells. It greatly reduces the body's ability to form collagen and repair collagen, and lastly, there is a very large amount of free radicals accumulating that worsen everything I just mentioned. The more sun damage there is, the reduced ability the body has to repair itself, leading to more damage and more wrinkles. It is a vicious cycle. The skin with photoaging has very coarse, deep wrinkles, a leathery look, dry, and mottled appearance. It also is suspect to precancer and cancer lesions of all types.

Two other things can cause skin to age faster are smoking and reduced hormone levels. Smoking accelerates the formation of free radicals and works synergistically with sun damage to cause wrinkles. Reduced hormone levels occur in both men and women as they age. We begin to lose critical hormones after 30 by 1-3% per year. This loss of hormones causes a decrease in collagen and elastin production which causes us to age even more. For women, the decrease in collagen production after menopause is 2.5% per year, which is more than 1% as seen with intrinsic aging. That is why in our center, we talk about hormone optimization as being part of the skin care program. Patients who don't want to do that, end up spending more money and see less change per treatment. My patients who do the wellness with the advanced skin care, have the best results because we can heal from the inside out and the outside in.

So, to stop wrinkles, you must use sunblock and vitamin C topical. Sunblock which has both UVA and UVB protection should be used everyday to prevent solar radiation exposure. Vitamin C serum is important to use as a topical anti-oxidant to reduce the formation of free radicals.

For patients who have wrinkling, I add Retinols which if used over time (for one year) will correct intrinsic damage done to the skin. OBAGI is a great skin care line to use for those with both deep and fine lines.

The other items I recommend are treatments. Patients with fine lines can see changes with both peels and laser skin rejuvenation. Laser skin rejuvenation involves an Intense Pulse Light (IPL) which penetrates the skin about 20-25 microns deep to improve skin tone, texture, and soften fine lines. This IPL treatment reorganizes damaged collagen and elastin but does not cause new collagen and elastin production. Most patients typically need about 5-6 treatments to obtain maximum improvements. They will need a touch up every three to four months.

Peels can help as well but are not as dramatic mostly because superficial peels penetrate only about 5-12 microns deep in the skin. The skin damage is usually 100's of microns deep in the skin. Peels are a great starting point for young people who want to prevent wrinkles, but for my more mature clients, I think the skin rejuvenation is better. The more deeper peels, are generally losing favor due to the down time of 5-10 days. Most of my clients work and that is not something they want to do or can afford to do. We don't even offer it in our centers because we have other laser treatments that work even better without the down time.

For patients with deeper lines or a lot of fine lines, I use our fractional ablative laser, the PIXEL. This is the newest technology to improve skin with minimum down time. The PIXEL uses the same Erbium laser that was used in the past with ablative lasers (the lasers used to peel off your whole skin and made you look like Freddie Kruger for a few weeks. The new skin would be regenerated over time improving appearance) However the down time associated the old lasers was too much and were falling out of favor. This new fractional ablation is great. We can have about 30-150 microns deep penetration in skin with each treatment and causes the formation of new collagen and elastin. This is what fills in the wrinkles resulting in a more even, health look. There is about two days of looking sun burned and two more days of some mild peeling but nothing to stop you from going to work with each Pixel treatment. Most people need about 3-6 treatments for optimal results and then maintenance every 6-12 months. It works for wrinkles, sun damage, melasma, scars, acne, and just overall appearance in skin tone and texture. It

The Pixel's counterpart is the Fraxel. The fraxel uses the same fractional ablation technology but the physician has to buy a whole new system for it (which means to the consumer, a more expensive procedure), a blue dye is placed over the skin to see where it has gone, and is more painful than the Pixel. I think as a consumer you should check out both but for cost and effectiveness, the Pixel is better.

The other things you can do to help reduce wrinkles is the skin tightening laser. Most people use this for the laxity around the jawline and turkey neck. This laser uses infrared technology to heat up the dermis to pull closer the stretched out collagen and elastin fibers, resulting in a tighter firmer look. Most clients need about 4 treatments once per month for optimal results and then a maintenance treatment once every six months.

For patients, who want to try injectables, there are lots of options. Botox is used for lines in motion whether they are on the forehead (your worry lines), the glabella (the frown lines you get when you get mad; also called the 11's), the crow's feet area (the smile lines around your eyes), the smoker lines around the lips, and for depressed mouths. It is a small injection done over these areas using Botulinum A. This weakens the muscle so it can not move but still allows for normal facial movements. It last about 3-6 months. My patients tell me that when they do the PIXEL and Botox, the Botox last longer.

For lines at rest, we use fillers. The most common fillers are Restylane and Juvaderm. Both are made from Hylauronic acid and both last about 6 months. The difference from the two is more what the individual physician and patient feels, thus far. Juvaderm is newer and less information is out on it in the United States. It came from Europe and has an excellent track record there. It uses slightly more hylauronic acid then Restylane and feels softer when applied. It is also the first filler approved for People Of Color. Restylane has a long track record of working well with minimum side effects. It does last about 6 months in average, and most patients require some block to be used before it can be injected. I use both and I prefer Juvaderm because it is easier for me to apply and less painful. I will have to see anecdotal which one last longer!

For the longer fillers, there is Sculptra and Radiesse. Sculptra was approved for HIV lipodystrophy (the thinning of the face from fat loss that is seen in HIV patients) but is now cosmetically used for aging on our thin, hollowed out faces. It is suppose to last about 1-2 years. Radiesse is the longer filler like Restylane and Juvaderm which is suppose to last 1-2 years. I recommend it only to my patients that love the way they look with the Juvaderm or Restylane since it is so long lasting. Patients do complain that it feels hard but not enough to stop anyone from getting it done.

As you can see there are lots of options for wrinkles. To find out which is the best for you, it is best to speak with a professional. Remember, skin care products and healing from the inside are just as important as healing from the outside!