Wrinkles, or rhytids, occur for two reasons: muscle contraction under the skin OR excess loose skin which can cause sagging. Let’s get familiar with some common locations for wrinkles.
Wrinkles can be treated in a variety of ways depending on the age of the patient, the depth of the wrinkle, and the location of the wrinkles. A quick summary of some treatment options is found below. Again I ascribe to a graduated approach that treats each patient differently depending on their motivations and goals. Therefore a consultation is recommended.
1. Wrinkle Creams – Promote water absorption of the dermis (deep layer of the skin). See the blog article “Do Wrinkle Creams Work?” for more information.
2. Tretinoin – The most popular first line treatment and one of the only approved medications for the prevention of wrinkles is tretinoin, also known as tretinoic acid or Rretin-A. This topical medication increases the thickness and collagen production of the dermis. As a result, there is also increased skin turnover and decreased fine wrinkles. Effects typically take around 6 months. Side effects can be dryness and photosensitivity.
3. Chemical Peels – Underneath the umbrella of chemical peels, are a variety of agents that cause shedding of the top layer of skin. As a result, new skin is able to form and replace the old skin. The new skin often has less of the fine wrinkling as a combination of skin tightening and new skin formation. The depth of the chemical peel is the main determinant of effectiveness. Based on your skin color, motivation, and expected down time, we can decide which peel and depth is the best choice for you. The medium or deep chemical peels are very different that the peels offered at spas. See the Facial Resurfacing Page for more information on the procedure.
4. Dermabrasion – This procedure also removes the top layer of skin, however instead of using chemicals or lasers, it is done with a very fine mechanical brush. Similar to a chemical peel, dermabrasion can be performed to different layers depending on the wrinkle depth and patient skin type. Caution should be used in darker skin patients. See the Facial Resurfacing Page for more information.
5. Laser resurfacing – Similar in action to chemical peels and dermabrasion, laser resurfacing provides a very controlled way of removing the most superficial layer of skin. This also causes some skin tightening of the deeper layers of skin due to the heat and healing process. See our Laser Resurfacing Page for more information on lasers, laser safety, expected downtime and results.
6. Botox or Dysport – This popular medication (onabotulinumtoxin A) is injected into muscles of the face to prevent the muscles from contracting. Contrary to what many people believe, it does not fill wrinkles (see injectable fillers below). By preventing muscle contraction, dynamic wrinkles no longer occur. Deep wrinkles that are present at rest may still be present after Botox injection. See our Botox/Dysport Page for more information on how Botox works, expected results, and how often you will need injections.
7. Injectable Fillers – The variety of fillers on the market (Juvederm, Restylane, Sculptra, Radiesse) act to increase collagen (the major structural protein in the skin). The result is increased fullness in the area of injection. This process usually takes up to 2 months to achieve maximum results and results typically last around one year. Injectables are typically used for deeper wrinkles or wrinkles present at rest. See our Injectables Fillers Page for more information on products offered and indications for use.
8. Lifting procedures – As we age and the skin becomes less elastic, stretching of the skin occurs. These wrinkles are present at rest (without facial expressions) and can also be described as “sagging” or “bulging” of skin tissue. The most effective way of dealing with wrinkles caused by excess, loose skin is the removal of that extra skin. Examples include a forehead/brow lift,facelift, necklift, or removal of extra eyelid skin (blepharoplasty). Click the links for more details on those procedures. Note that these procedures are not the last option for patients, and can often be the most cost-effective option for certain patients. Schedule a consultation to see whether this may be the best option for you.