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Wrinkles

Definition:
Wrinkles are a natural part of aging. As you grow older, your skin gets thinner, drier and less elastic. And it becomes less able to protect itself from damage. As a result, wrinkles, lines and creases form in your skin. Although genetics are the most important determiner of skin texture, a major contributor to wrinkles is spending too much time in the sun. Smoking also can negatively affect how your skin looks.

If your wrinkles are bothering you, you have more options than ever to help eliminate or at least diminish their appearance. Medications, skin resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments.

Wrinkle treatments can smooth out your skin, but the results aren't permanent. As you age, your skin continues to acquire new wrinkles. And sun exposure and smoking may hasten the development of new wrinkles. Though you can't turn back the hands of time, you can take steps to protect your skin from further damage.

Causes:
Wrinkles are caused by a combination of factors — some you can control, others you can't.
  • Age. As you get older, your skin naturally thins and becomes less elastic and more fragile. Decreased production of natural oils makes your skin drier and more wrinkled. Fat in the deeper layers of the skin, which gives the skin a plump appearance, starts to lessen. This causes loose, saggy skin and more pronounced lines and crevices.
  • Exposure to ultraviolet (UV) light. Ultraviolet radiation speeds up the natural aging process and is the primary cause of early wrinkling. Exposure to UV light breaks down the skin's connective tissue — collagen and elastin fibers, which lie in the deeper layer of skin (dermis). Without the supportive connective tissue, the skin loses its strength and flexibility. As a result, skin begins to sag and wrinkle prematurely.
  • Smoking. Smoking can accelerate the normal aging process of your skin, contributing to wrinkles. This may be due to changes in the blood supply to the skin around the lips. In addition, repeated exposure to the heat from burning cigarettes and the facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — may contribute to wrinkles.
  • Repeated facial expressions. Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. Each time you use a facial muscle, a groove forms beneath the surface of the skin. And as skin ages, it loses its flexibility and is no longer able to spring back in place. These grooves then become permanent features on your face.
When to seek medical advice:
If you're concerned about the appearance of your skin, see your dermatologist. He or she can help you create a personalized skin-care plan by assessing your skin type and evaluating your skin's condition. A dermatologist can also recommend medical wrinkle treatments.

Symptoms:
Wrinkles are the lines and creases that form in your skin as you age. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.


Treatment:
If your wrinkles are bothering you, you have many options to help eliminate or at least reduce their appearance. Wrinkle treatments include:

Medications

  • Topical retinoids. Derived from vitamin A, retinoids that you apply to your skin may be able to reduce fine wrinkles, splotchy pigmentation and skin roughness. Retinoids must be used with a skin-care program that includes sunscreen and protective clothing because the medication can make your skin burn more easily. It may also cause redness, dryness, itching, and a burning or tingling sensation. Tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) are examples of topical retinoids.
  • Nonprescription wrinkle creams. The effectiveness of anti-wrinkle creams depends in part on the active ingredient or ingredients. Retinol, alpha hydroxy acids, kinetin, coenzyme Q10, copper peptides and antioxidants may result in slight to modest improvements in wrinkles. However, nonprescription wrinkle creams contain lower concentrations of active ingredients than do prescription creams. Therefore results, if any, are limited and usually short-lived.

Surgical procedures and other techniques
A variety of skin resurfacing techniques, injectables, fillers and surgical procedures are available to smooth out wrinkles. Each works a little differently and has its own set of potential results and side effects.

  • Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. The planing removes the skin surface and a new layer of skin grows in its place. Redness, scabbing and swelling generally last a couple of weeks. It may take several months for the pinkness to fade and to see the desired results.
  • Microdermabrasion. This technique is similar to dermabrasion, but less surface skin is removed. It's done using a vacuum suction over your face while aluminum oxide crystals essentially sandblast your skin. Only a fine layer of skin is removed. You may notice a slight redness to the treated areas. Microdermabrasion usually requires repeated treatments to maintain the subtle, temporary results.
  • Laser, light source and radio frequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis), which stimulates the growth of new collagen fibers. As the wound heals, new skin forms that's smoother and tighter. It can take up to several months to fully heal from laser resurfacing. Less intense lasers (nonablative lasers), pulsed light sources and radio frequency devices don't injure the epidermis. These treatments heat the dermis and cause new collagen and elastin formation. After several treatments, skin feels firmer and appears refreshed. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.
  • Chemical peel. Your doctor applies an acid to the affected areas, which burns the outer layer of your skin. With medium-depth peels, the entire epidermis and a small portion of the dermis are removed. New skin forms to take its place. The new skin is usually smoother and less wrinkled than your old skin. Redness lasts up to several months. With superficial peels, only a portion of the epidermis is removed. After a series of peels, you may notice less fine wrinkling in your skin and a fading of brown spots.
  • Botulinum toxin type A (Botox). When injected in small doses into specific muscles, Botox blocks the chemical signals that cause muscles to contract. When the muscles can't tighten, the skin flattens and appears smoother and less wrinkled. Botox works well on frown lines between the eyebrows and across the forehead, and crow's-feet at the corners of the eyes. Results typically last about three to four months. Repeat injections are needed to maintain results.
  • Soft tissue fillers. Soft tissue fillers, which include fat, collagen and hyaluronic acid (Restylane, Juvederm), can be injected into deeper wrinkles on your face. They plump and smooth out wrinkles and furrows and give the skin more volume. You may experience temporary swelling, redness and bruising in the treated area. The procedure may need to be repeated every few months.
  • Face-lift. The face-lift procedure involves removing excess skin and fat in the lower face and neck and tightening the underlying muscle and connective tissue. The results typically last five to 10 years. Healing times can be lengthy after a face-lift. Bruising and swelling are usually evident for two to three weeks after surgery.

Keep in mind that results vary depending on the location of the wrinkles and how deep the wrinkles are. Plus, nothing stops the aging process of skin, so you'll likely need the treatments repeated to maintain benefits.

These procedures aren't usually covered by insurance. In addition, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you're considering.

Prevention:
Here are ways to improve and maintain your skin's youthful appearance:
  • Protect your skin from the sun. Protect your skin — and prevent future wrinkles — by limiting the time you spend in the sun and always wearing protective clothing and hats. Also, use sunscreen when outdoors, even in winter.
  • Choose products with built-in sunscreen. When selecting skin-care products, choose those with a built-in sun protection factor (SPF) of at least 15. Also, be sure to select products that block both UVA and UVB rays.
  • Use moisturizers. Dry skin turns plump skin cells into shriveled ones, creating fine lines and wrinkles long before you're due. Though moisturizers can't prevent wrinkles, they can temporarily mask tiny lines and creases.
  • Don't smoke. Even if you've smoked for years or smoked heavily when you were younger, you can still improve your skin tone and texture and prevent future wrinkles by quitting smoking.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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