Wrinkles

[Naturally]

What are wrinkles? Did you know that one of the easiest ways to tell the age of adults is by looking at their faces, or more specifically, at their skin? As people age, all the time they've spent in the sun, at tanning salons, or smoking cigarettes catches up with them. The result is often wrinkles! An anti-wrinkle strategy is part of every skin care plan.

Skin care specialists say that the skin is made up of three layers: the epidermis, the dermis, and the subcutaneous layer. The outermost layer of the skin that everyone can see is the epidermis, the middle is the dermis, and the innermost layer is the subcutaneous layer. All three work together to keep the skin in tip-top shape. All three layers must be addressed with proper skin care.

When you are young, the skin does a great job of stretching and holding in moisture. The dermis has an elastic quality thanks to fibers called elastin that keep the skin looking and feeling young. A protein in the dermis called collagen also plays a part in preventing wrinkles. Collagen is a part of skin care creams as well.

However, over time, the dermis loses both collagen and elastin, so skin gets thinner and has trouble getting enough moisture to the epidermis. The fat in the subcutaneous layer that gives skin a plump appearance also begins to disappear, the epidermis starts to sag, and wrinkles form. Wrinkles mean you didn't take proper skin care when you could.

There's not a magic age (like 40) where everyone suddenly gets wrinkles. Some people in their 20s have little wrinkles around their eyes (called "crow's feet") from squinting or spending too much time in the sun. Other people may be in their 50s or 60s before you can even see a wrinkle. This is usually because they have taken good skin care over the years and may have more sebum, the skin's natural oil. Eventually, however, everyone will have at least a few wrinkles. It's a natural part of the aging process.

Here are some skin care tips to prevent getting many wrinkles at an early age:

§ Avoid spending too much time in the direct sun, especially during the hours when the sun's rays are harshest (between 10:00 AM and 4:00 PM). Ultraviolet (UV) rays cause many wrinkles. Sunblock helps, but it doesn't block out all the damaging UV rays that cause wrinkles to the skin. Still, if you are outside a lot, be sure to wear a sunblock with sun protection factor (SPF) 15 or higher and reapply often (every 2 to 3 hours). That's your best skin care solution against the sun. Always reapply after swimming or playing sports that make you sweaty!

§ Don't go to the tanning salon. The UV light from tanning booths is just as damaging as the sun's and sometimes worse. UV is against skin care.

§ Don't smoke! Smoking robs your skin of precious moisture and causes premature (early) wrinkles. Smoking is a skin care enemy.

§ Moisturize dry skin every day with a hydrating cream or moisturizer, especially during months when the air is drier and you need extra skin care.

“The objective of skin moisturizer is to create a barrier between the skin and the air, temporarily maintaining your skin's natural moisture by keeping the water in the skin (not replacing moisture as you may have thought). “

Drink lots of water every day to keep hydrated and help your skin stay moist and smooth. Water is an essential skin care ingredient.

As a person ages, skin undergoes significant changes:

The cells divide more slowly, and the inner layer of skin (the dermis) starts to thin. Fat cells beneath the dermis begin to atrophy (diminish). The underlying network of elastin and collagen fibers, which provides scaffolding for the surface layers, loosens and unravels. Skin loses its elasticity. When pressed, it no longer springs back to its initial position but instead sags and forms furrows. The sweat- and oil-secreting glands atrophy, depriving the skin of their protective water-lipid emulsions. The skin's ability to retain moisture then diminishes and it becomes dry and scaly. Frown lines (those between the eyebrows) and crow's feet (lines that radiate from the corners of the eyes) appear to develop because of permanent small muscle contractions. Habitual facial expressions also form characteristic lines. Gravity exacerbates the situation, contributing to the formation of jowls and drooping eyelids. (Eyebrows, surprisingly, move up as a person ages, possibly because of forehead wrinkles.) In addition, the ability of the skin to repair itself diminishes with age, so wounds are slower to heal. Sun Damage (Photoaging) and Wrinkles
The role of the sun cannot be overestimated as the most important cause of prematurely aging skin (called photoaging) and skin cancers. Overall, exposure to ultraviolet (referred to as UVA or UVB) radiation emanating from sunlight accounts for about 90% of the symptoms of premature skin aging, and most of these effects occur by age 20.

Initial Damaging Effects of Sunlight.Sunlight consists of ultraviolet (referred to as UVA or UVB) radiation, which penetrates the layers of the skin. Both UVA and UVB rays cause damage leading to wrinkles, lower immunity against infection, aging skin disorders, and cancer. They appear to damage cells in different ways, however.

• UVB radiation is the primary cause of sunburn. Because of its shorter wavelength, however, UVB primarily affects the outer skin layers. UVB appears to damage skin cells by directly bombarding the genetic material, the DNA , inside the skin cells.
• UVA radiation is composed of longer wavelengths. They penetrate more deeply and efficiently into the inner skin layers and are responsible for tanning and allergic reactions to sunlight (such as from medication). The main damaging effect of UVA appears to be the promotion of the release of oxidants, also called oxygen-free radicals. These unstable particles are the result of many chemical processes in the body. In excess, however, they can damage cell membranes and interact with genetic material. They possibly contribute to the development of a number of skin disorders, including wrinkles and, more importantly, cancer. The large surface area of the skin makes it a prime target for oxidants.

Protective Measures.The skin protects itself against DNA damage from ultraviolet radiation in different ways:

• In response to sunlight enzymes in the skin produce melanin, the dark pigment and the source of tanning, which helps shield the sun's rays.
• Other enzymes are also released that use regenerated DNA to try to repair damaged skin cells.
• It these processes fail to preserve skin cells, the system signals severely damaged cells to literally kill themselves, a process called apoptosis. (Peeling after sunburn is the shedding of these severely damaged or dead cells).

Processes Leading to Wrinkles. Even small amounts of UV radiation trigger the following process that negatively effects skin:

• Sunlight damages collagen fibers (the major structural protein in the skin) and causes accumulation of abnormal elastin (the protein that causes tissue to stretch).
• In response to this sun-induced elastin accumulation, large amounts of enzymes called metalloproteinases are produced. (One study indicated that when people with light to moderate skin color are exposed to sunlight for just five to 15 minutes, metalloproteinases remain elevated for about a week.)
• The normal function of these metalloproteinases is generally positive, to remodel the sun-injured tissue by manufacturing and reforming collagen. (They may even have factors that protect against melanoma, although this is not clear.)
• This is an imperfect process, however, and some of these enzymes actually degrade collagen. The result is an uneven formation ( matrix) of disorganized collagen fibers called solar scars .
• Repetition of this imperfect skin rebuilding over and over again causes wrinkles.
• UV radiation also promotes oxidation, the release of damaging and unstable oxygen-free radicals. Oxidation contributes to wrinkling, possibly by activating the metalloproteinases that degrade connective tissue.

Other Factors Responsible for Wrinkles
In addition to sunlight, other factors may hasten the formation of wrinkles:

• Cigarette smoke produces oxygen-free radicals and is known to accelerate wrinkles and aging skin disorders. A 2001 study also found that smokers have considerably higher levels of metalloproteinases than non-smokers, which may help account for the skin-aging effects of smoking.
• Air pollution. Ozone, a common air pollutant, may be a particular problem for the skin. One study reported that it might deplete the amount of vitamin E in the skin; this vitamin is an important anti oxidant.
• Rapid weight loss can also cause wrinkles by reducing the volume of fat cells that cushion the face. This not only makes a person look gaunt, but can cause the skin to sag.

WHO IS MOST LIKELY TO HAVE WRINKLES?
Age and Risk

Exposure to Sun in Childhood. It is estimated that 50% to 80% of skin damage occurs in childhood and adolescence from intermittent, intense sun exposure that causes severe sunburns. In spite of this now well-known effect, many people still believe that a tan in children signifies health. And, even many parents who are concerned about sun exposure still rely too much on sunscreen and not enough on protective clothing.

The Elderly. Most people over 70 have at least one skin disorder and many have three or four. Everyone experiences skin changes as they age, but a long life is not the sole determinant of aging skin. Family history, genetics, and behavioral choices all have a profound impact on the onset of aging-skin symptoms.

Activities Leading to Overexposure to Sunlight

Of all the risk factors for aging skin, exposure to UV radiation from sunlight is by far the most serious. Indeed, the vast majority of undesirable consequences of aging skin occur in individuals who are repetitively exposed to the sun, including the following:

• Outdoor workers, such as farmers, fishermen, construction workers, and lifeguards.
• Outdoor enthusiasts.
• Sunbathers.

Skin Types
Experts have devised a classification system for skin phototypes (SPTs) based on the sensitivity to sunlight. It ranges from SPT I (lightest skin plus other factors) to IV (darkest skin). [ See Table ] People with skin types I and II are at highest risk for photoaging skin diseases, including cancer. It should be noted, however, that premature aging from sunlight can affect people of all skin shades.

Tanning and Sunburn History

Skin Type

Tanning and Burning History I

Always burns, never tans, sensitive to sun exposure

II

Burns easily, tans minimally

III

Burns moderately, tans gradually to light brown

IV

Burns minimally, always tans well to moderately brown

V

Rarely burns, tans profusely to dark

VI

Never burns, deeply pigmented, least sensitive

Gender

Although it is commonly believed that women are at greater risk for wrinkles than men, this does not appear to be true. Given the same risk factors, men and women in the same age groups appear to have comparable risks for photo skin aging. In fact, in one 1999 study, long-term sun exposure caused a greater number of wrinkles in men than in women. In a French study, the evidence of moderate to severe photoaging was seen in the following:

• In 22% of women and 17% of men between the ages of 45 and 49.
• In 36% of women and 38% of men by age 54.
• Nearly half of both men and women by age 60.

Men were more likely to develop nonmelanoma skin cancers. Smokers

Cigarette smokers are more prone to wrinkles and skin cancers. According to one study, heavy smokers are almost five times as likely to have wrinkled facial skin than nonsmokers. In fact, heavy smokers in their 40s often have facial wrinkles more like those of nonsmokers in their 60s. Studies of identical twins have found smokers to have thinner skin (in some cases by as much as 40%), more severe wrinkles, and more gray hair than their non-smoking twins. [For more detailed information, see the Well-Connected report #41, Smoking.]

WHAT ARE WAYS TO AVOID SUN EXPOSURE?

Staying out of the Sun

The best way to prevent skin damage in any case is to avoid episodes of excessive sun exposure. The following are some specific guidelines:

• Avoid exposure particularly during the hours of 10 AM to 4 PM when sunlight pours down 80% of its daily UV dose.
• Avoid reflective surfaces, such as water, sand, concrete, and white-painted areas. (Clouds and haze are not protective, and in some cases may intensify UVB rays.)
• Ultraviolet intensity depends on the angle of the sun, not heat or brightness. So the dangers are greater the closer to the summer-start date. For example, in the Northern Hemisphere, UV intensity in April (two months before summer starts) is equal to that in August (two months after summer begins).
• The higher the altitude the quicker one sunburns. (One study suggested, for example, that an average complexion burns at six minutes at 11,000 feet at noon compared to 25 minutes at sea level in a temperate climate.)
• Avoid sun lamps and tanning beds. They provide mostly UVA rays, and some experts believe that 15 to 30 minutes at a tanning salon are as dangerous as a day spent in the sun.

WHAT ARE THE GENERAL GUIDELINES FOR TREATING WRINKLES
Wrinkles can have a profound impact on self-esteem. Indeed, the stigma attached to looking old is evidenced by the fact that Americans spend more than $12 billion each year on cosmetics to camouflage the signs of aging. Our current society places a premium on youthfulness, and age discrimination in the workplace, although illegal, has stalled many a person's career. Indeed, the emotional ramifications of aging explain in large part why the cosmetics industry and plastic surgeons thrive.

Topical Creams and Lotions

Many effective skin creams and lotions are now available and are proving to reduce wrinkles or their effect without great expense or invasive and sometimes painful treatments. Some people receive such psychologic benefit from simple wrinkle-reduction programs that it might even help them avoid psychotherapy. One study, for example, was conducted using women whose skin was photodamaged and who had high anxiety and obsessive compulsive ratings. After receiving the topical vitamin A derivative, Retin A, for two years, they reported significantly reduced levels of anxiety and obsessive-compulsive behavior than those not using the cream.

Intensive Treatments

The outward manifestations of age represent hard-won experience and character, and those who wear its natural signs with a healthy and happy outlook should be regarded with respect as role models. Before embarking on an expensive and ultimately futile attempt to keep time at bay, consider the real bases for self-esteem and the pursuit of a lifestyle that will bring true health and youthful vigor rather than an imitation of it.

For people who make the decision to pursue intensive treatments, individuals should consider the following factors, among others, and discuss them with their dermatologist or plastic surgeon:

• The ability of the procedure to safely reduce wrinkles.
• The ease and safety record of the procedure.
• The skill of the doctor.
• The length of recovery.
• Possible complications.
• The duration of the benefits.

A person's age also helps determine the procedure.

• For people in their thirties, a simple chemical peel is sufficient.
• After age 40, people may benefit from collagen or fat implants.
• At age 50 and over, plastic surgeons recommend laser resurfacing and customized treatments for individual needs.

Combination procedures may be needed. Some examples include the following:

• Laser surgery may be used for deep lines (such as those around the mouth) and chemical peels used over the rest of the face.
• For enhancing the eye by correcting droopy eyelids and bags and raising the brow, combinations of blepharoplasty (eye lift), Botox, and laser resurfacing may be used.

WHAT ARE SOME HOME CARE TREATMENTS FOR REDUCING WRINKLES?
Daily Preventive Skin Care

Some daily measures for skin protection are as follows:

• Wash the face with a mild soap that contains moisturizers. Alkaline soaps, especially with deodorant, should be avoided.
• Pat the skin dry and immediately apply a water-based moisturizer.
• Always apply sunscreen, even if going outdoors for short periods.

Healthy Lifestyle
Needless to say, the best long-term prevention for overly-wrinkled skin is a healthy lifestyle including the following:

• Daily exercise to keep circulation moving.
• A diet with plenty of whole grains, fresh fruits and vegetables, and the use of healthy oils (such as olive oil) may protect against oxidative stress in the skin.
• Reducing stress and tension may have benefits on the skin.
• Smokers should quit. Smoking not only increases wrinkles, but smokers have a risk for squamous cell cancers that is 50% higher than nonsmokers' risk.

Vitamin A Topical Products (Tretinoin and Retinol)
Topical products containing natural forms of vitamin A (retinol, retinaldehyde) or vitamin A derivatives called retinoic acids (tretinoin,) have proven to be beneficial for skin damaged by the sun and also by natural aging.

• Tretinoin (Retin-A).Tretinoin (known commercially as Retin-A) is available only in prescription form (Avita, Renova, Differin). It produces a rosy glow, and reduces large wrinkles, brown spots, and surface roughness. It may also be applied to face, neck, chest, hands, and forearm. The cream should be applied at least twice a week. Noticeable improvement takes from two to six months. Because Retin-A may increase a patient's sensitivity to the sun, a thin coat is best administered at bedtime. A sunblock should be worn during the day, and overexposure to the sun should be avoided. Almost all patients experience redness, scaling, burning, and itching after two or three days that can last up to three months. Very low concentrations (.025%) may offer the same improvement as higher concentration and produce less irritation. A daytime moisturizer or low-dose corticosteroid cream, such as 1% hydrocortisone, may help reduce irritation. Oral tretinoin can cause birth defects, and women should avoid even topical Retin-A when pregnant or trying to conceive.
  
• Retinol. Retinol, a natural form of vitamin A, could not, until recently, be used in skin products because it was unstable and easily broken down by UV radiation. Stable preparations are now sold over the counter. In the right concentrations, retinol may be as effective as tretinoin and studies indicate that it has fewer side effects. An animal study suggests that adding antioxidant creams (such as those containing vitamins C or E) may offer added protection against degradation of retinol, but not tretinoin. The FDA warns that over-the-counter retinol skin products are unregulated; the amount of active ingredients is unknown, and some preparations, in fact, may contain almost no retinol.
  

Of some interest, and possible concern, are studies indicating that vitamin A may improve skin by blocking metalloproteinases, enzymes stimulated by UV radiation that destroy collagen and elastin. There is some indication that metalloproteinases may protect against melanoma, however. Furthermore, one study found that long-time use of tretinoin damages Langerhans' cells, special immune cells that help prevent skin cancers. It has not yet been studied in people with darker skin. (It should be noted that oral vitamin A is toxic in high doses, however, and no one should take it for dry skin.) Antioxidants

Antioxidants are substances that act as scavengers of oxygen-free radicals, unstable particles that can damage the body's cells and even their genetic material. The most well-known antioxidants are vitamins A, C, E, coenzyme Q10 (CoQ10), and beta carotene.

Topical Antioxidants.There is some evidence that lotions and creams containing antioxidants may help protect the skin when applied before sun exposure. (The do not seem to provide benefit after exposure.) Studies vary on their effect and the following are some positive ones:

• Studies suggest that topical vitamin E particularly alpha tocopherol (a form of vitamin E) cream decreased skin roughness, length of facial lines, and wrinkle depth. Studies on mice have also reported reductions in UV-induced skin cancer with its use.
• Vitamin C, or ascorbic acid, is a potent antioxidant and large amounts appear to reduce skin swelling from sunlight and long-term use may even promote collagen production. Vitamin C by itself is unstable, but products that solve the delivery problem are now available (including Cellex-C, Avon's Anew Formula C Treatment Capsules, and others).
• One 1999 study found that topical application of the antioxidant Coenzyme Q10 (CoQ10) improved the skin's resistance to the oxidative stress of UV radiation, and when applied long-term, could reduce crow's feet.

Oral Antioxidants. Some research has been conducted on the effects on wrinkles using oral antioxidant supplements. One small study found that taking a combination of vitamins oral C and E supplements may help reduce sunburn reactions, although the protection is much less than from sunscreens. (Taking the vitamins singly does not appear to have the same effect.)

Other Natural Substances.The following natural substances have antioxidant properties and are being tried for wrinkle-protection:

• Both green tea and ginger appear to have properties that may provide some protection against cancer. Green tea skin care products are now available. Scientific studies will be needed to learn if they are actually beneficial.
• The substance silymarin, found in the milk thistle family (which includes artichokes), may inhibit UVB-promoted cancers in animals.
• In one interesting study, eating garlic protected animals very effectively against UVB damage by interfering with urocanic acid in the skin. Whether these results may be applied to humans, and what quantities of garlic might be beneficial, is still unknown.
• Aloe, lemon oil, and coral extracts contain antioxidants and are promoted as being healthy for the skin, although evidence of their effects on wrinkles is weak.

Alpha Hydroxy Acid and Home Exfoliation
One of the basic methods for improving skin and eliminating small wrinkles is exfoliation (also called resurfacing), which is the removal of the top layer of skin to allow regrowth for new skin. Methods for doing this run from simple scrubs to special creams to intensive peeling treatments, including laser resurfacing. [see What Are Professional Resurfacing Procedures for Skin Wrinkles?] People with darker skin are at particularly higher risk for scarring or discoloration with the more powerful exfoliation methods.

Abrasive Scrubs. Scrub gently with a mildly abrasive material and a soap that contains salicylic acid to remove old skin so that new skin can grow. The motion should be perpendicular to the wrinkles. Use textured material or cleansing grains with microbeads. Organic materials, such as loofahs or sea sponges may harbor bacteria. Avoid cleansing grains that contain pulverized walnut shells and apricot seeds, which can lacerate skin on a microscopic level. Cleansing grains with microbeads don't have sharp edges and remove skin without cutting it. Exfoliation using scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels.

Topical Alpha Hydroxy Acid and Similar Substances. Alpha hydroxy acids facilitate the shedding of dead skin cells and may even stimulate the production of collagen and elastin. They are found naturally as follows:

• Malic acid (found in apples and pears).
• Citric acid (oranges and lemons).
• Tartaric acids (grapes).
• Glycolic acid (sugar cane).
• Lactic acid (our milk).

Lactic and glycolic acids are used most often in commercial products. The preparations containing lactic acid may be slightly more effective than those made with glycolic acid. Products have also been developed that are made from larger molecules called poly-alpha-hydroxy acids and others from beta-hydroxy acids or BHAs (usually containing salicylate acid, the primary ingredient in aspirin). Manufacturers claim that such products are less likely to irritate the skin.
Acid concentrations in over-the-counter AHA preparations are 2% to 10%. One clinical study suggested that 8% concentrations showed modest improvement. Some examples include Avon's Anew Intensive Treatment (8% glycolic), Pond's Age Defying Complex (8%), Elizabeth Arden's Alpha-Ceramid Intensive Skin Treatment (3% to 7.5%), and BioMedic's home product (10%). Prescription strength creams contain at least 12% glycolic acid, and glycolic acid peels of 30% to 70% concentration may be administered in a doctor's office at weekly or monthly intervals.

Response to AHA varies, and the treatment is not without risk, particularly in high-concentration products. Side effects from over-the-counter creams, prescription products, and professional AHA peels can include burns, itching, pain, and possibly scarring. Studies also suggest that AHA may increase sun damage, even at concentrations as low as 4%. Experts advise that people should purchase products with AHA concentrations of 10% or less. If any adverse effects occur, the product should be stopped immediately. In all cases, people are advised to avoid sunlight or use proper sun protection when using them.

Experts are further concerned because part of the wrinkle-reducing effects of alpha hydroxy involve calcium loss, which in turn may promote cell growth and impair differentiation. Theoretically, this might increase the risk for skin cancer. There is no evidence of this at all, but more research is warranted on long-term effects of AHA.

Moisturizers

Moisturizers help prevent dryness, bruising, and tearing but have no effect on wrinkles by themselves. They should be applied while the skin is still damp. These products retain skin moisture in various ways:

• Occlusives, such as petroleum jelly, prevent water from evaporating.
• Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin generally should use the humectant type.
• More powerful compounds, such as one called monolaurin (Glylorin), contain mixtures of fatty molecules called lipids, which may help restore the skin's natural barriers against moisture loss and damage.

Most moisturizers contain combinations of these and usually have other ingredients, such as AHA, sunscreens, collagen, and keratin. (Collagen and keratin leave a protein film and temporarily stretch the skin.) They range widely in price, and a major consumer organization found little difference in general between the more and less expensive products. Under-Eye Creams

The skin under the eyes is very thin and does not produce as much of the protective oils that keep skin soft and supple. Under-eye gels are aimed at reducing puffiness and dark circles. They typically work in one of two ways:

• Temporarily constricting blood vessels to prevent the build-up of fluids.
• Firming the skin with an invisible film.

Never rub under the eyes, as this may cause more wrinkles to form. Instead, apply these products with a light tapping motion to stimulate the skin. Other Skin Treatments

Kinetin. Kinetin is a naturally occurring growth hormone found in plant and animal DNA; it has antioxidant and anti-aging properties. Some small studies suggest that it may both delay the onset and decrease the effects of aging on skin. A topical formulation of kinetin, Kinerase, may prove to be an effective wrinkle reducer. Vitamin K. Microsponge-based vitamin K is being promoted to clear bruises, spider veins, and other small blood vessel damage. Vitamin K is important for blood clotting.

Cosmetics

Cosmetics, if properly applied, can be surprisingly effective in camouflaging the signs of aging skin, including wrinkles and age spots. Moreover, they offer additional benefits by retarding water loss and providing a physical barrier to UV radiation. Here are some suggestions:

• Moisturizers. Moisturizers should be applied before foundation. If reddish discoloration is extensive or the skin is sallow, tinted moisturizers may be helpful and can be worn alone or under foundation.
  
• Foundations. Large areas of the face are best covered with a moderate-coverage foundation with a matte or semi-matte finish. Facial powder reflects light and thus minimizes wrinkles but should be avoided by people with dry skin. When blemishes are especially prominent, colored undercover foundations called neutralizers are very effective. Green neutralizers mask red lesions; purple helps camouflage yellowish blemishes; and a white, pearled base is recommended for people with dark lesions and also helps to minimize wrinkles.
  
• Blushes. Blushes and color washes can help conceal the spidery network of dilated capillaries on the nose and cheeks. Powder blushes are preferred because they blend easily on top of foundation.
  
• Eyes. Powder eye shadows applied on top of a moisturizer are preferred to cream-based shadows. The appearance of deep-set eyes is best offset with light-colored shadow, which should be applied along the upper eyelid crease and above the iris. A slightly deeper shade of the same color should then be applied to the lower part of the eyelid and drawn out to the corner.
  
• Lips. A lip-setting cream or facial foundation should be applied before lipstick to help prevent it from bleeding into surrounding wrinkles. The lips should be lined with a lip-pencil, which acts as a border. (Some women use the pencil itself for the full lip, which gives color but appears natural.) Matte lipsticks with a low petroleum content are especially recommended.
  

WHAT ARE PROFESSIONAL EXFOLIATION PROCEDURES FOR SKIN WRINKLES?
There are many choices for skin resurfacing and the patient must discuss a number of different factors that affect the choice. Resurfacing can achieve the following:

• Removal of abnormal tissue and rough skin.
• Stimulation of new skin growth.
• Stimulation of collagen and elastin production.

In addition to determining the skill of the surgeon and the safety of the procedure, the patient must discuss the desired depth of the resurfacing and the capability of each procedure to reach this safely. All resurfacing procedures require a healing period afterward, during which the skin is red and sensitive. And it should be noted that the deeper the procedure, the higher the risk for complications, including delayed healing, infection, loss of pigment (skin color), and scarring. Chemical Peels

Chemical peels, also known as chemosurgery, help restore wrinkled, lightly scarred, or blemished facial skin. Much like chemical paint strippers, chemical peels strip off the top layers of skin, and new, younger-looking skin grows back. The procedure is very effective for the upper lip. It cannot be performed around the eyes. Partial peels are often done in conjunction with a face-lift.



The Procedure.

• Dermatologist applies chemicals to the skin. They include trichloracetic acid, high concentrations of alpha hydroxy or beta hydroxy acids, or combinations of them.
• In some cases, tretinoin (vitamin A derivative) or alpha hydroxy is applied four to six weeks before and starting one day after the peel. Such treatments can enhance the effects of a peel and reduce the risk of discoloration in people at risk for this complication. (Tretinoin itself is being tested as a chemical peel. In one small 2001 study, it effectively reduced wrinkles with no side effects.)
• A crust or a scab generally forms within 24 hours after surgery, which can be removed by gentle cleansing with soap and water.
• The skin takes six or seven days to heal.
• After the scab disappears, the visible skin is deep red but gradually lightens as it regenerates.

Complications. Complications include white heads, cold sores, infection, scarring, numbness, and permanent discoloration, particularly in Asians or people with dark skin. Refinement of chemical peel techniques are now permitting doctors to reach deeper skin, improvements which make it easier to apply peels to non-facial skin and to individuals with darker skin. Dermabrasion

Dermabrasion affects deeper layers of skin than chemical peels, and may be useful for removing disfiguring marks, such as deep acne scars or deep wrinkles. As with chemical peels, it is effective for wrinkles on the upper lip and chin and cannot be used around the eyes.

The Procedure.

• Standard dermabrasion uses a rotating brush that removes the top layers of a person's skin. As with chemical peels, dermabrasion selectively strips away the upper layers of skin, leaving the underlying dermal layers exposed.
• As with chemical peels, after the procedure, the treated skin oozes and forms a scab, a reaction that is both unsightly and uncomfortable, but only temporary.
• Postoperative care is similar for both procedures.

A gentler variation called microdermabrasion uses very tiny crystals to polish the skin and a vacuum technique to remove them. Results are similar to light chemical peels. Only mild redness occurs after treatment, although for best results five or six repetitive treatments are needed every one or two weeks. To date, patient satisfaction has been very high. Laser Resurfacing

Lasers are currently the most effective exfoliation tools for eliminating wrinkles. Their unique advantages over other resurfacing methods are their ability to tighten the skin. A successful procedure can make patients look 10 to 20 years younger, and the results can last up to 10 years. The procedure is most beneficial for the following areas:

• Best around the mouth and eyes. Recent evidence suggests CO2 lasers may be even better than dermabrasion for the upper lip.
• Slightly less beneficial for the area around the nose.
• Used alone, current laser therapy does not eliminate crow's feet, broken blood vessels, or dark circles under the eye.
• Lasers are too harsh for thinner skin layers, such as on the neck.
• The evidence of the effects of lasers on acne scars is unknown.

The Laser Resurfacing Procedure. In general the procedure works in the following way:

• Laser pulses penetrate the skin quickly, vaporizing water and surface skin without damaging the deeper layers, allowing new top skin to grow.
• In addition, enough heat is applied to shorten collagen fibers, restoring some elasticity to the skin.

Choice of Lasers . The lasers used depend on skin type and severity of the condition:

• The carbon dioxide (CO2) laser is the most powerful laser treatment and is used for deep wrinkles and skin imperfections. People who have had silicone injections should not have CO2 procedures, which can burn and scar the skin over the implanted area.
• The erbium:YAG (Er:YAG) laser is gentler than the CO2 and is effective for mild wrinkles and for providing a smooth texture. It has a shorter recovery time. Some experts have even found the YAG laser as effective in removing deep wrinkles as CO2 when used to sufficient depth. A so-called variable pulse YAG laser can shift between pulses that destroy skin to tissue to those that heat the skin; this process effectively resurfaces the skin with fewer side effects than CO2 laser therapy.

Some surgeons are using combination techniques that employ more than one laser technology in one session to achieve different effects. For example, one combination technique uses CO2, YAG, pulsed-dye laser, and one other laser technology to both improve wrinkles and clear under-eye dark circles and acne scarring.

Post-Procedure Recovery. The procedure itself is relatively painless, but the redness and irritation that occur during the healing process can be severe. For eight to nine days, the face looks skinned and swollen and requires continuous moisturizing. (Some experts suggest that people with very sensitive skin who can not tolerate the medications and lubricants should avoid laser resurfacing.) Redness and sensitivity can persist for one to four months. The patient must stay out of the sun as much as possible during this time and should always avoid sunbathing and damaging their skin again.

Complications. Scarring and infections can occur in about 1% of procedures, with risk increasing or decreasing depending on the experience of the surgeon. People with a history of herpes simplex may experience flare-ups of fever, facial pain, and flu-like symptoms for five or six days afterward. In addition, people with darker skin may wish to avoid the procedure because it can cause unpredictable and dramatic lightening of the skin.

Other Exfoliation Procedures

Cold Ablation. Cold ablation, called coblation for short, delivers saline (salt water) to the skin through which a cool electric current is passed. A subsequent reaction heats and vaporizes the top shallow layer of skin. The procedure is very specific and appears to minimize any damage to other areas of the skin.

Radiofrequency Resurfacing. A new technique uses low radiofrequency energy to resurface the skin. Preliminary research indicates that this procedure may eventually be as effective as laser surgery in reducing severe wrinkles around the eyes and mouth, with minimal pain and a shorter recovery time

 

[Sarah84]

well that was very very interesting, thanks for posting.

I'm terribly guilty of sunbathing from a young child :icon_eek: i know but I couldn't help it, I love the sun and even more loved having a sun tan *I was a very vain 7 year old haha*

And now I use sunbeds throughout the whole year because I can not stand the thought of being pale, well I'm not even naturally that pale I'm quite tanned but a little help from a sunbed never does any harm *well actually after reading that I guess it does*

When I'm on holiday I'm lying in the sun everyday from like 9/10 till about 5.

I guess when I'm about 30 I'll look 50 :icon_lol:

 

[Leony]

Thank you Kim!

Definitely informative!

 

[Little_Lisa]

Yes, i'm guilty of being a sun worshipper, too. I know it's bad but I just feel so much better with a tan.

 

[Sofia]

A very interesting and informative read. Thanks for sharing, Kim.

 

[yumi]

this post is great!! :icon_smil

as said, it's very informative. i've been avoiding the sun for two years now and i always wear sunblock. currently, i'm working on having a more healthy lifestyle.

again, great post!