Skin Wrinkles

Description

Alternative Names

Resurfacing 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.

Choosing a Resurfacing Approach

There are many choices for skin resurfacing (also called exfoliation) 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.

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.

In older individuals, combination procedures may be beneficial. 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.

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. Nearly a million were performed in 2003. 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. Combinations of the topical anti-oxidants, such as tretinoin and vitamin C, along with a chemical peel may be particularly effective.

The Procedure.

• Dermatologist applies chemicals to the skin. They include trichloroacetic 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 people with darker 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. Some experts prefer dermabrasion to lasers for skin surfacing of people with darker skin colors.

Standard Dermabrasion. Standard dermabrasion uses a rotating brush that removes the top layers of a persons 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.

Microdermabrasion. A gentler variation called microdermabrasion uses very tiny crystals to polish the skin and a vacuum technique to remove them. It has largely replaced the older dermabrasion, and, in fact, was the third most common cosmetic surgery method performed in 2003 (behind Botox injections and chemical peels) with close to a million procedures. Results are similar to light chemical peels. Patients can have this procedure done on their lunch hour and return to work. Only mild redness occurs after treatment, although for best results five or six repetitive treatments are needed every one or two weeks. To date, overall 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. It should be noted, however, that a 2002 study indicated that this procedure may not protect against skin cancers.

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.
• Standard laser dermabrasion is too harsh for thinner skin layers, such as on the neck. Newer and gentler laser techniques, however, stimulate collagen without taking off skin layers and may prove to be useful for necklines.
• 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.
• A gentle laser procedure called non-ablative laser resurfacing (NLite), also called photorejuvenation, is now approved for the treatment of all facial wrinkles. The procedure uses light energy to gently stimulate new collagen, and possibly elastin, without removing the skin tissue itself. Its effects are less pronounced than those of other laser procedures. However, because it does not injure the external layers of skin, it can be used on delicate skin areas, such as the neck and around the eyes. It also causes very little irritation afterward.

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. Pretreatment with botulinum injections before laser resurfacing significantly improved the treatment of crows feet in one 2001 study.

Post-Procedure Recovery. The procedure itself is relatively painless, but the redness and irritation that occur during the healing process can be severe. (Non-ablative laser resurfacing does not have the same severe after effects as other laser treatments.) 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 cannot 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. Early research suggests that silicone dressings may reduce post-procedure pain and crusting.

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 promising 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. In a 2003 study, one treatment with a topical anesthetic resulted in tighter facial skin for 14 out of 15 patients within 12 weeks. All but one patient returned to normal activity immediately afterward. A small clinical trial published in Dermatology Surgery found that a noninvasive radiofrequency technique called NARF safely and effectively improved drooping lower eyelids.

Intense Pulsed Light. Intense pulsed light (IPL) uses filters to selectively deliver wavelengths of light. It is being used to treat a number of photoaging skin problems and appears to have long-term effects. Typically, four to six treatments are performed over a four-month period. It takes 15 to 20 minutes. Unlike laser light, which uses one color wave-length (such as green or red), intense pulsed light starts with a full spectrum of light. It then allows the physician to selectively block off specific wave lengths depending on how shallow or deep the procedure should go. IPL machines are less expensive and safer than lasers.