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Skin Wrinkles

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Description

An in-depth report on the treatment and prevention of wrinkles.

Alternative Names

Alpha Hydroxy; Chemical Peels; Plastic Surgery

Implant Procedures

Implants, sometimes also called injectables, are becoming a common means of erasing wrinkles and folds. A number of materials are currently being used for deep wrinkles, depression under the eyes, lip enhancements, and for acne scars. In 2002, more than 1.5 million Americans removed wrinkles with injectables (including Botox).

After being banned from the market in 1992, silicone is making a comeback in research settings as a potential permanent wrinkle eraser. Scientists are looking into a new microdroplet technique combined with purified silicone as a way to eliminate any danger. The past problems with silicone occurred when it was mixed with a foreign substance, like mineral oil, or when it was injected in large doses.

Most implants to date, however, are not completely satisfactory. Collagen implants and biologic fillers from animal, bacterial, or human sources do not provide long-lasting benefits. Synthetic fillers are permanent but may provoke an allergic reaction, which can cause chronic problems. Such reactions are rare, but they can be painful and unattractive.

Implant Procedure and Material Used	Procedure	Specific Areas Affected	Benefits	Drawbacks
Collagen implants. Collagen is the protein that forms the structures in the body (e.g., skin, bones, cartilage). The implant procedure has typically used bovine (cow) collagen. A form of human collagen (CosmoDerm, CosmoPlast) has now been approved.	Injected into target wrinkles with needle and syringe. Several weeks after injection, cow collagen breaks down and is replaced by newly created human collagen.	Wrinkles around the eyes and mouth; used to give lips greater fullness.	Very simple with faster recovery than many other implant techniques.	Wrinkles reform and repeat treatments are needed three to 12 months later. Rarely, severe allergic reactions. Should not be used by children, pregnant women, and people with a history of autoimmune disease.
Microlipoinjection Fat tissue from the patients' own thigh or abdomen.	Injected into target wrinkles with needle and syringe.	Deep wrinkles around the nose and mouth, folds in the forehead, and wrinkles on the hands.	No allergic or immune reaction because substance is patient's own fat.	Body eventually absorbs the fat, so multiple injections are needed. Some studies suggest that 70% of the fat may still be viable after at least a year.
Gore-Tex. Highly porous and inert (not chemically active) synthetic material.	Requires some surgery. Tiny patches are inserted under the skin to fill out wrinkles. Skin cells and blood vessels penetrate the porous material easily, reducing the risk of severe inflammation.	Deep wrinkles.	Material does not degrade.	Possible scarring from surgical procedure. Allergic reactions are rare but can occur even with chemically inactive materials.
Artecoll. Contains PMMA, or polymethylmethacrylate, an inert substance, enclosed in tiny droplets of natural collagen.	Material is injected. Body absorbs collagen. PMMA remains and stimulates new collagen growth.	Deep wrinkles.	Although part of the implant is natural collagen implant, it does not degrade as quickly as a full collagen implant.	Repeat treatments still may be needed. Possible allergic reaction.
Hyaluronic acid (Restylane). Natural substance acts like a molecular sponge to absorb water. The FDA approved Restylane in December 2003. It is the first FDA-approved dermal implant made of a non-animal stabilized hyaluronic acid (NASHA) gel. The FDA has recommended conditional approval for Hylaform, a similar product.	Material is injected under the skin.	Deep wrinkles.	Low risk for allergic reaction (but still can occur). May last longer than bovine collagen.	Repeat treatments needed.

Botulinum (Botox)

The popularity of Botox injections has skyrocketed in the United States. Between 2002 and 2003 alone, the number of procedures performed jumped 157 percent. Botox injection was the number one cosmetic plastic surgery technique in 2003, with more than 2.8 million injections. Botulinum, the deadly toxin found in uncooked foods, is also a powerful muscle-relaxant, and tiny amounts of a purified form (Botox) are being injected into wrinkles to relax the surrounding muscles. It may benefit forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. It is also useful for treating involuntary muscle movements that can occur after a face-lift.

The injections need to be repeated every few months, since the effects wear off. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. When used for areas around eyes, it produces a rounder appearance afterward, which patients should be aware of before they undertake the procedure.

The drug does not cross the blood-brain barrier, and, to date, the only side effects are temporary muscle weakness near the injection site. Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also causes headaches in about 1% of cases. In some cases, the headaches can be very severe and long lasting (from eight days to a month). Some experts suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.

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