Skin

Like paper, skin forms lines when folded, and these lines become deeper with more folding and time. In general, wrinkles also called rhytids, as in rhytidectomy and expression lines are oriented perpendicularly to the muscles underlying them. Age, genetics, sun exposure, lifestyle habits, sleeping position, diet and medical history also contribute to the appearance of lines.

Treatment options for lines depend on the type, depth, and location of the wrinkle. Treatments vary in their invasiveness, and I tailor procedures to my patients’ aesthetic goals and ability to tolerate downtime. A detailed consult is a great way to start on a treatment plan. A brief overview of wrinkle treatment includes:

1. Skincare – hydration, protection, and exfoliation are important in skin health and appearance. Healthy skin is well moisturized and looks dewy, as opposed to dry skin, which looks dull and flaky, and is more prone to irritation. Healthy skin is also protected from sun damage (by sunblock, link to blog entry about sunblocks), vitamin C, and other antioxidants. Furthermore, healthy skin is well exfoliated and has good collagen support; tretinoin (also called retinoic acid, a cousin of the related retinols) is a well-tested and effective topical medication which promotes exfoliation of the epidermis (the outer layer of the skin) and thickens the collagen-bearing dermis (or the deeper layer of the skin). Tretinoin and related medications improve the appearance of skin and associated fine lines.

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 Retin-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 lines. Effects typically take around 6 months. Side effects can be dryness and photosensitivity, and these can be mitigated with less frequent application of tretinoin and increased moisturization.

3. Chemical Peels – Chemical peels cause shedding of the top layer of skin; after treatment, new skin grows and replaces the old skin. The new skin often looks smoother and younger due to skin tightening and new skin formation. The depth of the chemical peel is the main determinant of effectiveness. Based on your individual anatomy, motivation, and expected downtime, we can decide which peel and depth is the best choice for you. The medium or deep chemical peels performed at Aviva Plastic Surgery are very different from the peels offered at spas. See the Facial Resurfacing Page for more information on the procedure.

4. Dermabrasion – This procedure removes the top layer of skin, essentially sanding off the upper layer 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. [STB: why say “Caution should be used in darker skin patients” here? You know that, but what’s the point of mentioning it here?] 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. Skin tightening – Radiofrequency-generated heat, microneedling, and a combination of these techniques is a recent and popular addition to the world of skin rejuvenation. Heat and the mechanical injury of needling disrupts collagen within the deeper, dermis layer of the skin, and this injury stimulates healing with the associated formation of newer collagen, rejuvenating elastic, and other elements important for both skin function and a more youthful appearance.

7. Botox and Dysport – These popular medications (Botox is also called onabotulinumtoxin A, and Dysport is called abobotulinumtoxin A) are injected into muscles of the face and neck to relax them, or prevent the muscles from contracting at their full strength. Contrary to what many people believe, these medications do not fill wrinkles (see injectable fillers below). By preventing muscle contraction, Botox and Dysport essentially prevent dynamic wrinkles. Deep wrinkles that are present at rest may still be present after Botox injection, and these may require injectable fillers and/ or skin resurfacing for greater improvement. See our Botox/Dysport Page for more information on how Botox works, expected results, and how often you will need injections.

8. Injectable Fillers – The variety of fillers on the market (Juvederm, Restylane, Sculptra, and Radiesse) act to increase collagen (the major structural protein in the skin). The result is increased fullness in the area of injection. With most fillers, treatment results are evident immediately and last around one year. Injectable fillers are typically used for deeper wrinkles or wrinkles present at rest, and may be combined with Botox or Dysport to gain greater aesthetic benefits. See our Injectables Fillers Page for more information on products offered and indications for use.

9. Lifting procedures – As we age, our skin loses its elasticity and becomes less plump and hydrated. With continued facial muscle use and less skin elasticity, wrinkles start to appear. While fillers, lasers and skin resurfacing can address fine lines, the most effective way of dealing with wrinkles caused by excess, loose skin is the removal of this extra skin. Examples include a forehead/brow lift, facelift, necklift, or removal of extra eyelid skin (blepharoplasty). These procedures 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.