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Wrinkles are a natural part of aging and form in part because the supportive
components of the skin (such as elastin, collagen and hyaluronic acid) degrade as we
get older. Although much research has been directed at understanding why this happens,
it is still a mystery because everyone ages at a different rate based such factors as
genetics, sun exposure, general health, and lifestyle choices (such a smoking and
drinking). For example, sunlight damages the natural layers of the skin and destroys
collagen. For proof of this, examine parts of your skin with minimal sun exposure,
such as the inner arms, inner thighs, or buttocks. Notice how soft and smooth the
skin is compared to your forearms or face which is constantly exposed to sunlight. .
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The best wrinkle treatment is prevention. By avoiding any harmful rays
(including tanning booths) and living a healthy lifestyle, your skin will look
younger. However, there are many techniques in use today to treat wrinkles.
Nonprescription and Prescription Creams
- What are they?
Available over the counter, most wrinkle creams essentially moisturize the skin
although some formulations (such as those with retinol, vitamin C, or glycolic acid)
may improve its color and texture. Unfortunately, they typically do not have dramatic
effects and can be quite expensive. Prescription creams, most notably synthetic
derivatives of Vitamin A (retinoids), can provide better results in improving
sun-damaged and aging skin.
- What are the risks?
Over the counter creams are usually well tolerated. However, retinoids can be
irritating and some people are not able to use them. Also, they must be used
continuously for continued benefit. Creams may not work for everyone and the risks
and benefits need to be discussed with your physician.
Dermabrasion (Mechanical Resurfacing)
- What is it?
Mechanical resurfacing of the skin has been utilized for about 30 years and
involves the use of motorized abrasive tools to remove the outer layers of the skin
in a controlled setting. A new layer of skin, which typically has a more youthful
appearance, replaces what was removed.
- What are the risks?
Local anesthesia is required for pain control during the procedure while
dressings usually need to be worn afterwards. Temporary facial swelling and pain is
normal. Within 7-10 days, the skin has healed but is often very red and complete
healing may take up to one month and collagen remodeling may continue for months
after the procedure. With the advent of newer, less destructive techniques,
dermabrasion has become less popular but is still used for acne scarring.
Complications are rare but include infection, prolonged healing, abnormal
discoloration, and scarring. Dermabrasion is not for everyone and the risks and
benefits need to be discussed with your physician.
Microdermabrasion
- What is it?
Microdermabrasion is a fairly new and popular procedure classified as very
superficial dermabrasion. This method employs aluminum oxide crystals which are
propelled at the skin and then immediately vacuumed up. Although not scientifically
proven to improve wrinkles, many patients report that their skin feels smoother
after multiple treatments (7-10 spaced about one week apart).
- What are the risks?
The risks are minimal because microdermabrasion penetrates only the most
superficial layers of the skin so it is painless and requires no downtime. The cost
is moderate and requires a series of treatments. Microdermabrasion is not for
everyone and the risks and benefits need to be discussed with your physician.
Microdermabrasion
- What are they?
Your physician can administer a peel using a variety of different chemicals
designed to remove age spots, discoloration, wrinkles and fine lines. Chemical peels
may smooth and firm the skin and may also gradually lighten age spots.
The superficial peels, such as a glycolic acid peel, can be done during your lunch
hour and there is no recovery time. Deeper peels are more effective but require
longer recovery. See more details under discussion of chemical peels.
- What are the risks?
Different kinds of peels carry different risks. Superficial peels are usually
quite safe, however, you may need a series of them (performed approximately once a
month) before you'll notice improvement and costs can add up if you choose a series
of peels. The risks and benefits vary depending on the kind of peel and need to be
discussed in detail with your physician.
Laser Resurfacing
- What is it?
Laser resurfacing is an in-office treatment where age spots, wrinkles, and lines
are "burned" off with a laser. Laser resurfacing usually removes most age spots,
age related discoloration, and wrinkles, often in just one treatment. Some lasers,
such as the CO2 laser are considered the gold standard in terms of facial
rejuvenation. With good sun protection, the effects can last up to five years.
See more details under discussion of lasers.
- What are the risks?
Lasers actually remove the outer portion of the skin (the epidermis). Because of
this, you may experience some pain as well as redness and peeling plus you might
also form scabs in the days after the procedure. Expect recovery time of at least a
week. Laser therapy is also expensive as one treatment, depending on how much of
your face is treated, can cost anywhere from $1,000 to $5,000. The risks and
benefits of laser resurfacing need to be discussed in detail with your physician.
Intense Pulsed Light Therapy (IPL)
- What is it?
IPL is one of the newer forms of facial rejuvenation. Unlike lasers, which use
intense focused light, IPL is intense broadband light. Although IPL delivers energy
to both the superficial and deep layers of the skin, the epidermis is spared from
damage resulting in virtually no recovery time. In studies performed so far, IPL can
smooth the skin and fade age spots, freckles, melasma, and even broken blood
vessels. With proper sun protection improvements usually last for about a year.
- What are the risks?
Because it does not damage the epidermis, IPL is safer than laser therapy and
requires no recovery time however, there may be some pain during the actual
procedure. Unlike laser therapy, you may need multiple treatments
(average is 4-6 at three weeks intervals) to achieve the full benefit.
The cost is variable, but is usually more expensive than peels and less expensive
than lasers (300-600 dollars per treatment on average). As with any medical
procedure, the risks and benefits of IPL therapy need to be discussed in detail
with your physician.
Thermage
- What is it?
Thermage, which can be performed on all skin types, utilizes a technology that
delivers a radiofrequency pulse deep into the skin as a probe simultaneously cools
the epidermis to protect it during treatment. The energy from the radiofrequency
heats the collagen which immediately tightens the skin. Heating of the collagen may
also stimulate the production of new collagen such that improvements may continue
for up to six months.
- What are the risks?
Although relatively new, thermage appears to be safe with side effects reported
in less than 1% of patients and, similar to IPL, thermage does not damage the
epidermis which results in usually no recovery time. It can be painful, however,
and your physician may offer you pain medication or topical anesthesia. Side effects
include swelling, redness, bumps, and blisters on or around the treated area.
These side effects usually disappear in a few days or weeks. A rare (<0.2%) but
longer lasting side effect described as a skin depression has also been reported.
As with any procedure, the risks and benefits of thermage need to be discussed in
detail with your dermatologist.
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Cosmetic/Plastic Surgery
