History tells us that medieval European women drank large potions of poisonous arsenic and even covered their faces in bat’s blood in an effort to preserve their unwrinkled image. There is evidence that Roman women used warm male urine in an attempt to exfoliate their skin, but now, commercialism has jumped on the ‘wrinkle’ bandwagon and turned the ever declining dermis into an industry now estimated to be worth in the region of $160 billion a year. To put it another way, sensible Americans, those people that gave us Kellogg’s cornflakes, Gillette razor blades and even put a man on the moon now spend more on getting rid of wrinkles than they do on educating their children. You see, it is all a matter of perspective. Just try relating that fact to the old grey Kenyan lady shuffling along the red murram track with her two young grandchildren on their way to school.
So, what are wrinkles, how do we get them and why do we hate them so. To understand wrinkles, we have to understand skin. Everybody’s skin is made up of three layers: the outer protective epidermis, the inner dermis, and another deeper part, (which is not technically part of the skin) called the subcutaneous layer. When we are young, the differing layers work as one unit to allow the skin to stretch and remain supple by retaining moisture. The inner dermis at that stage has an elastic quality because of collagen building blocks and lots of fibres called elastin. These proteins interact to keep the skin looking and feeling young. However, over time, the outer layer gets bombarded with ultra-violet light, attacked by chemicals and the inner layer gets saturated with poisons from cigarette smoke and the ravages of time and the collagen building blocks begin to disappear.
To put it another way, let us imagine two houses in a village in Leitrim. One has recently been built and has become the nest of a fledgling family, continually painting the walls, dusting the cupboards, and washing the floors. The other is the residence of an older gentleman in the sunset years of life, satisfied with passing away his latter years with the odd trip to Mc Govern’s local pub. The first house is like new skin, the proud housewife never allows toxins to settle too long in case they harm her children, the proud father paints walls and hangs wallpaper to make their nest as habitable as possible. Both, pander to traditions as old as time immortal.
In the second house, the old man will keep up appearances by painting the outside walls, if the ‘yanks are coming home’. This is akin, to the aging lady who wants to look her best for her daughter’s wedding. This is because both events evoke emotions that make us remember how things used to be. The mother remembers herself on her wedding day and how times have changed her, the old man remembers how the house looked before Michael left and went to America. Both parties have feelings of guilt, of allowing neglect to take the place of repair. Maybe, it was for financial reasons or possibly, it was just that Old Man time just happened to creep unpon them unnoticed. To understand the mechanism of how skin ages and ultimately wrinkles; we can take the analogy of the old man’s house a little further. The whitewash lime paint that the old man goes out and buys and eventually gets somebody to put on the outside walls to give an ‘impression of repair to the yanks’ is like the putting cream on the epidermis. Of course, it will protect the house against the sweeping rains coming in from the Leitrim braes, but eventually it will just dissolve and be washed away.
The old man knows, if the long lost brother who went to America wanted to return home to the house of his youth, he would have to put in new windows, plaster the inner walls, possibly even replace the roof and the ceiling joices in order to make the place habitable again. By analogy, the wooden timber supporting structure that holds up the roof and forms the windows is akin to the basic building blocks of a protein called collagen, which is present in our dermis. The plaster on the inner walls of the house, that wraps around the window ledges and hides the ceiling spars is akin to another flexible protein called elastin. However, despite this analogy, there is one big difference between the house and our body…our skin has its own built-in repair system. This means if we fall, little repair cells called fibroblasts, come like fleets of handymen from the local village to immediately repair the problem. What happens, is that over a period, the repair cells become less, the timber is not repaired, the plaster begins to fall off, and dreaded wrinkles appear.
What are the main causes of wrinkles?
Most wrinkles are associated with reduction in the amount of collagen and elastin in aging skin. This process, like the decaying house in Leitrim is considered to be a natural process. Frequent exposure to the elements, especially sunshine results in premature skin wrinkling and increased pigmentation (liver spots). Unfortunately, the type of ultraviolet light in sunshine also increases the likelihood of skin cancer. Frequent exposure to cigarette smoke delays the repair mechanism of skin and is one the main environmental factors that increase premature wrinkling of the skin. We can do little to decrease the rate of skin aging, but it is within our power to stay out of the more powerful suns rays and of course to STOP SMOKING.
Common Causes of Wrinkles
Wrinkles can develop because of:
Normal aging changes in the skin
How Do We Treat Wrinkles?
Vitamin A Acid (tretinoin, Retin-A, Retinova).
These creams are the only ones that have been subjected to clinical trials and show some promise in reducing wrinkles. Retin-A has some limited ability to reduce other signs of aging, such as mottled pigmentation and rough skin. The effects are usually temporary and the creams must be used on an ongoing basis to maintain the effect. Many patients complain about the fact that they initially cause redness and peeling. Although this can be unpleasant for a while, it is essential to achieving an improvement once the peeling stops.
There is some evidence that the vitamins A, C, and E, as well as beta-carotene provide a certain amount of sun protection and some formulations of Vit C can help in the reduction of very fine wrinkles. In some ways, they are a step above regular over the counter creams, which usually promise quite a lot but do not contain any of the above substances. Allergan the makers of Botox ® have just released a new anti-oxidant called Prevage ® .
Glycolic acid peels use fruit acids such as the alphahydroxy acids (AHA) (glycolic, lactic, etc.) to remove some of the outer layer of skin. In fairness, these superficial peels can make a very slight difference in the intensity of fine wrinkles and have little effect on deep wrinkles. AHA peels are more commonly used to treat rough, dry skin and improve texture. They may be mixed with a bleaching agent to correct uneven pigmentation. They can be applied to the whole face or to an isolated area, such as the upper lip.
TCA peels use ingredients like trichloroacetic acid (TCA or salicylic acid (SA) to remove the outer layer of skin and penetrate deeper into the dermis. These deeper peels are more capable of removing fine wrinkles. Phenol peels penetrate deep enough to remove deep wrinkles. In general, however, the deeper the peel, the greater the risk of side effects, such as long-lasting pigment changes (changes in skin colour) and scarring. TCA peels may require some twilight sedation to help ease short-term but intense discomfort.
Botox® or Dysport ® are probably the most common therapeutic agents used in the treatment of wrinkles. Treatment is typically used to treat forehead frown lines and wrinkles around the eyes. The treatment only takes a few minutes and discomfort is minimal. Results appear after 3-5 days with maximum benefit appearing after 1-2 weeks. Results tend to last up to 6 months with the effect fading gradually. The treatment is very popular as it only takes a few minutes, discomfort is minimal and the results tend to last up to 6 months with the effect fading gradually.
Soft tissue fillers, most commonly the Hyaluronic Acids such as Restylane, Juvidem, Matridex, or Matridur are used to help fill in wrinkles. These products last between 6-12 months. Collagen was once widely used but is being rapidly replaced by a safer synthetic version called Evolence. This product will last about 18 months. Less biodegradable fillers such as Outline or Radiesse are increasing in popularity as their safety profile shows they will remain in skin without many problems for about 24 months. These fillers can also add fullness to the cheeks and lips and can be used alone or in conjunction with other resurfacing procedures such as Microdermabrasion and laser Photorejuvenation.
Collagen stimulators such as poly-L-lactic acid (New-Fill) (Sculptra) work from deep within the dermis to stimulate new collagen and remove wrinkles. They also tend to smooth and firm areas of the face and restore the skins natural elasticity. This compound, although recently used in cosmetic medicine has been used in plastic and reconstructive medicine for more than 20 years. Clinical trials have shown the effects of New-Fill can last for 1 to 2 years.
Isolagen® or Autologous Fibroblast Therapy is a unique process that uses the patient’s own collagen-producing cells, (fibroblasts) to repair and rejuvenate the skin, producing effects for up to 10 years. The effect is long-lasting because the patient’s immune system recognises the injected cells as the patient’s own and does not reabsorb or reject them as it does with other foreign materials. The Isolagen process can soften wrinkles, lines, and scars, giving your face a lasting, youthful appearance. Best of all, since the Isolagen process relies on your skin’s unique collagen producing ability, its benefits are long lasting. Unlike the results of temporary skin treatments, which typically last only a few months, the benefits of Isolagen continue for years
Microdermabrasion is a procedure that is performed by using a hand piece that the operator passes over the skin two or three times. This evenly removes the stratum corneum, the outermost layer of skin. The underlying epidermis is also stimulated by the abrasion and the vacuum. Recurrent treatments promote the generation of new collagen, which thickens the dermis and improves fine lines and wrinkles. It would be unfair to say that it is of benefit to most wrinkles unless they are comparatively new. The average microdermabrasion procedure takes less than thirty minutes, depending upon the skin condition, the area to be treated, and the desired outcome. Many will notice improvements in the texture and appearance of their skin immediately after the first treatment.
Dermabrasion is a surgical procedure in which the physician attempts to reduce wrinkles or more often scars less noticeable by sanding them away with a small hand held tool. The technique is sometimes performed under general anesthesia and the end result is dependent on the skill and experience of the operator. Dermabrasion can result in excellent improvement, but can also produce significant side effects, including scarring and permanent changes in skin colour.
Laser resurfacing is a technique that aims to reduce wrinkles by using an ablative laser to remove the top layer of skin. In essence, doctors can achieve results similar to those of dermabrasion with greater reliability and precision. There are two ablative lasers, the CO2 and the milder Erbium YAG. Both lasers will tend to remove the whole of the outer layer of skin (epidermis) in order to expose the inner layer (dermis). A second effect, collagen synthesis appears over the next months, which also helps to reduce wrinkles. Procedures may need to be repeated once or twice at 6 to 12 month intervals to maximize improvement. They are, however, associated with pain, lengthy healing times, and potential for permanent pigment changes and scarring.
Non-ablative laser resurfacing. Newer lasers such as the Polaris ® attempt to stimulate collagen synthesis under the skin without peeling or damaging the epidermis. This is one of the latest FDA-approved nonablative procedures for maintaining a youthful appearance. Another similar device called the Thermage, uses radio-frequency energy to try to reduce wrinkles. The Polaris uses an associated laser system to improve skin texture and skin colour. This causes the collagen to contract and tighten as well as reducing redness and brown blotches. Data on the effectiveness of the Thermage and the Polaris are still preliminary, but many trials suggest that results for fine lines and wrinkles may approach those of invasive laser resurfacing. Treatment can be painful but there is little or no redness, peeling, or “down-time” afterwards. Noticeable improvement may involve several repeated procedures over a few months.
Fraxel Laser, unlike the other ablative lasers already on the market, which remove the top layer of skin, produces tiny, microscopic areas of thermal wounds in a dot-like grid, leaving areas of untouched healthy skin in between. Patients receive a series of 3-5 treatments, spaced weekly, where the entire face is safely resurfaced. Each treatment takes roughly 20-30 minutes and can be done up to 5 times a week.
Curl Lift ® procedure also called the Soft Lift, is a minimally invasive face-lifting procedure that involves the placement of special nylon threads in a loop fashion and then pulling them upwards. The threads are placed with a needle through a small incision in the hairline and then tensioned according to the degree of suspension required. Threads can easily be removed, added or changed. The entire procedure is performed under local anesthesia, with most patients able to return to work in 24 hours.
Plastic surgical procedures:
Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients in order to remove wrinkles. The procedures are commonly performed whenever cosmetic medicine can be of no more advantage. The face-lift is particularly useful in improving wrinkles and the appearance of sagging by tightening the skin and facial muscles. The degree of improvement varies from individual to individual, and is influenced by the physical traits of the skin, and the amount of sun damage, the underlying bony structure and a variety of other factors. This operation takes from 3-5 hours depending on what eventual effect is required for the patient. This procedure is performed in an outpatient facility under general anesthesia.