What is a wrinkle? Despite demographic, socioeconomic and cultural differences, wrinkles seem to be universally despised by their wearers. The old school of thought that wrinkles are character lines portraying someone's emotions, life experiences and credibility is fast diminishing. People are living longer, smooth skin is keenly sought after and techniques to minimise wrinkles are now widely available.
By definition, a wrinkle is a line, furrow, crease or depression in the skin's surface. Wrinkles form due to a combination of factors - sun damage, habitual facial expressions (frowning, smiling, squinting), smoking, genetic disposition, lifestyle and as part of the natural ageing process. They fall into two main categories: dynamic and static wrinkles.
Dynamic wrinkles are formed by the repeated muscle contraction involved in facial movement. Static wrinkles are formed during the normal ageing process. Both of these wrinkle types are now treatable using nonsurgical methods and technologies.
As skin ages, it loses its elasticity. Collagen and elastin, the proteins and connective tissues that keep the skin smooth, supple and elastic, deteriorate and weaken over time. The skin becomes thinner and loses fat, and combined with gravity pulling at the skin, it begins to sag. In visible wrinkles, the thickness of the skin is diminished to approximately one third of the surrounding skin.
Australians are particularly susceptible to wrinkles, due to the potential for photoageing from exposure to the sun. Photoageing - the premature ageing of the skin caused by sunlight - plays a major role in generating wrinkles.
In the 1997 editorial in the New England Journal of medicine, dermatologists estimate that photoageing may contribute as much as 80 per cent of the damaging effects to the skin. Daily radiation from the sun breaks down the collagen and damages the elastin network. The single most effective strategy to prevent wrinkles is to wear a sunscreen on the face.
Damaged elastin can give skin an uneven appearance, and it is not naturally removed from or renewed in the body. Cosmetic processes such as dermabrasion can help with new elastin growth, to give a smoother appearance.
Collagen is one of the strongest natural proteins, giving the skin its durability and resilience, and helping it to heal. The latest light-based technologies not only rejuvenate the skin, but also hold the promise of stimulating the formation of new collagen after the treatments are finished, enabling the skin to stay stronger for longer.
Wrinkles are an inevitable part of growing older, but they ultimately betray us in our desire to look as young and happy as we feel. With the myriad of targeted treatments available today, this may finally be possible.
Treatment Options for Wrinkles
Botox and Dysport
Botulinum toxin A is injected in minute quantities to soften dynamic facial lines by blocking muscle contraction. It is especially effective for the frown lines (horizontal and vertical), crow's feet, scrunch lines on the nose, marionette lines, chin creases and neck bands. There is no down time and results usually take up to four days to be seen. Slight bruising may occur at the injection site. It is reabsorbed by the body, so to maintain results repeat injections are necessary every three to five months.
Fillers
Dermal fillers are used for smoothing fine lines, wrinkles and deeper folds as well as plumping lips.
Restylane A non-animal stabilised hyaluronic acid (HA) that combines with the body's own HA, and is completely biogradable and biocompatible. The areas most commonly treated are the glabellar lines, the nasolabial folds, smoker's lines and the lips. The forehead, cheeks and neck can also be successfully treated. It is injected into the skin in the form of a gel. Treatments usually last for more than six months.
Collagen The implants consist of sterile, purified reconstituted collagen fibrile from bovine skin. Collagen may be injected into the skin to fill out facial wrinkles and folds, skin depressions and some types of scars. It is also ideal for lip enhancement. It is very safe, having been used to treat patients for over 25 years. A top-up treatment is required two to three times a year. The implants contain a small amount of local anaesthetic for patient comfort. Results are immediate and the treatment requires no down time. Pre-testing is required.
Esthélis Containing hyaluronic acid, Esthélis is used in filling treatment for wrinkles such as nasal furrows, glabella wrinkles (between the eyebrows), laughter lines and crows feet. Esthélis can also be used for augmentation of the lips, cheeks or chin. Esthélis is particularly suitable for major filling, with injection into the middle or deep dermis. It takes approximately 30 minutes to perform. Final results are stable and long lasting.
Juvéderm Chemically related to Restylane, Juvéderm is largely composed of hyaluronic acid. Approved in June 2006 by the United States Food and Drug Administration, Juvéderm's prime use is correcting nasolabial folds, or ‘smile lines', creases of skin which run from the corners of the nose to the corners of the mouth. It is also used as a lip augmentation agent, to fill in hollow places and scars on the face. The effects of Juvéderm usually last 8 to 12 months. There is no need for preliminary testing.
Radiesse Made from calcium-based microspheres suspended in a water-based gel, Radiesse is injected into the skin in a simple and minimally invasive procedure, giving immediate visible improvement. Radiesse injections last anywhere from two to five years. Radiesse does not require skin testing because it is the same mineral component as bone and teeth. The procedure takes about 30 to 40 minutes. Down time is minimal and results can appear in 24 to 36 hours.
Aquamid An injectable to smooth facial lines, depressions and folds, and to fill lips, Aquamid consists of 2.5 percent polyacrylamide and 97.5 percent water. This makes it soft and uniform, and the polyacrylamide is cross-linked so is a single chain and doesn't contain any micro particles. It is injected under the skin where it can't be seen or felt and remains in place permanently.
Long-lasting dermal stimulants
Sculptra A polylactic acid that is injected into the skin to stimulate the dermis to produce new collagen. The effects are gradual but the results last indefinitely. Treatment areas include the cheeks, nasolabial folds, crow's feet, the glabellar region, the marionette lines, the lip borders and smoker's lines. It is also effective for treating acne scarring. There is no down time involved and no skin testing is required. Results usually last two to two-and-a-half years.
Fat transfer
Fat is taken from areas where it is unwanted and reinjected into areas that need it. The fat is harvested through the liposuction technique from areas such as the hips and abdomen. After careful cleaning and preparation it is reinjected into areas such as the lips and nasolabial folds to plump volume lost through age. It is injected in small amounts so it vascularises and lives as the patient's own fat. Some of the fat is reabsorbed by the body. The face will be swollen for a couple of weeks but the initial result can be seen after 10 days.
Intense pulsed light (IPL)
Using a broad spectrum of light to heat the target tissue, IPL is effective at smoothing wrinkles, evening skin tone, removing unwanted hair and correcting some sun damage. Little down time is required. Several treatments may be needed. Results continue to improve after the treatments have ceased due to collagen rebuilding.
Laser resurfacing
Using one wavelength of light the laser removes skin in microlayers until all the damaged top layers are gone. There are several different lasers used, depending on the problem. CO2 and Erbium lasers are used for diminishing lines and wrinkles, while others treat spider veins and vascular lesions, unwanted hair and pigmentation spots.
Ablative resurfacing lasers require considerable down time and the CO2 may show continued redness for up to six months. The newer non-ablative lasers such as Fraxel are the new kids on the block. They penetrate deep into the dermis and create multiple microscopic thermal zones of injury without any visible superficial injury. Only a few days are required to full recovery and collagenesis continues well after treatment.
Microdermabrasion
Fine crystals are projected onto the skin to remove most top layers. A course of six treatments is recommended, however the skin feels smoother and cleaner after one session. Mircrodermabrasion is an effective treatment for fine lines, some pigmentation spots, acne and acne scars. This treatment is virtually painless and involves no down time.
Peels
The range of peels is enormous. Deeper peels are effective at diminishing wrinkles and sun damage. Usually only one peel is needed and the treatment can be done in the doctor's rooms. Downtime can last for several weeks. Milder peels are available that are effective at smoothing the skin and evening skin tone. Peels are often combined with other facial procedures to optimise the skin's texture.
Cosmeceuticals
These skincare products contain active ingredients. They range from antioxidants such as Vitamins A, C and E to AHAs (alpha hydroxy acids) and BHAs (beta hydroxy acids). Cosmetceutical products are usually used at home and incorporated into a regular skincare regime, they can help ageing problems such as fine lines,
pigmentation, skin tone, texture and appearance.
Types of Wrinkles
Frown lines Horizontal creases can form across the forehead, glabellar lines between the eyebrows and horizontal lines across the bridge of the nose as a result of voluntary and involuntary frowning.
Eyelid droop Gravity drags the brow down causing heavy upper eyelids.
Crow's feet Smiling, laughing and squinting cause muscle contractions that result in lines etched at the corners of the eyes.
Eye bags The skin around the eyes is thinner and susceptible to creasing. As the orbital septum weakens, the fat bulges more around the eyes creating sags and bags.
Smile lines The nasolabial folds from the nose to the corners of the mouth become more deeply etched.
Lip grooves Smokers' lines form along the outer lip borders and at the corners of the mouth due to loss of skin elasticity, volume and weakening muscles.
Crinkly lips The underlying fat layer disintegrates with age causing the lips to flatten and become crinkly.
Mouth to chin folds The marionette lines are created by creases running vertically down from the corners of the mouth.
Neck bands The platysma muscles start to separate with age, creating a stringy look and horizontal rings.
ACSM #39
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