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Diseases & Conditions

Wrinkle Reduction: Laser Resurfacing&Injection Therapy

What causes wrinkles?

There are many factors that contribute to the onset of wrinkles. The following are the most significant:

Aging

Wrinkles are a by-product of the aging process. With age, skin cells divide slower, and the inner layer of the skin, called the dermis, begins to thin. The network of elastin and collagen fibers, which support the outer layer, loosens and unravels, which results in depressions on the surface. With aging, skin also loses its elasticity, becomes more fragile and is less able to retain moisture. In addition, oil-secreting glands are less efficient which makes the skin drier and appear more wrinkled. All of these factors contribute to the development of wrinkles.

Facial muscle contractions

Lines between the eyebrows (frown lines) and lines jutting from the corner of the eyes (crow's feet) are believed to develop because of the underlying muscle contractions. Smiling, frowning, squinting, and other habitual facial expressions cause these wrinkles to become more prominent. Over time, the expressions coupled with gravity contribute to the formation of jowls and drooping eyelids.

Sun damage

Excessive exposure to ultraviolet radiation (too much sun) can result in premature aging of the skin. Premature aging of the skin is called photoaging. The ultraviolet sunrays that cause photoaging damage collagen fibers (the major structural proteins in the skin) and elastin fibers (the protein that causes skin to stretch). Both of these fibers are important components of the skin’s connective tissue and without them, the skin loses its strength and flexibility, leading to wrinkles. When ultraviolet light damages skin tissue, an enzyme called metalloproteinases is produced. This enzyme creates and reforms collagen. During the process, however, some healthy collagen fibers are damaged, resulting in a disorganized formation of fibers called solar scars. Wrinkles develop when the rebuilding process occurs over and over.

Smoking

Healthy skin perpetually regenerates. While old collagen is broken down and removed, new collagen is being produced and installed. Researchers have found that smoke causes a marked reduction in the production of new collagen. A lack of new collagen results in the development of wrinkles. This may also be due to the lack of blood supply to the skin caused by smoking.

What are the treatment options for wrinkles?

Removing skin layers to reduce wrinkles or irregular depressions is an effective way to regain smoother, more youthful looking skin. Dermabrasion (scraping layers away) and chemical peels (dissolving skin away) are two of the traditional methods used in skin resurfacing. On the flipside, additional techniques have been developed to repair prematurely aging skin.

Laser skin resurfacing

Laser skin resurfacing is a treatment to reduce facial wrinkles and irregularities caused by sun damage or acne. The laser technique directs short, concentrated pulsating beams of light at irregular skin. Ablative laser skin resurfacing removes skin very precisely, layer by layer, which stimulates the growth of new collagen fibers. This mode of laser also results in fewer problems with hypopigmentation (lightening of skin). Non-ablative laser resurfacing promotes the development of new more healthy collagen, helping to restore the skin contour/appearance with minimal down time. A new fractional laser technology is also available. The laser light is delivered in a grid allowing normal, untreated skin to remain within the treated area which leads to quicker healing.

Who is a good candidate for laser resurfacing?

If you have fine lines or wrinkles around or under the eyes, the forehead, the mouth, or scars from acne, or non-responsive skin after a facelift, then you are an ideal candidate for laser skin resurfacing. If you have active acne or recently treated with Accutane®, you are not a candidate. Laser resurfacing is better suited for fair skinned individuals. Caution: Exposure to the sun after this treatment should be avoided for three months.

Botulinum toxin type A (Botox) injection therapy

Botox® is a medicine derived from the botulinum toxin and it blocks the chemical signals that cause muscles to contract. Botox is injected into the muscles whose contractions cause wrinkles such as between the eyebrows and the lines that radiate from the corner of the eyes (crow's feet). The effects of Botox usually last for 3-4 months. When the Botox wears off, the muscles again become active and the wrinkles will begin to reform. The treatment would then be repeated. If you choose not to repeat the injections, your wrinkles will return no worse than they were initially.

What are the risks associated with Botox?

There might be temporary redness, bruising, or stinging around the injection site(s). In rare cases, there might be a slight lid droop for several days after the injection, but all reported side effects have been temporary.

Fillers

Wrinkles that remain at rest may require filler to fill-in/lift up the depression. Prominent folds around the mouth, nose and chin are the most commonly treated. Most fillers are temporary providing improvement for around 4 to 6 months at which time the treatment would need to be repeated. Hyaluronic acid is the most common filler used. Side effects may include bruising, temporary swelling and pain. In very rare cases skin necrosis may occur.

Face-lift

With a face-lift, excess skin and fat are surgically removed on the face and neck. Tightening of the muscular and connective tissue layers is also performed. The results usually last 7 to 10 years.

Sun damage – Prevention and treatment

Sun exposure should be minimized to prevent further wrinkles and sun damage. Daily use of sun screen is very important in prevention. There are treatments to repair prematurely aging skin including topical retinoids and glycolic acid. If there is significant damage, photodynamic (blue light) treatment and/or topical chemotherapy creams are also sometimes used.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/20/2013...#8411