Dynamic lines or wrinkles are those produced by the actions of the underlying muscles. This can be illustrated by actively frowning or smiling. Contrast to Dynamic lines, static facial lines are those that are present all times – even during complete rest or sleep, i.e. – these lines are actual lines present on the skin resulting from long history of squinting, frowning, sun damage, etc.
Age wrinkling in the skin is promoted by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors.
Development of facial wrinkles is a kind of fibrosis of the skin. Misrepair-accumulation aging theory suggests that wrinkles develop from incorrect repairs of injured elastic fibers and collagen fibers. Repeated extensions and compression of the skin cause repeated injuries of extracellular fibers in derma. During the repairing process, some of the broken elastic fibers and collagen fibers are not regenerated and restored but replaced by altered fibers. When an elastic fiber is broken in an extended state, it may be replaced by a “long” collagen fiber. Accumulation of “long” collagen fibers makes part of the skin looser and stiffer, and as a consequence, a big fold of skin appears. When a “long” collagen is broken in a compressed state, it may be replaced by a “short” collagen fiber. The “shorter” collagen fibers will restrict the extension of “longer” fibers, and make the “long” fibers in a folding state permanently. A small fold, namely a permanent wrinkle, then appear.
There are several medical (topical medicines and creams) and many invasive techniques available for ameliorating wrinkles. They are all effective to the degree that
- They change the nature of aging collagen
- They stretch the skin
- Fill in the depressions in the skin.
- They paralyze muscles that cause the skin to crease. They include both medical and surgical methods.
- Medical treatments for fine wrinkling
- Vitamin A acid (tretinoin [Retin A, Renova]): This ingredient, available by prescription, has the longest track record of success in treating aging skin and fine lines. Creams containing tretinoin must be used on an ongoing basis. They may produce redness and peeling at first, but discomfort can usually be minimized by lowering the cream’s concentration or applying it less often until the skin gets used to it.
- Alpha-hydroxy acids: These so-called “fruit acids” include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. They produce only subtle improvement though.
- Antioxidants: These include preparations that contain the vitamins A, C, and E, as well as beta-carotene. There is very little compelling evidence that these sorts of creams produce a significant cosmetic improvement.
- Ordinary moisturizers: Creams that don’t contain any of the above substances can only make wrinkles look temporarily less prominent (“reduce the appearance of fine lines”).
- Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.
- Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels may require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.
- Microdermabrasion: This refers to “sanding the skin” with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in “packages” of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as “home microdermabrasion” are just mild exfoliants — harmless but not likely to produce any meaningful change in wrinkles.
- Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal 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 color.
- Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the damage reaches the middle of the dermis, the skin’s second layer. This helps stimulate the body’s natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some doctors perform laser resurfacing under “conscious sedation,” in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring.
- Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less “downtime” afterward. Several treatments are needed to achieve full benefit.
- Heat and radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devices and infrared light sources. Techniques are still being developed but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts.
- Plastic surgical procedures: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
- Botox: Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe; the muscle poison does not spread through the body to do damage elsewhere.
- Fillers: Fillers are injected into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), lactic acid (Sculptra), and autologous fat transplants are being used because their effect can last six to nine months or even longer.
Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.
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