Other Names:
Aging Skin, Sagging Skin, Drooping Skin, Wrinkled Skin, Aging Wrinkles, Expression Lines, Sleep Lines, Gravity Wrinkles, Aging lines, Photo damaged skin, sun damaged skin, frown lines, laugh lines, laughter lines, Crow’s feet, fine lines, skin in need of rejuvenation, skin that needs surgical skin rejuvenation, skin that needs chemical peeling, skin that needs soft tissue augmentation, skin in need of botox injection, skin in need of dermabrasion, skin that needs laser resurfacing.
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Other Names: Aging Skin, Sagging Skin, Drooping Skin, Wrinkled Skin, Aging
Wrinkles, Expression Lines, Sleep Lines, Gravity Wrinkles, Aging lines, Photo
damaged skin, sun damaged skin, frown lines, laugh lines, laughter lines, Crow's
feet, fine lines, skin in need of rejuvenation, skin that needs surgical skin
rejuvenation, skin that needs chemical peeling, skin that needs soft tissue
augmentation, skin in need of botox injection, skin in need of dermabrasion,
skin that needs laser resurfacing.
Wrinkles are visible lines and creases on the skin. Skin distortion in form of wrinkles is the most visible sign of aging. Skin wrinkles have come to be accepted as a normal and natural part of aging that occurs as the skin loses elasticity over time. Skin wrinkles due to aging are caused as skin cells begin dividing more slowly, weakening the structure of the inner layers of skin. This leads to pits and depressions which show up on the outer layers of the skin as wrinkles. In addition, aging causes the sebaceous (oil) glands of the skin to begin producing less oil, which significantly dries the skin and leads to a thinning of the outer layer, leading to the more pronounced appearance of the aforementioned depressions.
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Wrinkles generally occur everywhere on the body, but are more frequent in areas
where skin folds upon itself such as in the corners of the eyes and mouth.
Although a normal part of the aging process, excessive wrinkling of the skin
can be unsightly and harm a person's self esteem.
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Wrinkles and aging skin are the result of five independent factors working together:
Possible Cause of Wrinkles: Expression Lines
Over time, the face changes shape slowly as it reacts to the facial expressions
when we eat, chew, smile, laugh, cry or frown. These facial movements contribute
to the changing shape of our face and affect the collagen under the skin. Wrinkles
around the eyes (crow’s feet), mouth (laugh lines) and between the eyebrows
(frown lines) become more pronounced due to frequent contractions of muscles
beneath the skin that begin to crease the skin over time.
Possible Cause of Wrinkles: Sleep Lines
Each person has a favorite sleeping position and when the face is placed in
the same position on a pillow every night, certain lines begin to leave their
mark on the facial skin. Blood circulation is affected in that area and a shallow
line begins to form. When the patient awakes, these lines may diminish or disappear
but when the process is repeated, the same lines return and leave a slightly
deeper mark on the facial skin.
Possible Cause of Wrinkles: Natural Aging
Aging is a natural process. It causes the skin to thin and the fat under the
skin is lost. This results in a bony look with hollowed cheeks and pronounced
appearance of the eye sockets.
Possible Cause of Wrinkles: Gravity
Gravity affects everyone and pulls the skin and flesh towards the center of
the earth and causes it to sag, most noticeably on the face, neck, and upper
arms. When we stand, all parts of the face reposition themselves downwards,
the eyelids pull down, the chin drops and the lower lip falls. Facial changes
associated with gravity become more pronounced as we age. There are no facial
exercises that can negate the effects of gravity.
Possible Cause of Wrinkles: Toxins
Toxins can damage our skin. We are exposed, intentionally or unintentionally
to thousands of toxins, chemicals, paints and even skin care products during
our life. Some skin creams and lotions can actually damage the skin and cause
wrinkles. Toxins in cigarettes are just one of the causes of wrinkles on the
skin. Smoking causes a marked reduction in the creation of the structural proteins
that repair the skin. This can lead to an increased incidence of the appearance
of wrinkles. Researchers have found that people who smoke tend to have more
skin wrinkles than non-smokers of the same age, complexion and history of sun
exposure. The reason for this difference is not clear. It may be because smoking
also plays a role in damaging elastin. Facial wrinkling increases with the amount
of cigarettes and number of years a person has smoked.
Possible Cause of Wrinkles: Photo damage
The most preventable cause of aging skin is photo damage. These signs of aging
skin are created by exposure to the rays of the sun and the environmental elements.
The sun’s ultraviolet (UV) light damages the fibers in the skin called
elastin. The breakdown of elastin in the skin removes the skin’s ability
to snap back after stretching and the result is formation of wrinkles. Scientists
estimate that 80 percent or more of the damage on an aging face is due to exposure
to the environment including the sun. Light colored skin, light colored eyes
and long-term sun exposure makes people more susceptible to photo damage. Symptoms
are wrinkles on the skin, blotchy pigmentation and scaling on the facial skin.
Ultraviolet (UV) rays also damage the skin’s ability to repair itself
by facilitating the creation of abnormal proteins that would be otherwise used
to repair and rebuild skin in their healthy forms. If the abnormal proteins
become more prevalent than the normal ones, over time wrinkles will develop.
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Many manufacturers of commercial lotions and creams claim they can reduce the
appearance of skin wrinkles and "rejuvenate aging skin." Some of these claims
have merit whilst the majority of these claims are unreliable.
The American Academy of Dermatology believes that some cosmeceuticals (medicated
skin care products), can “improve the functioning of the skin and be helpful
in preventing premature aging. Examples are alpha hydroxy acids such as glycolic
acid, and beta hydroxy acid such as salicylic acid. These hydroxy acids increase
skin exfoliation (the removal of dead skin cells) making aging skin appear smoother
and feel softer. Some vitamins, such as vitamin A (retinol), may improve the
appearance of aging skin by making the skin function better, but they may be
drying or irritating and must be used appropriately… Sun blocks prevent
photo-aging and photo-carcinogenesis (cancer from the sun) and should be the
cornerstone of any skin care regimen.”
The Food and Drug Administration (FDA) has approved certain products to treat
signs of sun-damaged or aging skin including tretinoin cream and carbon dioxide
(CO2) and erbium (Er:YAG) lasers.
Tretinoin cream (Renova), a vitamin A derivative available
by prescription only, is approved for reducing the appearance of fine wrinkles,
mottled darkened spots, splotchy pigmentation and roughness in people whose
skin doesn’t improve with regular skin care and use of sun protection.
However, it doesn’t eliminate wrinkles, repair sun-damaged skin or restore
skin to its healthier, younger structure. Tretinoin hasn’t been studied
in people 50 and older or in people with moderately or darkly pigmented skin.
Topical creams, lotions and treatments are most effective when the skin has
modest or moderate signs of aging. Tretinoin cream 0.02% and 0.05% are the only
prescription treatments approved by the Food and Drug Administration (FDA) for
these indications. Other available forms of tretinoin are indicated for the
treatment of acne.
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Laser Skin Resurfacing: CO2 and Er:YAG lasers (Light Amplification
by the Stimulated Emission of Radiation) are used to treat or improve wrinkles,
lines and other effects of aging and photo aging. Doctors also use lasers to
remove warts and tattoos, to remove unwanted hair or vascular moles, to treat
superficial brown pigmented lesions such as age spots and deep pigmented lesions
such as birthmarks and port wine stains and even to remove some types of skin
cancer. The Dermatologists use the laser to remove skin one layer at a time.
Laser therapy is performed under anesthesia in an outpatient surgical setting.
Heat or light pulses from a laser gun are directed at aging skin and these help
rejuvenate the skin’s tone and texture. Laser therapy can remove moderate
to advanced fine lines and even some of the deeper wrinkles. Powerful and rapid
pulses of the infrared-wavelength CO2 laser can vaporize targeted skin. The
benefits of laser skin resurfacing include removal of the skin without any bleeding,
a much lesser risk of infection, precise targeting of the treatment areas, fairly
reliable treatment outcomes and a short outpatient treatment time. After-effects
and recovery times depend on the laser procedure.
Electrosurgical Resurfacing: This procedure, sometimes called,
“electrosurgery” or “cold ablation” involves a non-traumatic
cutting of the tissue and its coagulation using a high frequency electric current.
It is perhaps a better alternative to laser skin resurfacing and more patient-friendly
because it involves less discomfort during and after the procedure plus it heals
faster. This process involves no pressure or crushing of tissue cells. This
technique uses a micro-electrical radio frequency to deliver a pulse of energy
to the skin, removing or improving superficial to moderate skin damage. Electrosurgical
Resurfacing for the skin delivers electrical energy to particles in salt water
that have been applied to the skin and as a result the skin layers separate
and fall off. Lasers burn the layers of the skin off. Electrosurgical resurfacing
removes unwanted skin and seals unnecessary blood vessels. The procedure has
few after-effects and recovery from the mild to moderate swelling is usually
completed within a month. Electrosurgical resurfacing is more acceptable and
more applicable to most skin types and colors, without loss of skin pigmentation.
Overall, it can be said that when it comes to skin wrinkles, electrosurgical
resurfacing is ideal for younger patients with mild to moderate skin damage
and wrinkles.
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BOTOX: One of the much talked about treatments for skin wrinkles,
frown lines and crows’ feet is botulism toxin injections (Botox). Botulinum
toxin is that powerful agent of botulism food poisoning whose biological effect
in food poisoning is that it blocks the transmission of nerve impulses from
the brain to the muscles and that causes generalized paralysis of the muscles
including those muscles used in breathing. However botulism cannot be contracted
from cosmetic use of Botulinum toxin or BOTOX. Nonetheless it is important to
know that BOTOX is a poison used in cosmetic applications for treatment of skin
wrinkles and some individuals prefer not to receive poisonous chemicals injected
into their facial area. Botox is said to hold the skin stretched tight but actually
during Botox rejuvenation, the dermatologist injects a low dose of Botulinum
toxin into the patient’s facial muscles causing the muscles to be temporarily
paralyzed and immobilized by a nerve blockade of that muscle. Botox does not
therefore “tighten the skin”. The immobilization prevents the formation
of wrinkle lines from frowning or squinting. The procedure is said to be non-invasive
and needs little or recovery time. The effects are not always dramatic and usually
BOTOX treatment must be repeated several times and the patient must learn to
avoid certain facial movements to minimize the formation of new wrinkles. The
effects of BOTOX can last three to four months. BOTOX causes a paralysis of
some of the facial muscles and in some patients a BOTOX causes the face to experience
an awkward movement or lack of movement in the patient’s facial muscles.
Chemical Peels. Chemical peels for treating skin wrinkles
are available from dermatologists and spas. These can remove the top layer of
the skin to stimulate rapid rejuvenation. Chemical peeling, also called chemexfoliation
or dermapeeling, is a type of facial skin rejuvenation procedure that basically
peels the top layer of the skin so that a new skin which is smoother and less
wrinkled can grow. It is used for treatment of modest to moderate skin damage
by the sun. Younger people in their 20s and 30s with fine lines around the eyes
and mouth must use milder chemical peels. Patients with minimal skin damage
are advised to have a series of light peels in combination with a skin care
program that includes retinoid and sun block. Patients with moderate skin damage,
age spots, freckles and actinic keratoses will find a medium-depth peel more
effective. A medium-depth peel is sometimes combined with other treatments like
laser resurfacing. Chemical peeling does not remove deep acne scars, deeper
wrinkles of the skin, sagging jowls or drooping eyelids.
AHA & Anti-Oxidants: Over-the-counter products containing
retinols (of the vitamin A family), AHA, anti-oxidants and moisturizing agents
may temporarily improve the appearance of fine lines and skin wrinkles. Topical
antioxidants, especially vitamins C and E and alpha Lipoic Acid can help skin
cells repair damage caused by aging, ultraviolet radiation and smoking. The
FDA is still studying the safety of alpha hydroxy acids (AHAs), which are widely
promoted to reduce wrinkles, spots, and other signs of aging, sun-damaged skin.
Some studies suggest that they may work, but there is concern about the adverse
reactions of the skin and the long-term effects of using AHAs. If you use AHA
products, you will be more sensitive to the sun and the FDA advises that you
protect yourself from sun exposure by using sunscreen, wearing a hat and avoiding
mid-day sun. Alpha-hydroxy acids (AHAs) may be used alone or in combination
with tretinoin to treat mildly damaged skin. AHAs are derived from fruit and
dairy products.
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Dermabrasion: Dermabrasion is a very old technique for resurfacing
deep facial scars, deeper wrinkles, deep acne scars, chicken pox scars and rhinophyma,
a type of rosacea. Dermabrasion penetrates the skin deeper than microdermabrasion.
The process of dermabrasion is the mechanical sanding of the upper layers of
the skin and is sometimes called “surgical skin planning”. In dermabrasion,
the physician will use a rapidly rotating wire brush to basically sand the surface
layer of the skin and sculpt away the sharp edges of scars and deep grooves
associated with skin wrinkles. After dermabrasion, a new and smoother layer
of skin grows which has far fewer wrinkles. Dermabrasion is a medical procedure
that requires local anesthesia. For a few days after treatment, the patient
undergoing dermabrasion will experience a redness of the skin similar to severe
sunburn and a "brush burned" feeling which can be partially alleviated
by using semi-permeable dressings that let the skin breathe. Sometimes medications
are necessary to reduce the discomfort. For the first one or two weeks, the
new skin will have a pinkish or light red appearance but the color will gradually
fade in favor of a normal appearance of the skin. It is recommended that patients
avoid sunlight for 3 to 6 months after treatment and apply a sunscreen with
an SPF of 30 to protect the new skin against the damaging effects of the sun.
Dermabrasion is widely used in men over the age of 40 for treating rosacea,
which occurs when oil glands enlarge on the face resulting in a bulbous, red
nose and swollen cheeks. We can return the nose to a more normal appearance
and shape by using dermabrasion. It should be noted that dermabrasion is not
suitable for treatment of many skin diseases including burn scars, certain pigmented
birthmarks and congenital skin defects. Those who are prone to form keloids
after skin injury are at risk of scarring from dermabrasion. Pigmented skin
may be permanently lightened in the area of dermabrasion (which may or may not
be a good thing).
Sleep Position: Sleeping in the same position every night
can leave sleep lines on the skin. By changing the position and the way we sleep
several times during the night, we can minimize the effects of sleep lines on
our facial skin. However this is not easy to achieve.
Soft-tissue Augmentation: When the skin has deep irregularities
such as age wrinkles, pits and scars, dermatologists treat them by replacing
the lost tissue either by transferring fat and tissue from other parts of the
body to fill in the deep wrinkles or by using solid implants surgically placed
under the skin. Whatever substance is used must be compatible with the patient’s
body tissues and these substances are usually injected under the skin to elevate
it and make the surface smooth. Collagen is often used for this purpose. Collagen
is a fibrous protein substance found in human and animal tissues which gives
structure to the skin, the bones and to the ligaments. The collagen used for
soft-tissue augmentation is usually derived from animals and some people are
allergic to cow-derived collagen (bovine). Collagen or collagen-related substances
are sometimes obtained from the patient or another human tissue donor. If you
plan to receive a collagen injection, be sure to get tested to make sure you
are not allergic to bovine collagen. Collagen treatment usually takes several
injections under local anesthetic to reduce the discomfort of the injection.
The effects of collagen injection can last anywhere from 2 month to 12 months.
Body fat is sometimes harvested from the patient’s own body and re-injected
in the wrinkled areas of the skin in a procedure called micro-lipoinjection.
This transfers the fat from one part of the body to the part showing signs of
aging and wrinkling. Defects improved by micro-lipoinjection include wrinkles
on and around the forehead, the lips, the nose, the mouth, the chin and the
cheeks. The usefulness of the procedure varies between patients. The tissues
near the treatment area tend to experience some swelling and bruising but these
usually fade in one to five days. Aside from collagen, other fillers can be
effective in reducing the appearance of these wrinkles. For example some dermatologists
believe that injectible silicone and hyaluronic acid gel are the best soft tissue
fillers for aging men and women. Injectible treatments are usually performed
in an outpatient clinic whilst solid implants surgically placed under the skin
will be done in a surgery room.
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Topical Estrogen: In a very interesting study, Schmidt JB,
Binder M, Demschik G, Bieglmayer C, Reiner A. explored the reason why there
appeared to be a coincidence of the appearance of aging on the skin and climacteric
symptoms. They wondered if an estrogen deficiency was causing the skin to age
in peri-menopausal women. They decided to investigate whether topical treatment
of the skin with estrogen could reverse some of the changes in the aging skin
and they found that by using topical 0.01% estradiol and 0.3% estriol compound
for a six month treatment period, the patients experienced a great deal of improvement
in the elasticity and firmness of their skin as well as a significant reduction
in the depth of skin wrinkles and a reduction in the pore sizes by between 61
to 100% in the estradiol and the estriol groups.
Liposuction: Sometimes skin wrinkles appear because of fat
build ups and unwanted fat deposits around the face. Diet and exercise does
not easily burn the fat off the facial areas and therefore it becomes a great
challenge to return to a more youthful and slim look. Some plastic surgeons
and dermatologists specialize in performing tumescent liposuction which is a
procedure that removes localized fat, after a full medical evaluation and in
an outpatient setting, under local anesthesia. Anti-bleeding medication is necessary.
Some physicians may use ultrasound to liquefy the fat deposits and then remove
it with a vacuum tube inserted into the facial area (or the body, depending
on where the liposuction is targeting). Patients will experience a downtime
of at least 3 to 7 days after the procedure. The results are not always attractive
and often not lasting.
Plastic Surgery: Sometimes, if none of the above steps and
treatment options work, surgical procedure is the only effective means of dealing
with the long term effects of gravity. Patients may present more serious skin
surface defects or wrinkles in the deeper layers of the skin with sagging in
areas of the lips, eyelids, cheeks, forehead, shin and areas around the mouth.
Surgery can involve several weeks or months of downtime and an assortment of
risks including non-reversible change of looks that was not desired. Some of
the most common types of plastic surgery include brow lift which reduces the
appearance of wrinkles and lines in the forehead and raises the eyebrows, blepharoplasty
which is an eyelid surgery to correct droopy eyelids by removing excess fat
pads and skin and rhytidectomy, otherwise called a face lift that tightens and
trims loose and sagging skin from the face.
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First and foremost: you must keep your body and skin hydrated at all times.
Limit exposure to the sun to less than ten minutes per day.
Some research suggests that organic sulfur (also known as MSM) is an effective
wrinkle prevention treatment. Wrinkle prevention includes proper sun hygiene
(SPF 30 or higher sunscreen, hats and long sleeves), avoiding stress, preventing
exposure to toxins and smoke, a good physical exercise program that increases
blood circulation to all parts of the body and good nutrition, avoidance of
unnecessary sugary and staying away from starchy foods.
Some natural health products can protect repair mechanisms in skin cells and
support their healing properties. Antioxidants counteract the damaging effects
of free radicals. Vitamins A, E and C as well as Co Q10 are the most common
antioxidants known for use in maintaining healthy skin. Topical Vitamin C helps
retain skin elasticity and stimulates collagen production. Vitamin C however
is highly unstable when exposed to air or light. Advanced chemicals and chemistry
have made it possible to deliver Vitamin C through the skin. Ester C is the
right type of Vitamin C for skin.
Fitzpatrick RE, et al. in a double-blind, half-face study published in 2002
reported on the efficacy of Vitamin C in improving the overall look and feel
of the patients’ skin. The researchers carried out a clinical evaluation
of wrinkling, pigmentation, inflammation and hydration prior to the study and
then at weeks 4, 8 and 12 on individuals who applied topical vitamin C complex
on one-half of the face and placebo to the other side. A marked and significant
improvement was seen in the skin where vitamin C was applied and biopsies showed
increased collagen formation and reduced wrinkling.
Several studies suggest that topical vitamin E, particularly alpha tocopherol
(a form of vitamin E) decreases skin roughness and reduces the depths and length
of facial lines and skin wrinkles. Alpha tocopherol can also act as a scavenger
of free radicals that can halt the ultimate destruction of collagen fibers.
A German study proved Melatonin's potency as a free radical scavenger. It is
a more potent antioxidant than Vitamin C. Research from the Department of Dermatology
at the University of Zurich demonstrated that melatonin protects against the
hydroxyl free radical and enhances the skin's ability to repair itself from
free radical damage suffered through the effects of photo damage.
Vitamin A has been tested extensively and is currently accepted by the medical
community as a powerful product in managing aging skin. Researchers have found
that a seven-day topical application of vitamin A increased collagen synthesis
and reduced the appearance of wrinkles and fine lines. Further studies have
shown that topical application of vitamin A can protect the epidermis (outer
layer of the skin) and the most delicate areas of the skin against free radical
attack by actually absorbing ultraviolet light and preventing it from doing
its damage.
Alpha Lipoic acid has been recognized as an antioxidant. Alpha Lipoic acid
neutralizes the damaging powers of free radicals, penetrates the cells and safeguards
them. Alpha Lipoic acid also aids in the exfoliation process by loosening the
bonds between dead cells so they can slough off easily and rapidly.
The anti-stress hormone DHEA is found in human skin. Decreased levels of the
DHEA hormone are associated with aging skin. Researchers have identified several
mechanisms through which this hormone protects against skin aging and maintains
the overall health of the skin. A medical study in the Journal of Surgical Research
points to the ability of topical DHEA in protecting the health of the skin's
delicate blood vessels. The study suggests that safeguarding the blood vessels
can prevent progressive tissue destruction, slow down the process of aging,
help transport essential nutrients in the bloodstream via the capillary network
to the living cells of the skin and thereby preserve skin health. DHEA has been
linked to the regulation and production of collagen. The DHEA hormone helps
the skin defend itself against cancer-causing and skin-destructive pollutants
found in the environment. The DHEA is also an anti-inflammatory agent and aids
in the healing process of damaged skin.
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