Wrinkles are a part of aging and there is no way to completely prevent many of them from happening. While topical creams and lotions once were the only players for wrinkle prevention and treatment, that has changed significantly over the past decade. Botox, injectable fillers and various energy-based device treatments (e.g., laser) have moved in to now play major roles in wrinkle treatment.

But those facial lines which develop are more complex than they appear. They are numerous causes of wrinkles which range from the movement of facial muscles to gravity and sun damage. This creates different types of facial wrinkles which are structurally different. Getting the best treatment results depends on matching the facial wrinkle type with the appropriate treatment.  Facial wrinkles and lines can be divided into four general types.

The most common facial wrinkles are known as dynamic expression lines. They have become well known because of Botox injections, which are used to specifically treat them. They are known by a variety of names such as smile lines, crow’s feet and the ‘11s’. They develop due to the repetitive movement of muscles of facial expression and the wrinkling of the skin appears perpendicular to the direction that the muscle moves. The most obvious example are horizontal forehead wrinkles which develop because of the movement of the vertically-oriented large forehead frontalis muscle which runs from the eyebrows to the back of the head. By weakening these expressive muscles with Botox injections, the lines become less evident with movement. This works well around the eyes because less movement is always good. Around the mouth, however, less movement can affect how one smiles so injections are done more carefully or not at all.

Elastic skin creases occur in areas that are exposed to skin folding and have high sun exposure, most frequently on the cheeks and at the base of the neck. They are not the result of muscle movement but occur in those areas where the skin frequently becomes ‘creased’. This could be the result of sleeping repetitively on the side of one’s face (e.g., vertical or oblique skin creases in the forehead) or other external force that sheers against the skin. The best prevention is to avoid activities that crease the skin and keep it well moisturized.

Gravitational folds are not really wrinkles per se but lines that form from the effects of falling skin. They are the result of skin sagging and falling. The most well known are the nasolabial folds and marionette lines. Nasolabial folds appear and deepen as the cheek tissue above them descends, pushing lower cheek tissues against the fixed and non-falling upper lip tissues. The same occurs as jowl and facial tissues fall downward against the fixed tissue of the chin, creating marionette lines. Gravitational folds are best treated by either lifting procedures  that pull the weight of the descending tissues upward and back (e.g., lower facelift, cheek lift) or by plumping the fold with an injectable filler material.

Atrophic wrinkles occur from thinning skin and loss of its elasticity. These are the fine smaller wrinkles that often appear between and around dynamic expression lines, elastic creases and facial folds. They create what is known as creapy skin and usually appear as one of the last wrinkle types to occur. Excessive sun exposure and smoking make huge contributions to their occurrence and are what creates the ‘prune-face’ appearance in those with a long-history of sun bathing and have developed a more leathery skin appearance. Exfoliative skin treatments such as laser resurfacing and chemical peels are very effective because these wrinkles are often very superficial and their appearance can be lessened by removing some of the outer skin thickness.     

Between topical skin products, Botox, fillers, lasers and surgery, a wide variety of skin wrinkle treatments exist. But these treatments must be applied to the wrinkle type in which they work the best to get good results. Most patients need three or more of these over time to lessen the inevitable appearance of facial wrinkling.

Dr. Barry Eppley

Indianapolis, Indiana

Methods of decreasing the effects of aging on skin continues to find new and innovative approaches. The most recent one that I have come across is that of what you can do while you are sleeping…and it doesn’t come from an applied cream or lotion.

Rather it is something that is embedded in pillowcases and it may have a beneficial effect by reducing wrinkles while you sleep…copper-oxide infused fibers. Copper has proven antimicrobial properties and is an important elemental component of many of the body’s  tissues. There is a well known association of cooper peptides being used for skin enhancement. Several cosmetic skin products from well known manufacturers have it as part of their active ingredients.

Cupron, the company that makes the pillowcases here in the U.S. and sells them through Bed Bath and Beyond stores, published a study earlier this year in the  International Journal of Cosmetic Science. This study evaluated the pillowcase’s effectiveness in the appearance of wrinkles in patients who slept on them. The study looked at the skin of  fifty-seven women after two and four weeks of sleeping on the pillowcases. Those sleeping on the pillowcases containing the copper oxide had significant reduction in the appearance of wrinkles, a significant reduction in the appearance of fine lines, and overall improvement of skin glow.

This is an interesting concept and the first one that I have seen that moves a potentially skin-enhancing product into an everyday part of life. And a significant part it is, occupying up to a third of many people’s life.

While the effects of copper on skin emanating from a fabric sounds appealing, there is much science to prove that it actually works. While copper peptides are being effectively used in topical applications, it is copper oxide that is in these fabrics. Copper oxide is a much more reactive form of copper which continuously releases ions. Whether this copper ion release is significant enough to have any effect on stimulating collagen formation in skin is unknown.

Other important considerations are whether the skin can actually absorb any of the released copper ions and how long the fabric releases them. What happens after repeated washings and what effect different detergents and softeners may have on them would also be useful information.

Despite these drawbacks, this fabric-infused approach to wrinkle reduction remains appealing. While it may not be as effective as many other well-established methods, it may have an adjunctive skin rejuvenation role. And a good product to offer as part of a comprehensive skin treatment program.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis     

When facial laser resurfacing was first introduced over 10 years, the carbon dioxide lasers emitted precise levels of high energy for skin ablation. This resulted in a bloodless form of skin retexturing that had advantages over traditional demabrasion and chemical peels. Due to long recoveries with deep laser resurfacing, however, the current trend is the use of lower energy lasers that do not penetrate as deep, can be done without general anesthesia, and have quicker recovery times. While this approach to laser skin ablation will likely remain into the foreseeable future, the long-term effects of deeper laser resurfacing can not withstand scrutiny.

 
In the March 2008 issue of Plastic and Reconstructive Surgery, this very issue from a group in Chile was evaluated. They looked at long-term photographic results from 46 patients at 1, 5, and 10 year follow-ups. Their results showed that early results of skin texture was quite good. After 1 year, however, they were able to detect lines of demarcation between treated and non-treated skin and some skin had persistent redness. After 5 and 10 years, advantages were maintenance of good skin texture, elimination of fine wrinkles, and long-term correction of skin pigmenttaion. Some disadvantages included permanent hypopigmentation at the jaw-neck transition, skin telangectasias, and possible accentuation of skin redundancy.

 
This study supports what we have known for some time. Deep carbon laser resurfacing does an excellent job of removing many fine lines and wrinkles and this effect is maintained for some time. However, it does thin out the skin in some areas which is reflected in the development of telangectasias in the thinned skin. The line of demarcation between treated skin at the neck line is a well-known phenomenon. In other words, there are tradeoffs for wrinkle elimination and skin texture improvement….thinner skin with less pigment is some areas. These long-term effects support exactly why more superficial laser treatments are better. It may take more laser treatments to get similar effects but the results are more physiologic and natural.

 
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
htp://www.ologyspa.com
Clarian North Medical Center, Carmel, ,Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis