Wrinkles are a natural part of aging. As
you grow older, your skin gets thinner, drier and less elastic. And it
becomes less able to protect itself from damage. As a result, wrinkles,
lines and creases form in your skin. Although genetics are the most
important determiner of skin texture, a major contributor to wrinkles is
spending too much time in the sun. Smoking also can cause premature
aging of your skin.
If your wrinkles are bothering you, you have more options than ever to
help eliminate or at least diminish their appearance. Medications, skin
resurfacing techniques, fillers, injectables and surgery top the list of
effective wrinkle treatments.
Wrinkles are the lines and creases that form in your skin as you age.
Some wrinkles can become deep crevices or furrows and may be especially
noticeable around your eyes, mouth and neck.
When to see a doctor
If you're concerned about the appearance of your skin, see your
dermatologist. He or she can help you create a personalized skin-care
plan by assessing your skin type and evaluating your skin's condition. A
dermatologist can also recommend medical wrinkle treatments.
Wrinkles are caused by a combination of factors — some you can control, others you can't:
* Age. As you get older, your skin naturally thins and becomes less
elastic and more fragile. Decreased production of natural oils makes
your skin drier and appear more wrinkled. Fat in the deeper layers of
your skin, which gives the skin a plump appearance, starts to lessen.
This causes loose, saggy skin and more pronounced lines and crevices.
* Exposure to ultraviolet (UV) light. Ultraviolet radiation markedly
speeds up the natural aging process and is the primary cause of early
wrinkling. Exposure to UV light breaks down your skin's connective
tissue — collagen and elastin fibers, which lie in the deeper layer of
skin (dermis). Without the supportive connective tissue, your skin loses
its strength and flexibility. As a result, skin begins to sag and
* Smoking. Smoking can accelerate the normal aging process of your
skin, contributing to wrinkles. This may be due to changes in the blood
supply to your skin.
* Repeated facial expressions. Facial movements and expressions,
such as squinting or smiling, lead to fine lines and wrinkles. Each time
you use a facial muscle, a groove forms beneath the surface of the
skin. And as skin ages, it loses its flexibility and is no longer able
to spring back in place. These grooves then become permanent features on
Preparing for your appointment
Because appointments can be brief, and because there's often a lot to
cover, it's a good idea to be well prepared for your appointment.
Preparing a list of questions will help you make the most of your
appointment. List your questions from most important to least important
in case time runs out. For wrinkles, some basic questions to ask your
* What is the best course of action?
* What are my treatment options and the pros and cons for each?
* What will the treatments cost? Does medical insurance cover these costs?
* What results can I expect?
* What kind of follow-up, if any, should I expect?
Treatments and drugs
If your wrinkles are bothering you, you have many options to help
eliminate or at least reduce their appearance. Wrinkle treatments
* Topical retinoids. Derived from vitamin A, retinoids that you
apply to your skin may be able to reduce fine wrinkles, splotchy
pigmentation and skin roughness. Retinoids must be used with a skin-care
program that includes sunscreen and protective clothing because the
medication can make your skin burn more easily. It may also cause
redness, dryness, itching, and a burning or tingling sensation.
Tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) are examples
of topical retinoids.
* Nonprescription wrinkle creams. The effectiveness of anti-wrinkle
creams depends in part on the active ingredient or ingredients. Retinol,
alpha hydroxy acids, kinetin, coenzyme Q10, copper peptides and
antioxidants may result in slight to modest improvements in wrinkles.
However, nonprescription wrinkle creams contain lower concentrations of
active ingredients than do prescription creams. Therefore results, if
any, are limited and usually short-lived.
Surgical procedures and other techniques
A variety of skin-resurfacing techniques, injectables, fillers and
surgical procedures are available to smooth out wrinkles. Each works a
little differently and has its own set of potential results and side
* Dermabrasion. This procedure consists of sanding down (planing)
the surface layer of your skin with a rapidly rotating brush. The
planing removes the skin surface and a new layer of skin grows in its
place. Redness, scabbing and swelling generally last a couple of weeks.
It may take several months for the pinkness to fade and for you to see
the desired results.
* Microdermabrasion. This technique is similar to dermabrasion, but
less surface skin is removed. It's done using a vacuum suction over your
face while aluminum oxide crystals essentially sandblast your skin.
Only a fine layer of skin is removed. You may notice a slight redness to
the treated areas. Microdermabrasion usually requires repeated
treatments to maintain the subtle, temporary results.
* Laser, light source and radiofrequency treatments. In ablative
(wounding) laser resurfacing, a laser beam destroys the outer layer of
skin (epidermis) and heats the underlying skin (dermis), which
stimulates the growth of new collagen fibers. As the wound heals, new
skin forms that's smoother and tighter. It can take up to several months
to fully heal from ablative laser resurfacing. Newer developments in
laser technology have decreased the healing time. Less intense lasers
(nonablative lasers), pulsed light sources and radiofrequency devices
don't injure the epidermis. These treatments heat the dermis and cause
new collagen and elastin formation. After several treatments, skin feels
firmer and appears refreshed. This means shorter recovery times, but
treatment typically needs to be repeated more often and results are
* Chemical peel. Your doctor applies an acid to the affected areas,
which burns the outer layer of your skin. With medium-depth peels, the
entire epidermis and a small portion of the dermis are removed. New skin
forms to take its place. The new skin is usually smoother and less
wrinkled than your old skin. Redness lasts up to several weeks. With
superficial peels, only a portion of the epidermis is removed. After a
series of peels, you may notice less fine wrinkling in your skin and a
fading of brown spots.
* Botulinum toxin type A (Botox). When injected in small doses into
specific muscles, Botox blocks the chemical signals that cause muscles
to contract. When the muscles can't tighten, the skin flattens and
appears smoother and less wrinkled. Botox works well on frown lines
between the eyebrows and across the forehead, and crow's-feet at the
corners of the eyes. Results typically last about three to four months.
Repeat injections are needed to maintain results.
* Soft tissue fillers. Soft tissue fillers, which include fat,
collagen and hyaluronic acid (Restylane, Juvederm), can be injected into
deeper wrinkles on your face. They plump and smooth out wrinkles and
furrows and give your skin more volume. You may experience temporary
swelling, redness and bruising in the treated area. The procedure may
need to be repeated every few months.
* Face-lift. The face-lift procedure involves removing excess skin
and fat in your lower face and neck and tightening the underlying muscle
and connective tissue. The results typically last five to 10 years.
(Healing times can be lengthy after a face-lift. Bruising and swelling
are usually evident for several weeks after surgery.
Keep in mind that results vary depending on the location of your
wrinkles and how deep your wrinkles are. However, nothing stops the
aging process of skin, so you'll likely need the treatments repeated to
These procedures aren't usually covered by insurance. In addition, any
of the procedures can have side effects, so be sure to discuss them with
your doctor. Make sure your dermatologist or plastic surgeon is
specially trained and experienced in the technique you're considering.
Many wrinkle creams and lotions sold in department stores, in drugstores
and on the Internet promise to reduce wrinkles and prevent or reverse
damage caused by the sun. But these products are not likely to make a
noticeable difference in your skin.
The Food and Drug Administration (FDA) classifies these creams and
lotions as cosmetics, which are defined as having no medical value. So
the FDA regulates them less strictly than it does drugs. This means that
products don't need to undergo rigorous testing for safety and
effectiveness before approval to go on the market.
Because the FDA doesn't evaluate cosmetic products for effectiveness,
there's no guarantee that any over-the-counter product will reduce your
Here are ways to improve and maintain your skin's youthful appearance:
* Protect your skin from the sun. Protect your skin — and prevent
future wrinkles — by limiting the time you spend in the sun and always
wearing protective clothing and hats. Also, use sunscreen when outdoors,
even in winter.
* Choose products with built-in sunscreen. When selecting skin-care
products, choose those with a built-in sun protection factor (SPF) of at
least 15. Also, be sure to select products that block both UVA and UVB
* Use moisturizers. Dry skin turns plump skin cells into shriveled
ones, creating fine lines and wrinkles long before you're due. Though
moisturizers can't prevent wrinkles, they may temporarily mask tiny
lines and creases.
* Don't smoke. Even if you've smoked for years or smoked heavily
when you were younger, you can still improve your skin tone and texture
and prevent future wrinkles by quitting smoking.