What are wrinkles?

Wrinkles are fine to deep folds on the skin surface that appear due to loss of collagen, which is the main building material in the skin; due to loss of skin elasticity, and due to loss of the underlying fatty and connective tissue. They can also form due to underlying muscle activity. The wrinkles that are present when our muscles are at rest are called static wrinkles, and those that are apparent only when underlying muscles are contracting are called dynamic wrinkles. This division into static and dynamic wrinkles is important for choosing the correct treatment.

How did I get wrinkles?

If you live long enough on this planet you will get wrinkles, but especially if you had a lots of exposure to ultraviolet radiation from the sun, or indoor tanning devices, if you were exposed to tobacco smoke, and if you have lived in areas of the planet with air pollution. Genes (i.e. inheritance) also plays a role. However, the exposure to ultraviolet radiation is the main cause. You can check this fact yourself by comparing some parts of your skin that have not been exposed to the sun (e.g. inner parts of the arm, breasts or buttocks) with skin that has been exposed (face, upper chest, backs of forearms or hands) and you will see the stark difference. Also the loss of underlying fatty and connective tissues that mainly happens with aging is very important as well.

How can I prevent wrinkling of my skin?

You can prevent many wrinkles by staying away from the sun, by avoiding tanning, by avoiding exposure to tobacco smoke and air pollution. You should also drink plenty of water, eat lots of fruits and green vegetables, avoid starchy and sugary foods, eat foods that come from farms and not foods that come from factories and, of course, keep your skin well moisturized, preferably with some good sunscreen. Exercise daily; you just have to put it on your calendar and to-do list, since it is one of the most important daily tasks. Walk outdoors during the lunch break, walk outdoors before sleep. Also, have a good night’s sleep of about 8 hours, and try to have a mid-day nap of about 20-30 minutes daily. Lack of sleep causes increased stress, which in turn increases stress hormone cortisol in our system, which in turn breaks down the main building block of our skin – a protein called collagen. In addition without sleep our body does not have enough time to repair the damage sustained the previous day. As a consequence our skin starts sagging and becomes wrinkly over time. Turn off all electronic devices (phones, TV etc.) 1 hour before sleep, eat very light supper and please, please no alcohol before sleep – it will make it easier to get asleep, but it will make your sleep shallower (i.e. the sleep will be of poor quality). Now back to the sun exposure – here are some tips on protection from ultraviolet radiation:

  • Seek shade and stay out of the sun in the middle of the day (from 10 a.m. to 5 p.m.).
  • Wear a wide-brimmed hat, sunglasses, long-sleeved loose-fitting shirts, long loose-fitting pants, or long skirt outside.
  • Put on sunscreen with at least a Sun Protection Factor (SPF) of 30. Look for sunscreens with titanium dioxide and zinc oxide. My family’s favorite is Banana Boat KIDS with SPF 50 that contains both titanium dioxide and zinc oxide.
  • Do not use tanning beds.

We also like to point one fact to our patients – The Sun is a humongous nuclear reactor in the sky, and there is only an empty space between you and that nuclear reactor. When you think like that, it is a bit easier to follow the above recommendations.

Worth of mentioning is an iconic Slip-Slop-Slap sun protection campaign in Australia during the 1980s.

It stands for:

Slip on a shirt,

Slop on the 30+ sunscreen,

Slap on a hat

Be grateful for every wrinkle, but do whatever you can to prevent them, and to make them less visible. That being said, do not obsess about every sign of aging, because you will never be able to completely reverse the clock. What you can change is the way you experience your aging: be content, radiate gratefulness and happiness and many signs of aging that no doctor, cream or procedure can erase will be totally neutralized by your positive outlook.

Exercise the positive thinking just as you would do any physical exercise, be grateful for every moment you were given, every experience you have gone through that made you the better person.

How can my health care provider help me?

Your health care provider can prescribe you tretinoin cream that can help clearing up and preventing the fine wrinkles (brand name: Renova), but for deeper wrinkles you will need a specialized care.

What are the available treatments?

For dynamic wrinkles the best are botulinum toxin injections (brand names: Botox, Dysport and Xeomin). For static wrinkles the options are tretinoin cream (e.g. Renova), intense pulsed light (IPL), lasers (e.g. Fraxel), chemical peels (e.g. Jesnner’s + TCA), dermabrasion, fillers (e.g. Restylane, Juvederm, Radiesse, Sculptra). For a sagging face, the lost volume must be replaced with: injections (transfer) of your own fat or by deeper placement of fillers, that should be combined with surgical face lift if needed. You do not want to have the face or neck lift  (which is basically cutting off a redundant skin, so that the skin can again snuggly fit the face framework) without replacing the lost tissues underneath, since stretching the skin over the bones can unmask the underlying bone framework, which looks rather unnatural and not youthful.

What are the newest treatments in the pipeline?

Well, I’ve just done some literature search and this is what I have found to be interesting and rather feasible:

Platelet-Rich Plasma with Basic Fibroblast Growth Factor (PRP+b-FGF) for Treatment of Wrinkles and Depressed Areas of the Skin.

By Kamakura T. et al.

Published on-line in Plastic and Reconstructive Surgery in July  2015 .

This is the study with over 2000 participants from Japan which demonstrated over 97% satisfaction rate among patients with results after injections of their own blood plasma with addition of b-FGF  into the wrinkles and depressions on the face. Authors conclude:

“PRP+b-FGF is effective in treating wrinkles and depressed areas of the skin of the face and body. The study revealed that PRP+b-FGF is an innovative therapy that causes minimal complications.”

We’ll keep an eye for similar studies, and may try it one day on my patients as well!


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