The Wrinkle Report

The Wrinkle Report

Over-the-counter topicals
These are lotions, creams, and serums containing antioxidants (vitamins C and E, coenzyme Q10, alpha lipoic acid, and retinol, a form of vitamin A), peptides (copper and growth factors), and alpha and beta hydroxy acids (glycolic, lactic, and salicylic).

How they work: Antioxidants operate preventively by destroying rogue molecules that break down collagen and make skin more susceptible to wrinkles. Peptides and retinol have been shown to stimulate collagen production. Hydroxy acids exfoliate the top layer of skin, smoothing texture. But don't expect miracles, says Patricia K. Farris, MD, clinical assistant professor of dermatology at Tulane University. She's seen modest improvement with some peptide formulas (specifically the Neutrogena Visibly Firm copper line and the Olay Regenerist line) and retinol creams (like Roc Retinol Correxion). Antioxidants are difficult to stabilize and deliver; Farris suggests asking your dermatologist which products work best.

On the horizon: Topical genistein, a plant hormone found mainly in soybeans, has been shown to protect the skin from the photodamage that causes wrinkles and skin cancer. Products containing this potent antioxidant are expected to be on the market within the next six months, says Neil Sadick, MD, clinical associate professor of dermatology at the Weill Medical College of Cornell University.

Doctor-dispensed and prescription topicals
Products (like M.D. Forté, Afirm, and TNS Recovery Complex) typically contain hydroxy acids, retinol, or growth factors in concentrations higher than what you can buy at a store but not quite prescription strength. Prescription creams like Renova, Retin-A, and Avita (generic Retin-A) contain tretinoin, a vitamin A derivative. (Renova is less drying than Retin-A.) Avage and Tazorac contain tazarotene, similar to tretinoin but stronger.

How they work: The retinoids reach the skin's middle layer (dermis), where they increase cell turnover and stimulate collagen production, which thickens the skin and helps smooth wrinkles. They also cause exfoliation, which improves texture. Stinging, peeling, flaking, and redness are common, but your skin will eventually adapt to the side effects. Doctor-dispensed topicals work similarly to OTC products but can deliver better and faster results.

On the horizon: The antioxidant idebenone, a derivative of Q10, will be a key ingredient in a doctor-dispensed product called Prevage. Lab tests show that it's more potent than some of the more popular antioxidants, says Patricia K. Farris, MD. The research is promising, but the clinical data still needs to be analyzed; Prevage should be available by the end of this year.

Chemical peels
One or a combination of acids is painted on skin like a mask in varying strengths—light (or superficial), medium, or deep.

How they work: The acid solution peels away layers of the skin. Superficial peels increase cell turnover and are used to improve skin texture (and uneven pigmentation); significant wrinkle reduction is unlikely. Medium and deep peels, which encourage collagen production and cell turnover, are more effective for wrinkles, but the deeper the peel is, the longer—and more painful—the recovery. Following a medium or deep peel, skin is red and a surface crust forms. This flakes off after about a week, but skin can remain red for a month.

On the horizon:New, superficial peeling solutions containing citric (from citrus fruits) or malic (from apples) acid are being developed and tested. These formulas could potentially give better results with less irritation than glycolic acid, says Jeffrey Dover, associate professor of dermatology at Yale University School of Medicine.

Laser resurfacing and rejuvenation
A laser delivers heat to skin cells.

How it works: Nonablative lasers (CoolTouch and Smoothbeam) allow energy to pass through the top layer of skin (epidermis) and heat only the dermis. Over the course of about five treatments, a "wound response" produces new skin cells and some collagen, which smooths fine lines. Skin texture shows the greatest improvement; results for wrinkles are more modest, says Jeffrey Dover, associate professor of dermatology at Yale University School of Medicine. Ablative lasers (CO2 and the erbium:YAG) remove the outer layer of skin and work more intensely within the dermis. "One treatment can truly make older skin look young again," says Dover. Though the procedure treats deep wrinkles and very rough skin texture, many people choose alternatives because of the two-month recovery period. Following treatment, skin becomes very red and hurts, and a surface crust forms.

On the horizon: Fraxel skin treatment is a new category of laser skin rejuvenation that promises the dramatic results of ablative treatments without the serious side effects. The Fraxel laser involves resurfacing only 17 percent of the skin's surface at a time so there's no major redness or scabbing, says Roy Geronemus, MD, director of the Laser & Skin Surgery Center of New York. Instead of delivering a solid beam of light that removes the entire outer layer of skin, the beam is split up and heats microscopic columns of tissue (leaving healthy tissue in between). It basically creates a grid of small wounds on the skin (invisible to the naked eye). After three to five treatments about a week apart, the results are similar to traditional ablative resurfacing. The technique is still in the testing phase;it may be available this year.
 

 

Radio frequency treatment
Also called Thermage, ThermaCool, or ThermaLift, this FDA-approved procedure delivers radio frequency energy to the dermis. 

How it works: While a cooling spray protects the epidermis from burning, the energy heats the collagen fibers, causing them to tighten and lift the skin. Discomfort varies depending on the person and can be lessened by topical anesthetic cream. Mild and temporary swelling may occur, but major side effects are rare, says Roy Geronemus, MD. It can take about four to six months to see results from one nearly hour-long treatment, but some people experience immediate improvement. 

On the horizon: The Polaris WR system delivers both laser and radio frequency energy (using electro-optical synergy, or ELOS) to the dermis in order to build collagen and tighten skin during one series of about five treatments. The system was approved by the FDA last December; more doctors will soon begin offering it.


 

 

Intense pulsed light photorejuvenation
A handheld device delivers pulses of light to the skin to treat hyperpigmentation and redness caused by broken blood vessels and to improve skin texture and tone.

How it works: The light pulses are absorbed by the hyperpigmentation and blood vessels, causing the melanin deposits to break apart and visible blood vessels to be reabsorbed by the body. As with a laser, a mild wound response also promotes cell turnover and some collagen production. Four to six treatments, three weeks apart, are needed. Skin may be slightly pink for about a day.

On the horizon: Photomodulation uses pulses of low-energy light (less than what's emitted from a 25-watt bulb) to deliver signals, like a remote control, to skin cells. During the treatment, you sit in front of the device, called GentleWaves, which resembles a computer screen. When the machine is set at a certain parameter (much as a remote control is programmed with a TV-specific code), the light painlessly, and without side effects, "turns on" the cells responsible for collagen production and "turns off" production of the enzyme that breaks down collagen, says Roy Geronemus, MD. It can also increase cell production and turnover; doctors believe that the light energy is somehow converted into cell energy within the skin, similar to photosynthesis in plants, says Jeffrey Dover. Studies show a mild to moderate improvement in wrinkles and skin texture and tone after eight to ten treatments, says Geronemus. Clinical studies have been submitted to the FDA for approval of the company's claims.
Injectables
Botox (botulinum toxin type and Myobloc (botulinum toxin type B) are purified forms of bacteria. Soft-tissue fillers include collagen (human or bovine) and hyaluronic acid (Restylane).

How they work: Botox and Myobloc shut down the nerve signals responsible for the muscle contractions that make facial expressions causing wrinkles and furrows. That's why it's more effective as a preventative treatment, says Jeffrey Dover. After about a year, however, existing lines can soften and smooth out, he says. (They will return once you stop getting injections.) One treatment usually lasts three to four months. Fillers are injected into the skin to plump up wrinkles. Bovine collagen has been used for more than 25 years. Two skin tests determine whether you're allergic to it, and the effects typically last four months. With human collagen, bioengineered from infant foreskin tissue, there's no allergy test or waiting time necessary between the initial consultation and treatment. Hyaluronic acid (Restylane) is found naturally in the skin. Because it lasts longer (six to nine months) and allergic reaction is rare, it appears to be a better filler than collagen. If necessary, doctors can also remold Restylane several weeks after injecting it. One drawback: It may cause swelling that lasts one to three days.

On the horizon: The most promising new fillers are Sculptra, Perlane, and silicone. The FDA is reviewing study results for Sculptra, a deep-tissue filler made of poly-L-lactic acid. Sculptra plumps up thin or sunken cheeks. Perlane, like Restylane, is made of hyaluronic acid, but in larger particles, which fill deeper wrinkles. Jeffrey Dover anticipates FDA approval in the next year or so. Silicone, once used as a filler, was banned in 1992 for safety and efficacy reasons. Since then, doctors have developed a better, medical-grade injectable form that's approved for treating retinal detachment. The FDA is monitoring preliminary studies of its cosmetic uses. Unlike most fillers, silicone is permanent, which makes it appealing only to some. "Permanent fillers have permanent side effects," says Dover. These could include a lumpy look. "I'd never choose it for myself," he says, "but my patients who hate to come back for repeat collagen treatments think it's wonderful."

linda's picture
Posted November 22, 2009
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