Wrinkles- The Basics
Article updated and reviewed by Michael S. Lehrer, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania. Editorial review provided by VeriMed Healthcare Network on April 18, 2005.
Wrinkles are the thin, creased, and sagging skin that is especially noticeable on the face, neck, and hands.
Wind, heat and chemicals and the natural effects of aging cause a certain amount of wrinkling in everyone, but it is much worse in people who spend a lot of time in the sun. Years of exposure to the sun cause "photoaging," which includes freckles, yellowing, roughness, visible blood vessels, and dark spots, as well as wrinkling.
Years of sun exposure cause the supporting structures of the skin, primarily the collagen and elastin, to weaken and break down. In addition, as a person ages, the sweat and oil glands of the skin become less numerous and smaller in size. This causes the skin to lose moisture and to dry out. Dry skin with weak collagen and elastin will sag, shrivel, and wrinkle. The skin around the eyelids, jaw, and neck is especially thin, and therefore more naturally prone to aging.
In addition to sun exposure, smoking may contribute to the formation of wrinkles. Finally, it is believed that some wrinkling is predetermined genetically from one's parents.
Although people may have a genetic predisposition to severe wrinkling, it is known that sun exposure promotes and exacerbates wrinkling of the skin. Smoking may also negatively affect the skin.
The most critical step in the treatment of wrinkles is sun avoidance and sunscreen use. Without these steps, more aggressive wrinkle treatments may be futile.
Some physicians may recommend daily moisturizing creams, including those with hydroxy acids as well as sunscreen (SPF 15 or greater).
It is difficult to repair deeply furrowed skin that appears with photoaging, but thinner wrinkles, dark spots, and rough skin may be improved with the use of topical medications. Over the counter creams containing retinol or glycolic acid may help somewhat. Your dermatologist may also recommend more aggressive prescription acid creams or peels, or, prescribe stronger retinoids such as Retin A (tretinoin) or Tazorac (tazarotene.)
More recently, dermatologists have begun to use injectable materials to help soften wrinkles. Botox (botulinum toxin) may soften the appearance of wrinkles caused by squinting or grimacing. Collagen or hyaluronic acid (Restylane, Hyalaform, Captique), may be injected under wrinkles or folds to elevate them.
Lasers may also be used to minimize wrinkles. Non-ablative (or “lunchtime”) lasers do not break the skin and have minimal side effects, but, are also not very effective. More aggressive lasers such as the carbon dioxide laser may remove deeper wrinkles but require several weeks of healing after a treatment.
Finally, for excessively deep wrinkles or folds, a facelift may be used. This surgical procedure is expensive and invasive, but, may also produce excellent results.
What is the principal cause of the wrinkles?
Are any treatments effective?
What are the risks and side effects?
If there is improvement, how long will it last?
What is the cost?
What can be done to prevent any further wrinkling?
Does sunscreen help?
Onset of wrinkles and further progression of those already present can be prevented by following these tips:
- Never use a sunlamp or tanning bed or lie in the sun to get a tan.
- Wear a sunscreen on your face and hands every day. Many companies make daily moisturizing creams that also contain sunscreen.
- When exposure to the sun cannot be avoided, wear a wide-brimmed hat, sunglasses, and tightly-woven clothing. The sun can cause damage even on cloudy and winter days, especially between 10 AM and 3 PM.
- About 30 minutes before you go out in the sun, apply a sunscreen with a sun-protection factor (SPF) of at least 15. If you have a fair complexion or sun-sensitive skin, you may need a higher SPF, such as 30 or even 45, especially in a southern climate or at a high altitude. Remember that water, sand, snow, and concrete reflect the sun's rays and increase the likelihood of sunburn. Rub plenty of sunscreen on all exposed skin, paying special attention to the back of the neck, ears, nose, and shoulders.
- Reapply sunscreen after swimming, perspiring heavily, or toweling off.
Harmful effects of the sun build over a lifetime, so protection should begin in early childhood. Although sunscreens are very helpful, they do not protect you completely from the sun's damaging rays.