Wrinkles

Wrinkles

Draw the Line on Early Lines

Frowning with concentration, you're all business when you put on your makeup. You squint gently as you glide on a touch of eyeshadow. You raise your eyebrows as you stroke on mascara and a sweep of blush. Then you pucker for lipstick. Nice. You reward yourself with a smile in the mirror.

Then it hits you. The frown is still there, along with the squint and the smile lines.

Wrinkles--already? Character is great, and you've always admired women who age with grace, but these lines feel premature--like a message from the future delivered too soon. You're just not ready for wrinkles.

Suddenly, you feel old. And maybe less attractive. You worry that a big smile will show your big wrinkles. You keep your eyes wide open, to erase those crow's-feet.

The Roots of the Ruts

Doctors say that the inevitable wrinkles from genetics and gravity really shouldn't arrive until you near your sixties. But they come a lot earlier--in the late twenties and thirties--for many of us. Here's why.

During the 1920s, French designer Coco Chanel came back from the tropics bronzed and glowing--and the centuries-old tradition of keeping skin in the shade was lost in the glare of the news. Fashion-conscious women everywhere began to bask in the sun. In search of elegant tans, they started a new tradition: of sunburns and tanning booths--and skin cancer and early wrinkles. Even in naturally dark skin, sun damage causes 80 to 90 percent of the visible signs of aging, including wrinkles, doctors say.

The number-two cause of wrinkles is smoking, which speeds your skin's aging by up to ten years. Smoking reduces blood flow to the skin, blunting its ability to repair damage. It also sets off enzymes that attack the tissues of your skin the way meat tenderizer weakens the fibers of meat. And because skin gets a "memory" when it's folded in the same place over and over again, the mechanics of smoking cause wrinkles, too. Constant puckering to draw on a cigarette forms lip creases, and squinting against the smoke carves crow's-feet.

Some lines will form simply because we express emotion--with a ready smile or worried frown. The way you sleep can leave a wrinkle memory in your skin, too, especially if you snooze facedown.

But what can you do if you already have years of wrinkle-promoting habits behind you? Can the damage be undone? Yes, it can. You can prevent most new wrinkles from forming and remove the worst of the old ones with help from your doctor.

A New Wrinkle on Prevention

If you're determined to fight wrinkles, even if it means abandoning bronze for a paler, healthier beauty, here's where to begin.

Put up a chemical parasol. Sunscreen is your number-one weapon against further sun damage, says Albert M. Kligman, M.D., professor of dermatology at the University of Pennsylvania School of Medicine in Philadelphia. Use a full-spectrum sunscreen that blocks both kinds of ultraviolet radiation (UVA and UVB), and use it every day, year-round, Dr. Kligman says. After you cleanse your skin in the morning, leave it slightly damp and apply pea-size dabs of sunscreen on your cheeks and forehead, working it into the skin all over your face. Don't forget the backs of your hands, neck and décolletage.

You need to use a sunscreen of SPF 15 or higher. SPF stands for sun protection factor, and SPF 15, which most doctors recommend, means that you can stay out in the sun 15 times longer than you normally could before burning. Remember, too, that although daily use of SPF 15 sunscreen will protect you adequately while you dash in and out of buildings, for long hours in the outdoors you'll need to use higher-SPF products and reapply frequently.

Doctors disagree on how high to go with SPF numbers, however. Some say that numbers over 25 may give a false sense of security. While higher numbers do screen out the burning UVB rays, they may let in more UVA radiation. The UVA rays penetrate deeper into skin and cause most age-related changes such as wrinkles, says Melvin L. Elson, M.D., medical director of the Dermatology Center in Nashville.

Joseph Bark, M.D., a dermatologist in Lexington, Kentucky, and author of Retin-A and Other Youth Miracles, disagrees. He says research shows that skin will burn somewhat even with SPF 15 sunscreens, and he recommends using the highest SPF you can find, even for everyday use.

And read the sunscreen's contents. "The best of the broad-spectrum sunscreens contain titanium dioxide--fine particles that stay in your skin and resist washing or rubbing off," says Dr. Kligman. An example is Sundown.

Don't rely on cosmetics. Your favorite cosmetic counter may offer foundations and moisturizers that contain low-SPF sunscreens, but these are too weak for real protection, Dr. Kligman says.

Protect your eye area. While you exercise, you don't want sunscreen to sting your eyes when you sweat. Try this workout tip from Dr. Elson. "Take a wax-based sunscreen made for lips and apply it around and over your eyes. It won't run," he says. You should also protect your eyes with a good pair of shades, preferably the wraparound kind. Make sure they shield UV radiation.

Dress for the sun. Innovative clothing manufacturers have come out with basic collections of shirts, swimsuits and casual wear that are specially knit to prevent the sun's radiation from reaching your skin.

Dump that nasty habit. Yeah, yeah, you've been told before that smoking isn't cool anymore. Now you have one more reason to quit.

Feed your face. For general skin health, eat a balanced diet full of fruits, whole grains and vegetables. You may also want to try supplements that have been proven to reduce sun damage to skin, says Karen Burke, M.D., Ph.D., a dermatologist in private practice in New York City. She recommends daily supplements of 100 micrograms of selenium (best taken as l-selenomethionine) plus 400 IU of vitamin E. Use the d-alpha tocopheryl acetate, d-alpha tocopheryl acid succinate or d-alpha tocopherol form of vitamin E--not the "dl tocopherols" form, which is far less active. You should have no side effects from these safe doses, Dr. Burke says. Although research has not been designed specifically to link these nutrients with wrinkle repair, they may help, she adds.

Take your measure in the mirror. Set a small hand mirror beside your telephone for a few days and watch yourself in conversation. You may have a few face-wrinkling habits you're not aware of, such as frowning or squinting while you mull something over. The mirror will help you learn to relax the facial muscles you're working overtime and to reduce expression lines.

No aerobics for your face. Although facial exercises have been touted in many beauty books, most of them actually increase wrinkling, says Dr. Burke. When you grimace or contort your face through exercises, you wind up working the same muscles that caused wrinkles in the first place, she says.

Sleep on your back. "It's the best position for a younger-looking, unlined face," says Gary Monheit, M.D., assistant professor of dermatology at the University of Alabama School of Medicine/University of Alabama in Birmingham. If you've been burrowing into your pillow face-first for years, lying on your back every night with a pillow under your knees may help you to change the habit.

The ABCs of Wrinkle Repair

Now that you're committed to preventing new wrinkles, are you stuck with those you've already acquired? Not at all. There are many new developments in dermatology and plastic surgery that can remove your wrinkles. They range from prescription peeling lotions and creams to surface repairs and surgery.

But remember this: "You can't go out and get an unlimited amount of plastic surgery. Do as little as possible to get the maximum amount of improvement possible," says plastic surgeon Geoffrey Tobias, M.D., of Mount Sinai School of Medicine of the City University of New York. "You're never going to be 21 years old again or take 20 years off your face. But if two or three wrinkles bother you, take care of them. You'll look and feel better."

Consider this.

Smooth them with Retin-A. Tretinoin (Retin-A), derived from vitamin A, has earned its reputation as an excellent wrinkle smoother, particularly for the fine lines caused by years of indulging in the sun. But be warned: Retin-A cream is available only by prescription. The legions of similar-sounding ingredients in many cosmetics and lotions are only that: sound-alikes. See your dermatologist. (For tips on using Retin-A, see chapter 106.)

Try AHA lotions. Your dermatologist has a gentle new approach to wrinkle reduction, says Dr. Elson. Highly concentrated lotions made from alpha hydroxy acids (AHAs), derived from wine, milk, apples, lemons or sugarcane, will gradually peel off the top layers of dead skin. "Over time, they will make crow's-feet and fine wrinkles less visible," says Dr. Elson. Some of the most popular lotions contain glycolic acid from sugarcane, which has small molecules that are easy for skin to absorb. Low-concentration AHAs are also available at your drugstore or cosmetics counter in some cleansers and moisturizers such as Avon's Anew Alpha Hydrox Skin Treatment System and Eucerin Plus Alphahydroxy Moisturing Lotion, but these are less effective than the higher-strength products your dermatologist can provide.

So far, AHAs offer the only real competition for Retin-A's wrinkle-fighting ability. AHA lotions give less dramatic results than Retin-A, but they are also less likely to irritate your skin.

Peel away the lines. Though the name may sound drastic, chemical peeling can be a fairly gentle procedure, says Sorrel S. Resnik, M.D., clinical professor of dermatology and cutaneous surgery at the University of Miami School of Medicine. The dermatologist wipes your face with acetone, a strong cleansing solvent, and then applies acid to your skin with a swab. The skin turns white and stings briefly as the acetone penetrates; then several layers of skin (and fine wrinkles) peel off a day or two later. Many doctors offer a series of three to six light acid peels at intervals of several weeks, for results that are only a little less effective than a medium or deep peel. With the series, you'll have less discomfort and a quicker healing time, usually only a few days. Trichloroacetic acid has a good record for safety and effectiveness, and glycolic acid, which is less penetrating, is also popular.

Very deep peels can be dangerous, says Dr. Resnik, and are usually offered only to people with extremely weathered, leathery skin. The chemical most often used for deep peels is phenol, which may cause cardiac or kidney problems. Phenol must be applied in the operating room because it requires close heart monitoring.

Ask about fillers. Plumping up the skin beneath a wrinkle is an alternative to peeling off wrinkles from the surface, says Dr. Monheit. Dermatologists use several substances as wrinkle fillers, but the best known is cattle-derived collagen. Collagen is a fibrous tissue that forms a supporting network just under the surface of the skin. The doctor injects the collagen into your wrinkle, and a lump appears above the skin surface. When the lump fades (in as little as six hours), the wrinkle will have been smoothed away.

The problems with collagen? It's temporary--results last from 4 to 15 months, Dr. Monheit says. And some people may be allergic to this form of collagen, so the doctor must first perform an allergy test.

If you do prove allergic to cattle collagen, ask about a newer method called autogenous tissue implant, says Dr. Elson. A patch of skin harvested from another part of your body is sent out to a company that processes your own collagen from the skin. The processor then returns to your doctor a syringe filled with the collagen for an injection.

A wrinkle filler called Fibrel may last up to five years, says Dr. Monheit. Fibrel is a gelatin-based material that is mixed with your own blood serum and injected beneath a wrinkle. Your body responds by making its own collagen, which, in turn, fills out the wrinkle. Drawbacks? Fibrel injections hurt more than collagen shots, and the procedure is more time-consuming, Dr. Monheit says.

"The best filler would be something natural from your own body," says Michael Sachs, M.D., a plastic surgeon in private practice in New York City. A technique for wrinkle filling that's still in the experimental stage is called fat transfer, or microlipoinjection. The doctor extracts a tiny amount of fat from another part of your body, such as your belly or buttock, and injects it beneath the wrinkle. There's no danger of an allergic reaction, since this is you being injected into you. However, results are short-lived. Researchers aren't sure why, but the fat cells just don't seem to last long in their new location.

Surgical thread can plump up a wrinkle, too, says Dr. Sachs. "The surgeon places a protein-based thread directly under the wrinkle line, where it stimulates local cells to produce their own collagen. In about six months or so, the thread dissolves, and the remaining collagen will fill out the wrinkle for two to five years." Dr. Sachs developed this procedure. Check with your doctor about its availability.

Scrape them away. A procedure called dermabrasion, which is often used to remove acne scars, can also be very effective on wrinkles around the mouth but not on areas where the skin is very thin, such as around the eyes, Dr. Sachs says. A special instrument called a dermabrader literally sands away the top layer of skin, leaving a scab that will heal within about ten days, he says. A drawback is that dermabrasion often removes pigment from the skin, adds Dr. Resnik. So if you choose this method of wrinkle removal, you'll need to always wear makeup on the treated areas.

When You're Thinking of Surgery

There's a wide range of surgical options for wrinkle removal, says Dr. Tobias. Some surgeries will lift and tighten facial skin, smoothing wrinkles in the process. Other procedures remove wrinkly bags and pouches or fill out wrinkle folds in the skin. Here are two options.

Smooth the eye area. Over the years, eyelids may crease into heavy folds that make you look tired all the time. With a traditional blepharoplasty, or eye-lift operation, a surgeon trims and removes this excess skin for a firmer, younger-looking eye area. Or you may have wrinkly bags above or beneath the eyes that are composed primarily of fat. A new procedure invented by Dr. Sachs, called fat-melting blepharoplasty, can help. A surgeon inserts a heated probe through a tiny incision at the corner of the eye and vaporizes the water content of the fat, which literally melts away the pouches. Recovery times can vary from a few days to a week or more, depending on the procedure used, Dr. Sachs says.

Get rid of gaunt. One of the natural processes of aging is the gradual loss of bone along the jaw and of soft tissue beneath the cheeks. Solid silicone implants can fill out the aging hollows and wrinkle folds that result, says Dr. Tobias. Solid silicone implants have not been associated with the difficulties that have been seen with liquid silicone implants, he adds. Working from incisions within the mouth, a surgeon can insert these forms under cheeks and along the jowl line.