Wednesday, February 20th, 2019
Wrinkled or crepey facial skin is caused by an interplay of the skin and how it ages, gravity, loss of supporting volume, and action of the underlying muscles. As we age, the skin stops producing both collagen (the substance that gives the skin its thickness and strength) and elastin (the substance that makes the skin elastic). This happens around 30 years of age with collagen only being made after that as part of healing. With both collagen and elastin present, the skin contracts and then, because of its thickness, resists further muscle pull. With the loss of them, the skin does not contract and the muscle pulls the skin further than normal and causes it to pleat. With time, the muscles also hypertrophy and pull even harder and the places where the skin tends to bend become permanent lines. How much the skin crinkles or wrinkles varies due to your genetic predisposition and how you have treated your skin. Smoking, diet and other environmental factors speed the process. There are, however, several things that can be done to improve or reverse this.
If the muscle can be weakened with Botox® or a similar neurotoxin, the process can be slowed. This works best around the eyes and in the forehead where the muscle function is not essential. If started early, it can even slow the creation of wrinkles.
You can also slow the process and even reverse it by adding collagen and elastic tissue to the skin. Collagen can be added by use of tretinoin (Retin-A) or good retinol or by microneedling or similar laser procedures. We prefer tretinoin or retinol regularly as it continually stimulates collagen production, is less invasive and, we think, more reliable. Elastin can be added by use of Obagi’s ELASTIderm®, the only product proven to do this. We generally add these to Basic Skin Care at about 30 years of age when the skin stops producing collagen and elastin without some encouragement.
If the wrinkles are minimal or small, the above options will reverse them, but it takes about a year or so to do so. There are 2 things you can do to improve the wrinkles faster. One is laser resurfacing or a leveling peel that brings the surface of the skin down to the level of the bottom of the wrinkles and stimulates significant collagen production. Both these, however, have a prolonged recovery. The other is to fill the lines or depressions with a filler like Juvederm® Volbella and then crisscross it under the skin to stiffen it. This also helps the tretinoin work since it can increase the body’s use of the hyaluronic acid from the filler to convert it to collagen (something that is now proven to happen). Fillers are also the answer if the wrinkles are due to volume loss as they fill deep, replacing the lost volume, and stretch the skin back, flattening many of the wrinkles. This is especially true with lip wrinkles. The recovery from this is minimal with only a little swelling and, occasionally, some bruising that is easily camouflaged.
To find out more or to determine what is right for you, call 828-526-3783 to make an appointment at our Highlands office.