What Causes Wrinkles and The Best Way to Rejuvenate the Face

As we age, our skin develops wrinkles, hollows, and age spots. Some people also lose volume in their cheeks and develop jowls. These signs of aging are the result of four processes I call the four “D’s” of aging: damage, dynamic muscle movement, deflation, and drooping.

Damage refers to damage of the skin caused by ultraviolet radiation from sun exposure or tanning bed use. Over time, ultraviolet radiation leads to the appearance of dark spots (sometimes called age or liver spots); dilated facial blood vessels on the nose, chin, and cheeks; and roughness and coarsening of the skin. In the worst case scenario, sun exposure and tanning leads to skin cancer including melanoma, a potentially deadly form of cancer.

Fractional CO2 Laser Before
Fractional CO2 Laser After

A variety of approaches can reverse the signs of damage. A good topical regimen should be your first line of defense. Of utmost importance is the daily use of sunscreen. Choose a sunscreen of SPF 30 or higher that contains zinc oxide in its list of active ingredients. Many other creams can also reduce the signs of damage including those containing tretinoin (Retin-A), vitamin C, bleaching agents, and glycolic acid. These can be used in combination with sunscreen to create an optimal daily skin care routine.

Chemical peels reverse the signs of damage by exfoliating the outermost layers of skin to both remove damaged skin cells and reduce the barrier for medications to work more effectively. Peels can be varied in depth depending on the type of chemical used, and peeling can last anywhere from 1 – 7 days depending on the depth.

Photodynamic therapy is a newer, sophisticated approach used to reverse signs of damage. In this procedure, a medicine called ALA (aminolevulinic acid) is applied to the skin. The damaged cells of the skin preferentially absorb this medicine over non-damaged cells. When activated using a laser or special light source, ALA selectively kills the damaged skin cells and leaves the good ones behind. The result is smoother, healthier skin. Incidentally, photodynamic therapy also effectively treats acne.

The last way to reverse signs of ultraviolet damage is with laser therapy. Lasers selectively target dilated facial blood vessels and discolored spots, and stimulate collagen production. Lasers are selectively absorbed by facial blood vessels, background redness, and dark spots causing these targets to heat up and disappear. Lasers also induce collagen production to restore the health of the dermis (the second layer of skin which becomes thinner as we age). Not all lasers are the same, and a true understanding of laser physics is essential for the best result. Many dermatologists receive a thorough education in laser physics and science during their training.

Dynamic Muscle Movement
Dynamic muscle movement refers to wrinkle formation caused by movement of the muscles of facial expression. Muscles that often cause wrinkling are those of the frown, forehead, and crow’s feet areas. Movement of muscles in these areas often causes bunching and wrinkling of the overlying skin. Eventually wrinkles can become etched into the skin. It’s kind of like the old saying, “If you don’t stop making that expression, your face will freeze in that position.” Maybe mom was right!

Botox softens muscle movement. By placing a few drops strategically into the muscles that cause wrinkling, Botox reduces wrinkles and gives a more relaxed appearance.

As we age, our face looses volume. To illustrate this point, think of a baby’s face. It’s round and full. Now imagine the face of a very old man. It’s thin and gaunt.

Many studies have shown that as we age, we lose both fat and bone in our face. Volume loss leads to hollows under our eyes, fine wrinkling of the cheeks, and prominence of the smile lines. To combat volume loss, several fillers are available.

Sculptra is used to add volume to large areas of the face and to provide overall filling. Sculptra stimulates the dermis (the second layer of skin) to thicken, and by doing so, softens hollows and lines.

Unlike Sculptra which provides an overall fill, Juvederm, Restylane, and Radiesse fill localized hollows and depressions. The smile lines, marionette lines, lips and lip lines, and hollows under the eyes and cheeks respond well to Juvederm, Restylane, and Radiesse.

The last of our four “D’s” is drooping. In addition to losing volume as we age, tissue begins to sag. Part of sagging results from volume loss and drooping of excess tissue, and may be corrected by replacing lost volume. Excess skin and tissue that cannot be corrected by volume restoration and by stimulating collagen formation, however, may need to be lifted.

Several techniques for lifting tissue exist. Traditionally, face lifts have been used. Now, there are less invasive alternatives including laser and Thermage radiofrequency tissue tightening.

Laser and radiofrequency tissue tightening refers to the process of collagen tightening induced by devices such as Thermage, Titan, Accent, and other intense pulsed light and laser sources. These procedures can produce modest improvement and have little to no downtime.

Lastly, excess tissue that collects under the neck can often be easily removed by liposuction. Liposuction of the neck is performed in the office and can provide excellent results.

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