Treatment of Wrinkles
Risks of Botox Injections
Risks are very minor with this procedure. The main risks consist of headache, pain, and flu-like illness. In rare cases, there may be a drooping lid or eyebrow area.
Since wrinkling does not seem to affect one's general health, the decision of when to visit a physician depends on one's economic situation and one's personal feelings. A reasonable alternative to fixing this external problem is to work on the reason for considering the need in the first place.
Cosmetic procedures
The treatments for wrinkles are cosmetic procedures. Cosmetic procedures are those that do not produce a functional improvement in the patient's condition but they may produce an enhancement in a sense of well-being. They are generally not covered by most insurance plans.
Cosmetic procedures for wrinkles can be grouped into four groups:
Some of these procedures are as simple as the application of a topical cream while others are surgical procedures that require general anesthesia and an operating room environment. The determination of which procedure is best is often difficult and requires an individual with expertise in multiple approaches.
Botox, Dysport, Xeomin, and MyoblocThis is a relatively recent innovative use of a toxin produced by a bacteria, Clostridium botulinum. This protein was responsible for a number of human deaths from eating contaminated, inappropriately canned foods. Patients died because of the loss of muscle control of respiration. Enterprising scientists refined and diluted this material so that it could be injected into spastic muscles and superficial facial muscles producing a paralysis that lasts two or three months at a time. The result was the disappearance for a time of wrinkles induced by these muscles. Currently, there are two brand-name medications that have FDA indications for injection, onabotulinumtoxinA (Botox Cosmetic) and abobotulinumtoxinA (Dysport), that can be injected into the muscles of the face to ameliorate wrinkles by paralysis of the tiny muscles involved. Other brands of this chemical, although not officially indicated for facial injection, may work as well.
They are incobotulinumtoxinA (Xeomin) and rimabotulinumtoxin B (Myobloc). Injections usually have to be repeated at regular intervals to maintain the desired result. Side effects are generally caused by the injection of too much toxin in the wrong anatomical site. Luckily, the effect of the toxin is self-limited. Currently, there is ongoing research into a topical preparation that potentially could be applied to the skin at home.
Fillers and ElevatorsThere are a variety of substances that have been used to elevate the furrows of depressed wrinkles. There are many FDA-approved fillers that include
There are also a variety of unapproved fillers such as silicone and mineral oil, which are potentially dangerous and should be avoided. Which brand of filler to be used on which wrinkle in a particular anatomic site is part of the art of cosmetic dermatology and requires special expertise. Most of these substances require reinjection at various intervals and all have occasional side effects.
Certain vitamin A analogs have been shown to induce the remodeling of the upper dermis by inducing fibroblasts to synthesize new collagen when applied topically over a long period of time. Of these "retinoids," tretinoin (Retin-A, Renova, Atralin, Retin A Micro, Avita) is easily available and has been shown to produce subtle but discernable changes in appearance of fine wrinkles induced by ultraviolet exposure. This outward transformation is accompanied by an alteration in the microscopic appearance of the upper dermis.
Invasive procedures
There are a variety of invasive procedures that can change the appearance of collagen in the dermis which hopefully result in a global cosmetic improvement to the treated skin. These include
As a group, these technologies damage the dermis just enough to induce the scar-forming cells (fibroblasts) to reconfigure the photo-damaged collagen sufficiently to reduce fine wrinkling and yet produce no unsightly scarring. This is a fine line that only those healthcare professionals with sufficient expertise dare tread. No matter who performs such a procedure, the prudent patient ought to seek to confirm the accuracy of any claims with a number of previous patients.
Low-power radio frequency and ultrasound devices
Recently, low-power radio frequency (Polaris WR and Thermage) and ultrasound devices (Ulthera System) have been touted as potentially useful in reducing fine wrinkling. These devices presumably work by producing heating of the collagen sufficiently so there is protein denaturation and shrinking. This so-called "skin tightening" seems to produce some cosmetic benefits. If heating of collagen is a necessary requirement, special care should be taken to ensure no burn injuries occur. The efficacy and safety of these devices remain to be demonstrated.
Microdermabrasion
Microdermabrasion is a technique in which air propels sand particles at the skin. The result is a transient diminution in the degree of fine wrinkling. This technology will not produce significant damage to the skin so collagen remodeling is unlikely. It seems reasonably safe and may work by producing mild temporary swelling (edema) in the treated skin. This procedure must be repeated at regular and frequent intervals to maintain improvement.
The removal of excess, loose skin by surgical means was the original technique used to remove wrinkles. This procedure is generally performed in an operating room under general anesthesia. The result when performed by a master can be quite impressive.
There is very little that can be done to affect intrinsic wrinkling other than attempting to limit normal muscular movement, a suggestion that is obviously ludicrous. One has to accept one's genetic inheritance.
On the other hand, extrinsic aging can be controlled to a great extent by limiting exposure to ultraviolet light and by not smoking. When the skin darkens in response to exposure to light, this is a sign that damage has occurred to the collagen in the deeper layers of the skin. This damage is cumulative so it is never too late to change one's behavior.
The major wavelengths of light responsible for this damage are in the ultraviolet range and have been labeled "A" and "B." Sunlight is the major source of this type of radiation, but tanning parlors have light bulbs that produce wavelengths in this range. Ultimately, there is no such thing as a safe tan!
Sunlight avoidance by wearing appropriate clothing, staying in the shade, and wearing a durable, effective sunscreen over exposed areas is a good strategy.
Any health benefit produced by the synthesis of vitamin D by the skin is overshadowed by the negative aspects of ultraviolet light exposure. Vitamin D requirements can be satisfied by taking almost any commercially available multivitamin (1,000 IU/day).
Since the longer wavelengths of ultraviolet light can penetrate window glass, it might be reasonable for especially compulsive individuals to coat suitable windows with a transparent plastic film that absorbs those wavelengths.
Whichever combination of techniques is used to reduce the appearance of wrinkles, the healthcare professional and their team are the most important variable in obtaining the most desirable result.
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Risks are very minor with this procedure. The main risks consist of headache, pain, and flu-like illness. In rare cases, there may be a drooping lid or eyebrow area.