There are several medical (topical medicines and creams) and many invasive techniques available for ameliorating wrinkles. They are all effective to the degree that 1) they change the nature of aging collagen, 2) they stretch the skin, 3) fill in the depressions in the skin, or 4) they paralyze muscles that cause the skin to crease. They include both medical and surgical methods:

1. Medical treatments

  • Vitamin A Acid: This ingredient, available by prescription, has the longest track record of success in treating aging skin and fine lines. Creams containing tretinoin must be used on an ongoing basis. They may produce redness and peeling at first, but discomfort can usually be minimized by lowering the cream's concentration or applying it less often until the skin gets used to it.
  • Alpha-hydroxy acids: These so-called "fruit acids" include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. They produce only subtle improvement though.
  • Antioxidants: These include preparations that contain the vitamins A, C, and E, as well as beta-carotene.
  • Ordinary moisturizers: Creams that don't contain any of the above substances can only make wrinkles look temporarily less prominent.

2. Cosmetic procedures

  • Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.
  • Deeper peels: do a better job of smoothing fine lines. However, the greater the risk of side effects, such as long-lasting pigment changes and scarring.
  • Microdermabrasion: This refers to "sanding the skin" with a machine containing silica or aluminum crystals. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother.
  • Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color.
  • Laser resurfacing: physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the peel reaches the middle of the dermis, the skin's second layer. This helps stimulate the body's natural collagen synthesis, which plumps up sagging skin and wrinkles. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring.
  • Plastic surgical procedures: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
  • Botox: Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the "frown lines" on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe; the muscle poison does not spread through the body to do damage elsewhere.
  • Fillers: Fillers are injected into the skin to increase volume and flatten wrinkles and folds. For a long time, the most popular filler was collagen, whose effect only lasts a few months.



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