Q. I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth?

A. It is difficult to completely eradicate fine lines on the face, but there are certainly some non-surgical options that will improve the skin. First and foremost, start protecting your skin against further damage with regular application of a good broad spectrum higher SPF (above 35) sunscreen. This one step in your daily skin care regimen is the most important thing that you can do, both to reduce additional premature aging and to protect your skin against skin cancer, which is epidemic in the South. The next thing you can do is incorporate a few topical creams in your skin care routine that will begin to slow the aging process. A good medically directed skin care program can make a significant improvement in skin quality. The skin care program that I recommend in most cases of sun damaged skin includes a regimen of several key products, including Tretinoin (Retin-A®) which stimulates new collagen that can reduce existing fine lines and slow the onset of new ones. In addition, a mild exfoliant is employed to remove the outer layer of dull, dead skin which can help restore a healthier glow to your complexion. Finally, if you have brown spots on your face, hydroquinone cream, which is a prescription medication, will significantly fade these brown spots. There are, of course, other topical applications that can be added that will improve the skin even more. You should seek an individual evaluation by a licensed medical aesthetician, dermatologist or plastic surgeon in order to design a skin care program that maximizes the chance of improving your skin. 

Once you have reached maximum improvement with the topical skin creams, if the wrinkles have not improved to your satisfaction, the next step to consider is either a chemical peel or laser skin resurfacing. Chemical peels range in strength from very mild to very deep. In my practice, we use the medium depth peels for mild skin aging issues and employ the laser for more damaged skin. The laser can be set to deliver different levels of energy to customize the treatment based on one’s skin type (oily, dry, fair complexion, dark complexion, etc.) and the degree of your skin damage. The fractionated CO2 laser is our go-to device for resurfacing facial skin and restoring a healthier, smoother appearance in cases of more advanced aging or more severe sun damage. The laser treatment can be performed under oral sedation and a local anesthetic to the face. The recovery ranges from 1-2 weeks depending on the severity of skin damage. If laser treatment is deemed necessary, the procedure is typically performed by a plastic surgeon or dermatologist.