ASK DR. BARBER
BY WILLIAM BYRON BARBER II, M.D.
Q. Can you tell me what the latest options are on non-surgical wrinkle reduction? I have fine lines around my mouth, my cheeks and under my eyes. I am only 50 and definitely do not want to have a face lift. I have tried pretty much every cream in the department stores and on the infomercials and my wrinkles are still in the mirror. Please tell me there are some good options.
A. You have posed one of the most common questions I get in my practice; how do I get rid of the fine lines on my face? These wrinkles often first appear in your 40’s and continue from that point on. Just to set your mind at ease, a face lift is almost never the answer for fine lines on the face. Unless there is also sagginess of the face, like in the jowl area, a lift does not do much for wrinkles. When you are young and you smile, cheek lines appear, and when you are not smiling, they disappear. That is because young skin has lots of collagen and elastin which makes your skin firm and wrinkle resistant. Unfortunately, after the age of about 40 collagen and elastin begin to decrease in our skin and we lose firmness and turgor. This causes those previously disappearing lines to be memorized in the skin and eventually they become permanent. The age of onset of wrinkling is different in everyone, and genetics play a crucial role in their appearance. Other more controllable factors in skin aging include sun exposure and smoking, both of which accelerate the onset of wrinkles.
Let’s get to your question. Step one: see a plastic surgeon or a dermatologist and begin a medically managed skin care program with the goal of stimulating new collagen growth. This often will include using tretinoin (Retin-A®) plus a mild acid exfoliator, and a skin bleacher to fade brown spots. After establishing this routine, your doctor will reevaluate your skin to gauge improvement. If additional wrinkle reduction is desired, you will have the option of laser resurfacing of the skin to maximally stimulate new collagen formation, which if successful, will lead to additional softening of the wrinkles and tightening the skin. Laser resurfacing is performed with some oral sedation to make the procedure tolerable and requires about a week recovery time. It takes several weeks for the redness to diminish but you can wear makeup after about a week. Complications include prolonged redness, scaring (very rare), and inability to improve the wrinkles to your satisfaction. It is not likely that all the wrinkles will go away, but the laser will smooth and tighten the skin of the face. See a board-certified plastic surgeon or dermatologist who has an interest in skin care and lasers to get an individual evaluation.