Q.   I have a lot of lines on my face from too much sun when I was younger. I recently went to an aesthetician at a local spa who did 4 chemical peels on my face over a four-month period. I really do not see much improvement in the wrinkles. I do not want surgery but is there anything other than surgery that will help smooth my skin? I am almost 50 years old but my skin wrinkles make me look much older.

A. Sun can have a profoundly negative effect on the skin of the face if you do not protect it with a good sunscreen, consistently applied while outdoors. Genetics also plays an important role in how one ages. Since you cannot affect your genetics, at least for now, the only control you have is protection from the sun’s harmful rays. Unfortunately, it sounds like your skin was not given the protection it needed and now you are paying the price. If we only had this wisdom when we were younger, we all could avoid so many of the damaging effects of over exposure to the sun, including skin cancers, brown spots and as in your situation, wrinkles. Wrinkles are not easy to erase, and to be quite honest, it is unlikely that face wrinkles can ever be totally eradicated. If the wrinkles are fine (not deep) like ones around the lower eyelids, they are more amenable to treatment and can be significantly improved in some cases. Coarse or deep wrinkles are much more difficult to successfully treat and the best you can hope is that they are improved and therefore less noticeable.

In my practice, the first step to improving the quality of the skin is to be evaluated by my skin care specialist who will outline a skin care program. Generally, the first step is to begin an at-home program that uses several facial creams. These creams will include tretinoin (Retin-A®) to stimulate collagen, alpha hydroxy acid cleanser to exfoliate the dead outer layer of skin and a skin bleacher to fade any brown spots on the skin surface. After being on this program for several months, you will be reevaluated to see what the next step should be. If the cream program has reached its maximum improvement and the wrinkles are still bothersome, a laser resurfacing procedure can be considered to smooth the wrinkles. We use the fractionated CO2 laser, which is designed to create a controlled injury to the skin which stimulates collagen in the skin, which in turn should decrease the depth of the wrinkles. Most of the wrinkles will still be present but should be less deep and therefore less noticeable. I recommend that you make an appointment with either a board certified dermatologist or plastic surgeon who has an interest in skin rejuvenation and get a personalized evaluation of your situation.

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