The key to treating wrinkles is to know what causes them and what products can help you fight them. To learn more, visit askderm.com to find the right products for you! Now available at http://www.askderm.com.

1. How to
Effectively
Treat Wrinkles

2. What Are They?
• Wrinkles are a natural part of aging, but
they're most prominent on sun-exposed skin,
such as the face, neck, hands and forearms.
• Wrinkles come in two categories:
1. fine surface lines
2. deep furrows
Wrinkle treatments are in general much more
effective for fine lines. Deeper creases may require
more aggressive techniques, such injection of fillers
or plastic surgery.

3. What Causes Wrinkles?
• Wrinkles are caused by a combination of
factors, resulting in the reduction of the
protein that helps support the skin (collagen)
and subsequent loss of elasticity in the skin.
Although genetics are the most important
determinant of skin structure and texture, sun
exposure is the major contributor to wrinkles.
Environmental exposure, such as to heat, wind
and dust, as well as smoking, also may
contribute to wrinkling.

4. Causes Cont’d
• Age. As you get older, your skin naturally becomes less
elastic and more fragile. Decreased production of natural
oils makes your skin drier and appears more wrinkled. Fat
in the deeper layers of your skin, which gives the skin a
plump appearance, starts to diminish. This causes loose,
saggy skin and more-pronounced lines and crevices.
• Exposure to ultraviolet (UV) light. Ultraviolet radiation
markedly speeds up the natural aging process and is the
primary cause of early wrinkling. Exposure to UV light
breaks down your skin's connective tissue — collagen and
elastin fibers, which lie in the deeper layer of skin (dermis).
Without the supportive connective tissue, your skin loses
its strength and flexibility. As a result, skin begins to sag and
wrinkle prematurely.

5. Causes Cont’d
• Smoking. Smoking can accelerate the normal aging process of your
skin, contributing to wrinkles. This may be due to changes in the
blood supply to your skin.
• Repeated facial expressions. Facial movements and expressions,
such as squinting or smiling, lead to fine lines and wrinkles. They
are called dynamic wrinkles. Each time you use a facial muscle, a
groove forms beneath the surface of the skin. And as skin ages, it
loses its flexibility and is no longer able to spring back in place.
These grooves then become permanent features on your face.
• Gender. Women tend to develop more wrinkles around their
mouths (perioral) than men do. That may be because women have
fewer sweat glands and glands that secrete an oily matter known as
sebum (sebaceous glands) to lubricate the skin and fewer blood
vessels in this area.
• Poor nutrition. Nutritional deficiencies are believed to contribute to
skin aging.

6. Signs and Symptoms
• The classification of wrinkles, also known as rhytids, is based on
how deep into the skin the wrinkles extend. They could be fine
surface lines and deep furrows.
• Fine wrinkles or fine lines: Are the result of changes in the upper
dermis and may appear "etched" in the skin. They are superficial
and are often located around the eyes, secondary to the
contraction of facial muscles during smiling. Are also called
“expression lines”. (Fig. 1)
• Deep wrinkles: Some wrinkles can become deep crevices or
furrows and may be especially noticeable around the eyes, mouth
and neck. (Fig. 2)

7. Treatment
• Today we have more options than ever to help eliminate or at least
diminish the appearance of wrinkles. Medications, skin-resurfacing
techniques, fillers, injectables and surgery top the list of effective wrinkle
treatments.
• Non-prescription topical products: The effectiveness of anti-wrinkle
products depends in part on the active ingredient or ingredients. Retinol,
alpha hydroxy acids, poly-hydroxy acids, copper peptides and antioxidants
may improve the appearance of fine lines, wrinkles and the overall tone
and texture of skin. Newer products containing active ingredients such as
adult stem cells have also been shown to be effective at stimulating
collagen and enhancing skin tone.
• Topical Retinoids: Prescription retinoids, derived from vitamin A (e.g.
tretinoin, tazarotene) may be able to reduce fine wrinkles, splotchy
pigmentation and skin roughness and must be used with a skin care
program that includes daily broad-spectrum sunscreen application and
protective clothing because the medication can make your skin burn more
easily. It may also cause redness, dryness, itching, and a burning or tingling
sensation.

8. Treatment
• Cosmetic procedures:
• Chemical Peels: Can be performed with different type
of acid and can be superficial, medium or deep. With
superficial peels, only a portion of the epidermis (outer
layer of the skin) is removed. After a series of peels less
fine wrinkling and a fading of brown spots may be
noticed. With medium-depth peels, the entire
epidermis and a small portion of the dermis are
removed. New skin forms to take its place. The new
skin is usually smoother and less wrinkled than the old
skin. Redness lasts up to several weeks. Deep peels are
rarely performed due to the long recovery time.

9. Treatment
• Microdermabrasion: This refers to "sanding the skin" with a machine
containing silica, aluminum crystals or diamond tips. Microdermabrasion
does not change skin anatomy, though it may make the face feel
smoother.
• Laser, light source and radiofrequency treatments. In ablative (wounding)
laser resurfacing, a laser beam destroys the epidermis and heats the
underlying skin (dermis), which stimulates the growth of new collagen
fibers. As the wound heals, new skin forms that's smoother and tighter. It
can take up to several months to fully heal from ablative laser resurfacing.
Newer developments in laser technology, such as non-ablative fractional
resurfacing, in which the laser divides the light up into many smaller
pulses, have decreased the healing time. Non-ablative lasers are less
intense, so they don't injure the epidermis. These treatments heat the
dermis and cause new collagen and elastin formation. After several
treatments, skin feels firmer and appears refreshed. Non-ablative laser
treatment typically needs to be repeated more often and results are
subtle. There's also a device that uses radiofrequency instead of light to
heat the dermis and underlying tissue to achieve mildly to moderately
tighter skin.

10. Treatment
• Botulinum toxin type A. When injected in small doses into
specific muscles, botulinum toxin blocks the chemical
signals that cause muscles to contract. When the muscles
can't tighten, the skin flattens and appears smoother and
less wrinkled. Botox works well on frown lines between the
eyebrows and across the forehead, and crow's-feet at the
corners of the eyes. Results typically last about four to five
months. Repeat injections are needed to maintain results.
• Soft tissue fillers. Soft tissue fillers, which include fat,
collagen, hyaluronic acid, calcium hydroxylapatite, poly-L-
lactic acid can be injected into mid and deep dermis or
below to improve deep wrinkles. They plump and smooth
out wrinkles and furrows and give more volume to the skin.
Temporary swelling, redness and bruising in the treated
area may be present. The procedure may need to be
repeated every few months.

11. Treatment
• Combination of treatments: Best results are achieved
with the combination of treatments to improve skin
texture, restore volume and produce a scaffold to the
skin. These include a good home skin care regimen,
resurfacing with chemical peels or laser treatments,
botulinum toxin and medium to deep fillers.
• Face-lift. The face-lift procedure involves removing
excess skin and fat in the lower face and neck and
tightening the underlying muscle and connective
tissue. The results typically last five to 10 years. Healing
times can be lengthy after a face-lift. Bruising and
swelling are usually evident for several weeks after
surgery.

12. Where to get help?
• http://www.askderm.com/skin-care
• http://www.askderm.com/skin-
care?skin_concern=278
• http://www.askderm.com/lifecell-all-in-one-
anti-aging-treatment
• http://www.askderm.com/dcl-balancing-
cleanser-anti-aging-system
• http://www.askderm.com/cellex-c-hydra-5-b-
complex