Skin wrinkles and blemishes
As you age, your skin undergoes progressive changes:
- The cells divide more slowly, and the inner layer of skin starts to thin. The thinning skin becomes vulnerable to injuries and damage.
- The deeper layer of the skin, which provides scaffolding for the surface skin layers, loosens and unravels. Older skin sags and forms furrows.
- The oil-secreting glands shrink, leaving the skin without a protective layer of fat. The skin's ability to stay moisturized then decreases, and it becomes dry and scaly.
- Under new Food and Drug Administration (FDA) labeling rules, UVA protection in sunscreens would be rated on a 1 - 4 star system (4 stars being the highest protection). UVB protection would still carry the SPF rating, but maximum protection would now be rated SPF 50, instead of 30.
- Sunlight is the most important cause of prematurely aging skin (a process called photoaging) and skin cancers.
- Overall, exposure to ultraviolet radiation from sunlight accounts for about 90% of the symptoms of premature skin aging.
- Most of the damage is initiated by age 20.
- Chemical peels, dermabrasion, laser therapy, wrinkle fillers, and Botox injections can be used alone or in combination, depending on the extent of photodamage and skin wrinkles. A qualified doctor can categorize patients to determine treatment option(s).
- Antioxidant ointments, creams, and lotions may help reduce the risk of wrinkles and protect against sun damage.
- Implants, also called injectable fillers, are becoming a popular way to reduce wrinkles and folds.
As you age, your skin undergoes progressive changes:
- The cells divide more slowly, and the inner layer of skin (the dermis) starts to thin. Fat cells beneath the dermis begin to shrink. In addition, the ability of the skin to repair itself decreases with age, so wounds heal more slowly. The thinning skin becomes vulnerable to injuries and damage.
- The deeper layer of the skin, which provides scaffolding for the surface skin layers, loosens and unravels. Skin then loses its elasticity (ability to stretch). When pressed, it no longer springs back into position. Instead, older skin sags and forms furrows.
- The oil-secreting glands atrophy (shrink), leaving the skin without a protective layer of fat. The skin's ability to stay moisturized then decreases, and it becomes dry and scaly.
- Frown lines (between the eyebrows) and crow's feet (lines that spread from the corners of the eyes) appear to develop because of permanent small muscle contractions. Habitual facial expressions also form characteristic lines.
- Gravity makes the situation worse, contributing to the formation of jowls and drooping eyelids. Eyebrows, surprisingly, move up as a person ages, possibly pulled up by forehead wrinkles.
Wrinkles can have a profound impact on self-esteem. The stigma attached to looking old is evidenced by the more than $12 billion Americans spend each year on cosmetic procedures to hide the signs of aging. Our society places a premium on youthfulness, and age discrimination in the workplace, although illegal, has stalled many people's careers. The emotional consequences of aging explain in large part why the cosmetics industry and plastic surgeons thrive.
Ultraviolet Radiation, Sunlight, and Photoaging
Sunlight is the most important cause of prematurely aging skin (a process called photoaging) and skin cancers. Overall, exposure to ultraviolet radiation from sunlight (radiation referred to as UVA or UVB) accounts for about 90% of the symptoms of premature skin aging. Most of the damage is initiated by age 20:
- Even small amounts of UV radiation trigger the processes leading to skin wrinkles.
- Long-term repetitive exposure to sunlight adds up, and likely is responsible for the vast majority of unwanted consequences of aging skin, including basal cell and squamous cell cancers.
- Intense exposure to sunlight in early life is an important cause of melanoma, a particularly aggressive type of skin cancer.
Initial Damaging Effects of Sunlight. Ultraviolet radiation penetrates the layers of the skin. Both UVA and UVB rays cause damage that leads to wrinkles, lower immunity against infection, aging skin disorders, and cancer. UVA and UVB damage cells in different ways.
- UVB is the main cause of sunburns, and it primarily affects the outer skin layers. UVB is most intense at midday when sunlight is brightest. People receive slightly over 70% of their yearly UVB dose during the summer. They receive only 28% during the remainder of the year. Window glass filters out UVB.
- UVA penetrates more deeply and efficiently. The intensity of UVA rays is less dependent on the time of day and season of the year than that of UVB rays. For example, you receive only about half of your yearly UVA dose during the summer months, with the balance spread over the rest of the year. Window glass does NOT filter out UVA.
Both UVA and UVB rays cause damage to the body, including genetic injury, wrinkles, aging skin disorders, and skin cancers. Exactly how they cause this damage is not yet fully understood.
Processes Leading to Wrinkles. As mentioned above, even small amounts of UV radiation trigger the processes that can cause wrinkles:
- Sunlight damages collagen fibers (the major protein that gives structure to the skin). Sunlight also damages elastin, a protein in the skin that normally maintains the springiness and strength of tissue beneath the skin.
- In response to this sun-induced elastin damage, the body produces large amounts of enzymes called metalloproteinases.
- Some of these enzymes degrade (break down) collagen. The result is an uneven formation (matrix) of disorganized collagen fibers called solar scars. Repetition of this abnormal skin rebuilding causes wrinkles.
- An important event in this process is the over-production of oxidants, also called free radicals. Excessive amounts of oxidants damage the body's cells and even alter their genetic material. Oxidation may contribute to wrinkling by activating the specific metalloproteinases that degrade connective tissue.
Other Factors Responsible for Wrinkles
In addition to sunlight, other factors may hasten the formation of wrinkles:
Cigarette Smoke. Smoking produces free radicals, which accelerate wrinkles and aging skin disorders, and increase the risk for non-melanoma skin cancers. Studies also suggest that smoking and subsequent oxidation produce higher levels of metalloproteinases, the enzymes associated with wrinkles.
Air Pollution. Ozone, a common air pollutant, may be a particular problem for the skin, and deplete an important antioxidant, Vitamin E.
This report covers three types of blemishes: Liver spots, purpura, and seborrheic keratoses.
"Liver Spots" (Lentigos)
"Liver spots" (known as lentigos, or sun-induced pigmented lesions) are flat brown spots on the skin. Despite the common name, these blemishes have nothing to do with the liver. Instead, they are almost universal signs of aging. Occurring most noticeably on the hands and face, these blemishes tend to enlarge and darken over time. The extent and severity of the spots are determined by a combination of skin type, sun exposure, and age. These spots are harmless, but they should be distinguished from lentigo maligna, which is an early sign of melanoma.
Liver spots or age spots are a type of skin change associated with aging. The increased pigmentation may be brought on by exposure to sun or other forms of ultraviolet light, or other unknown causes.
Treating Liver Spots. Liver spots do not require treatment, although some people are distressed by their appearance. Treatments may include the following:
- Trichloroacetic acid (a chemical peel).
- Tretinoin (Retin A) alone, or in combination with mequinol (Solage). Tretinoin is related to vitamin A, and is also effective in treating wrinkles.
- Gentle freezing with liquid nitrogen (cryotherapy).
- Laser treatment. Specific lasers, such as the Nd:YAG, are effective in eliminating 80% of liver spots in one treatment. Laser treatment may be more effective than cryotherapy and may have fewer side effects.
- Bleaching creams are commonly available but are not as satisfactory as peels, and high concentrations can sometimes cause permanent loss of skin color.
Purpura occurs when tiny capillaries (blood vessels) break and leak blood into the skin. In older people, the condition (called senile or actinic purpura) is usually caused by fragile blood vessels. The capillaries appear as flat purplish patches. These patches are called petechiae when they are smaller than 3 mm (about a tenth of an inch). When they are greater than 3 mm, they are referred to as ecchymoses. Patients typically have a rash, which may appear reddish at first but gradually changes color, turning brown or purple.
Treatment. Although there is no specific treatment for purpura, patients are advised to avoid trauma, including vigorous rubbing of the skin, which may damage the capillaries. Emollients that soften the skin may be helpful. Some doctors also recommend vitamin C, but its effectiveness is unproven.
Seborrheic keratoses are among the most common skin disorders in older adults. Their cause or causes are unknown. They usually appear on the head, neck, or trunk and can range in size from 0.2 - 3 cm (a little over an inch). They are well defined and appear to be pasted onto the skin, but their appearance can vary widely:
- They can be smooth with tiny, round, pearl-like formations embedded in them.
- They can be rough and warty.
- They can be brown or black.
Seborrheic keratoses sometimes look like melanoma, because they can have an irregular border, but they are always benign. A dermatologist can tell the difference between them, although experts warn that melanomas may "hide" among these benign lesions and go unnoticed without close inspection. In general, seborrheic keratoses have a uniform appearance, whereas melanomas often have a smooth surface that varies in height, color density, and shading. In some cases, keratoses may cause itching or irritation. They can be easily removed with surgery or freezing. Vitamin D3 ointment is also showing promise in clinical trials.
Exposure to Sun in Childhood. It is estimated that 50 - 80% of skin damage occurs in childhood and adolescence from intermittent, intense sun exposure that causes severe sunburns. In spite of this now well-known effect, many people still believe that a tan is a sign of good health in children. Even though many parents are concerned about sun exposure, they still rely too much on sunscreen and not enough on protective clothing.
The Elderly. Most people over 70 have at least one skin disorder, and many have three or four skin disorders. Everyone experiences skin changes as they age, but a long life is not the sole determinant of aging skin. Family history, genetics, and behavioral choices all have a profound impact on the onset of aging-skin symptoms.
Activities Leading to Overexposure to Sunlight and Ultraviolet Radiation
Of all the risk factors for aging skin, exposure to UV radiation from sunlight is by far the most serious. The vast majority of undesirable consequences of aging skin occur in individuals who are repetitively exposed to the sun, including the following:
- Outdoor workers, such as farmers, fishermen, construction workers, and lifeguards
- Outdoor enthusiasts
- People who regularly attend tanning salons or use tanning beds
Experts have devised a classification system for skin phototypes (SPTs) based on the sensitivity to sunlight. It ranges from SPT I (lightest skin plus other factors) to IV (darkest skin). People with skin types I and II are at highest risk for photoaging skin diseases, including cancer. It should be noted, however, that premature aging from sunlight can affect people of all skin shades.
Tanning and Sunburn History
Tanning and Burning History
Always burns, never tans, sensitive to sun exposure
Burns easily, tans minimally
Burns moderately, tans gradually to light brown
Burns minimally, always tans well to moderately brown
Rarely burns, tans profusely to dark
Never burns, deeply pigmented, least sensitive
The common belief is that women are at greater risk for wrinkles than men. Some evidence suggests, however, that given the same risk factors, men and women in the same age groups have comparable risks for skin photoaging. Some studies report that men are more likely than women to develop non-melanoma skin cancers.
The skin of smokers in areas of their bodies not exposed to sunlight also seems to age more rapidly compared to nonsmokers in the same age group. In fact, heavy smokers in their 40s often have facial wrinkles more like those of nonsmokers in their 60s.
Studies of identical twins have found smokers to have thinner skin (in some cases by as much as 40%), more severe wrinkles, and more gray hair than their nonsmoking twins. Cigarette smokers are also more prone to skin cancers, including squamous cell carcinoma and giant basal cell carcinoma. Research has found that women who smoke have much lower levels of vitamin E secretions in their skin. Vitamin E is an antioxidant that may help protect the skin from sun damage. [For more information, see In-Depth Report #41: Smoking.]
The best long-term prevention for overly wrinkled skin is a healthy lifestyle.
Eat Healthy. A diet with plenty of whole grains, fresh fruits and vegetables, and healthy oils (such as olive oil) may protect against oxidative stress in the skin. Benefits from these foods may be due to high levels of antioxidants found in them.
Exercise. Daily exercise keeps blood flowing, which brings oxygen to the skin. Oxygen is an important ingredient for healthy skin.
Avoid tobacco smoke. Smoking not only increases wrinkles, but a smoker's risk for squamous cell cancers is 50% higher than that of a nonsmoker. People should quit smoking to prevent many health problems, not just unhealthy skin. Secondhand smoke is also dangerous.
Daily Preventive Skin Care
The following are some daily measures for skin protection:
- Don't wash your face too often with tap water. (Once a day is enough.) It strips the skin of oil and moisture. Chlorinated water, particularly at high temperatures, poses special risks for wrinkles.
- Wash your face with a mild soap that contains moisturizers. Avoid alkaline soaps, especially with deodorant.
- Pat the skin dry and immediately apply a water-based moisturizer.
- Always apply sunscreen, even if going outdoors for short periods of time. Research has shown that applying a cream containing a UVA and UVB protective sunscreen every day helps prevent sun-related skin damage.
- Avoid drinking alcohol within 3 hours of bedtime. Alcohol increases the risk for leaks in the capillaries, which allows more water in and causes sagging and puffiness. Capillary leakage increases when you lie down.
- Lie on your back when sleeping. This helps offset the effects of gravity.
Avoid Sun Exposure
One of the most important ways to prevent skin damage is to avoid excessive sun exposure. The following are some specific guidelines:
- Use sunscreens that block out both UVA and UVB radiation. However, do not rely only on sunscreen for sun protection. Also wear protective clothing and sunglasses.
- Avoid sun exposure, particularly from 10 a.m. - 4 p.m., when sunlight pours down 80% of its daily UV dose.
- Avoid reflective surfaces, such as water, sand, concrete, and white-painted areas. Clouds and haze are not protective and, in some cases, they may intensify UVB rays.
- Ultraviolet intensity depends on the angle of the sun, not its heat or brightness. The dangers are greater the closer to the start of summer. For example, in the Northern Hemisphere, UV intensity in April (2 months before summer starts) is equal to that in August (2 months after summer begins).
- The higher the altitude, the quicker you will sunburn.
- Avoid sun lamps and tanning beds or salons. They provide mostly high-output UVA rays. Some experts believe that 15 - 30 minutes at a tanning salon is as dangerous as a day spent in the sun. People should not be misled by advertising claims of "safe" tanning or promotions offering unlimited tanning.
Sunscreens. The use of sunscreens is complex, and everyone should understand how and when to use them. The bottom line is that people should always use them in combination with other sun-protective measures, apply generously and reapply every few hours or after swimming or excessive sweating.
Protective Clothing. Wearing sun-protective clothing is extremely important, because it protects even better than sunscreens. Special clothing is now available for blocking UV rays. It is rated using SPF ratings or a system called the UPF (ultraviolet protection factor) index, with 50 UPF being the highest. Protective clothing is expensive, however.
The following are some sun protection tips for everyone:
- Wear a hat with a wide brim. However, even wearing a hat may not fully protect you against skin cancers of the head and neck.
- Look for loosely fitted, unbleached, tightly woven fabrics. The tighter the weave, the more protective the garment.
- Washing clothes over and over improves UPF by drawing fabrics together during shrinkage. An easy way to assess protection is simply to hold the garment up to a window or lamp and see how much light comes through. The less light, the better.
- Everyone over age 1 should wear sunglasses that block both UVA and UVB rays.
Chemical Tanners. Some research suggests that melanin and dihydroxyacetone (DHA), the active ingredients in many self-tanning lotions, may help filter out UVA and UVB radiation and are therefore protective against sun damage. More research is underway.
When choosing a sunscreen, look at the ingredients. Preparations that help block UV radiation are sometimes classified as sunscreens or sunblocks, according to the substances they contain. In general, sunscreens contain organic formulas and sunblocks contain inorganic formulas. However, the term sunblock is used less and less as sunscreens increasingly contain both kinds of ingredients:
Organic formulas contain UV-filtering chemicals such as octocrylene, octyl salicylate, homosalate, and octyl methoxycinnamate (block UVB), avobenzone-Parsol 1789 (blocks UVA), cinoxate, ethylhexyl p-methoxycinnamate (blocks UVB and small amounts of UVA), oxybenzone, and benzophenone-3 (blocks UVA/UVB). Look for a wide-spectrum sunscreen that contains combinations of these ingredients and filters both UVA and UVB light.
Inorganic formulas contain the UV-blocking pigments zinc oxide or titanium dioxide. Zinc and titanium oxides lie on top of the skin and are not absorbed. They prevent nearly all UVA and UVB rays from reaching the skin.
- Older inorganic sunblocks were white, pasty, and unattractive, but current products use so-called microfine oxides, either zinc (Z-Cote) or titanium. They are transparent and nearly as protective as the older types.
- A newer sunscreen, Anthelios SX, prevents sunburn and protects against UVA and UVB rays. The product contains ecamsule, an ingredient not previously marketed in the United States. Research finds that sunscreens containing this ingredient are highly effective at absorbing UVA rays -- the cause of DNA, cell, and tissue damage that lead to skin aging.
- Inexpensive products with the same ingredients work as well as expensive ones. The FDA regulates the specific drugs and maximum approved concentrations in sunscreens, but is currently proposing improved use and label requirements for manufacturers. Under the new labeling rules, UVA protection would be rated on a 1 - 4 star system (4 stars being the highest protection). UVB protection would still carry the SPF rating, but maximum protection would now be rated SPF 50, instead of 30.
Organic formulas and inorganic microfine oxides do not protect against visible light, which is a problem for people who have light-sensitive skin conditions, including actinic prurigo, porphyria, and chronic actinic dermatitis.
Calculating SPF. SPF is a ratio based on the amount of UVB radiation needed to turn sunscreen- or sunblock-treated skin red compared to non-treated skin. For instance, people who sunburn in 5 minutes and who want to stay in the sun for 150 minutes might use an SPF 30 sunscreen. The formula would be: 30 (the SPF number) times 5 (minutes to burn) = 150 minutes in the sun.
SPF Levels by Age Group. Although sunscreens are safe in most toddlers and children, they should not be the first and only lines of defense. All young children should be well-covered with clothing, sunglasses, and hats. Children should be kept out of the sun during peak sunlight periods. Do not use sunscreens on babies younger than 6 months without consulting a doctor.
Older children and adults (even those with darker skin) benefit from using SPFs of 15 and over. Some experts recommend that most people should use SPF 30 or higher on the face and 15 or higher on the body. Adults who burn easily instead of tanning and anyone with risk factors for skin cancer should use SPF 50+.
Timing and Amount of Application. Apply sunscreen or sunblock liberally as follows:
- Adults should wear sunscreen every day, even if going outdoors for only a short time.
- Apply a large amount to all exposed areas, including ears and feet. To get the level of protection indicated by the sunscreen's SPF, experts recommend half a teaspoon each for the head, neck, and each arm and a teaspoon each for the chest area, back, and each leg.
- Apply sunscreen or sunblock 30 minutes before venturing outdoors for best results. This allows time for the sunscreen to be absorbed.
- Also reapply each time after exercise or swimming or at least every 2 hours. Choose a waterproof or water-resistant formula, even if your activities don't include swimming. Waterproof formulas last for about 40 minutes in the water, whereas water-resistant formulas last half as long.
Possible Hazards of Sunscreens, Sun Avoidance, or Both. When used generously and appropriately, sunscreen products and sun avoidance help reduce the severity of many aging skin disorders, including squamous cell cancers. There are certain concerns, however. Although sunscreens help prevent squamous cell carcinomas and other skin disorders, sunscreen use may not protect against basal cell and melanoma cancers, and may even increase the risk of getting them. It is important to note, however, that sunscreens themselves are not harmful. Unfortunately, some people use the wrong products, use them unwisely, or mistakenly fail to avoid direct exposure to sunlight.
The reasons for the possible increased risk of cancer are unclear, though some theories include the following:
- Until recently, many sunscreens blocked UVB rays and not UVA, the more deeply penetrating rays now known to be especially dangerous. Past studies may not have reflected the effects of the broad-spectrum sunscreens now available, which block both UVA and UVB rays.
- People who apply sunscreens may feel safe and stay in the sun longer than is safe during intense UV hours. Even if a person doesn't sunburn, UVA rays can still penetrate the skin and do harm.
- People may not put on enough sunscreen. Most people apply only 20 - 60% of the recommended amount of sunscreen, which can provide significantly less SPF protection than what is on the label.
Sunscreen Use May Increase the Risk for Health Problems Related to Sunlight Deficiencies. There is significant concern that underexposure to sunlight, due to the use of sunscreens or sun-avoidance measures, may produce other health problems, such as the following:
- Vitamin D Deficiency. Vitamin D is found in only a few foods, such as fortified dairy products and fish, but it is produced in the skin in response to UVB sunlight. UVB rays may outshine dietary supplements for building the body's vitamin D reserves. Without an appropriate mix of diet and supplements, vigorous sun protection measures may increase a person's risk for developing vitamin D deficiency. Vitamin D is important for preventing rickets and osteoporosis, and it may reduce the risk of some cancers. People who need to avoid sunlight and whose diet is low in foods that contain vitamin D should check with their doctor about taking supplements. People with darker skin are at higher risk for deficiencies from sun protection than those with whiter skin. Note: vitamin D is toxic in high doses. Most doctors recommend 400 IU a day (for young adults) to 800 - 1000 IU a day (for middle-aged and older adults). Doses up to 2,000 IU a day are considered safe.
The bottom line is that modest "doses" of sunlight may be healthful, but taking vitamin D may provide similar benefits without damaging the skin.
An increasing number of dermatology patients are looking for a way to improve the appearance of their skin. As a result, more and more products have become available to treat skin wrinkles and blemishes. From vitamins and supplements to exfoliants and chemical peels -- the options can be overwhelming. In some cases, more than one approach may be needed.
Antioxidant Creams, Lotions, and Ointments
Antioxidants are substances that neutralize oxygen-free radicals, the unstable particles that can damage cells. Free radicals may also contribute to sun damage and even skin cancers. Exposure to sunlight depletes antioxidants in the skin, but these antioxidants can be replaced.
Antioxidant ointments, creams, and lotions ("topical products") may help reduce the risk of wrinkles and protect against sun damage. Unlike sunscreens, they build up in the skin and are not washed away, so the protection may last longer. Selenium, coenzyme Q10 (CoQ10), and alpha-lipoic acid are types of antioxidants that come in topical form. Evidence of their benefit is limited however, and more studies in humans are needed.
Vitamin A. Vitamin A is important for skin health. UV radiation leads to vitamin A deficiencies in the skin. Topical products containing natural forms of vitamin A (retinol, retinaldehyde) or vitamin A-related products called retinoids (tretinoin, tazarotene) may help repair skin damage due to sunburn and natural aging.
- Tretinoin (Retin-A). Tretinoin (known commercially as Retin-A) is the only topical medication approved for treating photoaging. It is available in prescription form (Avita, Renova, and Differin). This drug produces a rosy glow and reduces fine and large wrinkles, liver spots, and surface roughness. It reduces the signs of aging by stimulating collagen production. Tretinoin also may help prevent more serious effects of ultraviolet radiation. Patients may apply tretinoin to the face, neck, chest, hands, and forearms, and should do so at least twice a week. Noticeable improvement takes 2 - 6 months. Because Retin-A increases a person's sensitivity to the sun, patients should apply just a tiny amount at bedtime and wear sunblock during the day. Patients should also avoid overexposure to the sun. Almost all patients experience redness, scaling, burning, and itching after 2 or 3 days that can last up to 3 months. In women who experience irritation, a daytime moisturizer or low-dose corticosteroid cream, such as 1% hydrocortisone, may help. There is some concern that overuse of high-dose tretinoin may cause excessive skin thinness over time. Studies now suggest that low concentrations (as low as .02%) of tretinoin can produce significant improvements in wrinkles and skin color, with less irritation than higher doses.
- Retinol. Retinol, a natural form of vitamin A, could not, until recently, be used in skin products because it was unstable and easily broken down by UV radiation. Stable preparations are now sold over the counter. In the right concentrations, retinol may be as effective as tretinoin, and studies indicate that it has fewer side effects. Adding antioxidant creams (such as those containing vitamins C or E) may offer added protection against the degradation of retinol. The Food and Drug Administration warns that over-the-counter retinol skin products are unregulated. The amount of active ingredients is unknown, and some preparations may contain almost no retinol.
- Tazarotene. Tazarotene (Tazorac, Zorac, Avage) is a retinoid used for acne and psoriasis. It has now been approved for treating wrinkles, skin discoloration, and blemishes due to photoaging. At high doses, however, it can cause very severe irritation. Redness and peeling may be reduced by administering tretinoin first to get the skin acclimated. More research is needed to determine whether tazarotene produces any long-lasting significant benefits.
Warning: Pregnant women and those who may become pregnant should avoid any vitamin A derivative (a product related to vitamin A). Oral tretinoin is known to cause birth defects. Topical (applied to the skin) tretinoin may also cause birth defects.
Vitamin C. Vitamin C, or ascorbic acid, is a very potent antioxidant. Most studies on the effects of antioxidants on the skin have used this vitamin. In laboratory studies, large amounts of vitamin C reduced skin swelling and protected immune factors from sunlight. Vitamin C may even promote collagen production. Vitamin C by itself is unstable, but products that solve the delivery problem are now available (such as Cellex-C, Avon's Anew Formula C Treatment Capsules, Physician Elite, and others). Currently their benefits are unproven, and more research is needed.
Antioxidants Under Investigation for Skin Care. Other antioxidants are being investigated for their value in skin protection. Most available brands, however, contain very low concentrations of these antioxidants. In addition, the antioxidants are not well absorbed and have only a short-term effect. New delivery techniques, however, may offset some of these problems.
- Vitamin E. Studies suggest that topical vitamin E, particularly alpha tocopherol cream (a form of vitamin E), decreases skin roughness, length of facial lines, and wrinkle depth.
- Niacinamide. This B complex vitamin may have a positive effect on wrinkles and may be beneficial for wrinkles around the eyes.
- There is some evidence that pomegranate and soy extracts may help rejuvenate aging skin.
- Aloe, ginger, grape seed extract, and coral extracts contain antioxidants and are promoted as being healthy for the skin, although evidence of their effects on wrinkles is weak.
Alpha Hydroxy Acid and Home Exfoliation
One of the basic methods for improving skin and eliminating small wrinkles is exfoliation (also called resurfacing), which is the removal of the top layer of skin to allow regrowth of new skin. Methods for exfoliation run from simple scrubs to special creams or intensive peeling treatments, including laser resurfacing. People with darker skin are at higher risk for scarring or discoloration with the more powerful exfoliation methods.
Abrasive Scrubs. Scrub gently with a mildly abrasive material and a soap that contains salicylic acid to remove old skin so that new skin can grow. The motion should be perpendicular to the wrinkles. Use a textured material or cleansing grains with microbeads. Avoid organic materials, such as loofahs or sea sponges, which may harbor bacteria. Also avoid cleansing grains that contain pulverized walnut shells and apricot seeds, which can scratch skin on a microscopic level. Cleansing grains with microbeads don't have sharp edges and remove skin without cutting it. Scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels.
Topical Alpha Hydroxy Acid and Similar Substances. Alpha hydroxy acids (AHA) ease the shedding of dead skin cells and may even stimulate the production of collagen and elastin. Their natural forms are:
- Lactic acid (milk)
- Glycolic acid (sugar cane)
- Malic acid (apples and pears)
- Citric acid (oranges and lemons)
- Tartaric acids (grapes)
Most alpha hydroxy acid products contain glycolic acid. Skin care products are also made from polyhydroxy acids (PHAs) and beta hydroxy acids (BHAs). Research suggests that PHA products may cause less skin irritation than AHA or BHA products.
Acid concentrations in over-the-counter AHA preparations are 2 - 10%. Prescription strength creams contain at least 12% glycolic acid. Glycolic acid peels of 30 - 70% concentration may be administered in a doctor's office at weekly or monthly intervals.
Response to AHA varies, and the treatment is not without risk, particularly in high-concentration products. Side effects from over-the-counter creams, prescription products, and professional AHA peels can include burns, itching, pain, and possibly scarring. Studies also suggest that AHA may increase susceptibility to sun damage, even at concentrations as low as 4%. Such effects can persist up to a week after a person stops using the product. Experts advise that people purchase products with AHA concentrations of 10% or less. Chemical peels of up to 60% are available without a prescription on the Internet, but these concentrations are not recommended, except under a doctor's supervision. If any adverse effects occur, stop using the product immediately. Always avoid sunlight or use proper sun protection when using these products.
Other Skin Treatments
Copper Peptides. Certain copper-containing compounds may protect skin and help repair it. Most studies have been conducted on the copper peptide glycyl-l-histidyl-l-lysine:copper (II) or GHK-Cu. It is currently used in a number of products. Note: copper is a toxic metal. When using products containing copper, buy only those that contain peptides (small protein fragments) that bind to copper.
Topical Fluorouracil. A twice daily application of topical fluorouracil was shown to improve skin appearance. The cream stimulates wound healing similar to laser therapy.
Moisturizers help prevent dryness, bruising, and tearing, however they have no effect on wrinkles by themselves. Moisturizers should be applied while the skin is still damp. These products retain skin moisture in various ways:
- Occlusives, such as petroleum jelly, prevent water from evaporating from the skin.
- Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin generally should use the humectant type.
- More powerful compounds, such as monolaurin (Glylorin), contain mixtures of fatty molecules (lipids), which may help restore the skin's natural barriers against moisture loss and damage.
Most moisturizers contain combinations of these compounds. They usually have other ingredients as well, such as alpha hydroxy acids, sunscreens, collagen, and keratin. Collagen and keratin leave a protein film and temporarily stretch the skin. They range widely in price, and a major consumer organization found little difference in general between the more and less expensive products.
The skin under the eyes is very thin and does not produce much of the protective oils that keep skin soft and supple. Manufacturers market their under-eye gels as being able to reduce puffiness and dark circles. The creams typically work in one of two ways:
- By temporarily constricting blood vessels to prevent the build-up of fluids
- By firming the skin with an invisible film
Never rub the creams under the eyes, as this may cause more wrinkles to form. Instead, apply these products with a light tapping motion to stimulate the skin.
Cosmetics, if properly applied, can be surprisingly effective in camouflaging the signs of aging skin, including wrinkles and age spots. Moreover, they offer additional benefits by retarding water loss and providing a physical barrier to UV radiation. However, as women age, less is more when it comes to cosmetics.
Here are some suggestions for older women:
Moisturizers. Apply moisturizers before foundation. If reddish discoloration is extensive or the skin is sallow, tinted moisturizers may be helpful and can be worn alone or under foundation.
Foundations. Caking on make-up will cause cracks at the wrinkle lines and will only increase the appearance of aging. Try to cover large areas of the face with a moderate-coverage foundation that has a matte or semi-matte finish. Facial powder reflects light and thus minimizes wrinkles, but people with dry skin should avoid it.
Correcting Color. When blemishes are especially prominent, applying color correctors under the foundation can be very effective:
- Green neutralizers mask red lesions.
- Yellow will camouflage dark circles and bruises.
- Mauve (a purplish-pink color) helps neutralize sallow skin or yellowish blemishes.
- A white, pearled base helps minimize wrinkles.
Blushes. Blushes and color washes can help conceal the spidery network of dilated capillaries on the nose and cheeks. Powder blushes are preferred because they blend easily on top of foundation.
Eyes. Powder eye shadows applied on top of a moisturizer are better than cream-based shadows. Light-colored shadow, applied along the upper eyelid crease and above the iris (the colored part of the eye) is best for offsetting the appearance of deep-set eyes. Then apply a slightly deeper shade of the same color to the lower part of the eyelid, and draw it out to the corner.
Lips. A lip-setting cream or facial foundation should be applied before lipstick to help prevent it from bleeding into surrounding wrinkles. Try using a stiff bristle brush instead of a lip pencil. The brush will help keep the lipstick on and prevent it from bleeding. (Some women use the pencil itself for the full lip, which gives color but appears natural.) Some make-up artists recommend cream lipsticks instead of matte.
Herbs and Supplements
The Food and Drug Administration (FDA) does not regulate herbal remedies and dietary supplements. In other words, the manufacturers and distributors of such products do not need FDA approval to sell their products. However, any substance that affects the body's chemistry can, like any drug, produce side effects that may be harmful. There have been numerous reported cases of serious and even deadly side effects from herbal products.
Overexposure to sunlight can damage skin. The following natural remedies may cause extra sensitivity to light (photosensitivity):
- St. John's wort (Hypericum perforatum) is a popular herbal remedy for depression. People who are sensitive to light should not use it.
- Kava (Piper methysticum) is an herb promoted to calm nerves and reduce stress. In addition to photosensitivity, it can cause severe, even fatal, liver damage. Do not take kava.
- Yohimbe (Pausinystalia yohimbe) is promoted to treat erectile dysfunction. Both the herb and the pharmaceutical drug (yohimbine) can cause sensitivity to light. Its use is not recommended.
- Essential oils in many botanical aromatherapy products can trigger photosensitivity. Avoid citrus oils (grapefruit, lemon, lime, and orange) as well as bergamot, cumin, ginger, and angelica root oils.
There are many choices for skin resurfacing (also called exfoliation), and you must consider several different factors when making your choice. Resurfacing can achieve the following:
- Removal of abnormal tissue and rough skin
- Stimulation of new skin growth
- Stimulation of collagen and elastin production
In addition to determining the skill of the surgeon and the safety of the procedure, discuss the desired depth of the resurfacing and the capability of each procedure to reach this depth safely. All resurfacing procedures require a healing period afterward, during which the skin is red and sensitive. The deeper the procedure, the higher the risk for complications, including delayed healing, infection, loss of pigment (skin color), and scarring.
If you make the decision to pursue intensive treatments, consider the following factors, among others, and discuss them with your dermatologist or plastic surgeon:
- The ability of the procedure to safely reduce wrinkles
- The ease and safety record of the procedure
- The skill of the doctor
- The length of recovery
- Possible complications
- How long the benefits will last
A person's age also helps determine the procedure:
- For people in their 30s, a simple chemical peel is sufficient.
- After age 40, people may benefit from collagen or fat implants.
- At age 50 and over, plastic surgeons recommend laser resurfacing and customized treatments for individual needs.
In older individuals, combination procedures may be beneficial. Some examples include the following:
- Laser surgery may be used for deep lines (such as those around the mouth) and chemical peels used over the rest of the face.
- For enhancing the eye by correcting droopy eyelids, bags, and a "sinking" brow, combinations of an eyelift (blepharoplasty), Botox, and laser resurfacing may be used.
Chemical peels, also known as chemosurgery, help restore wrinkled, lightly scarred, or blemished facial skin. Much like chemical paint strippers, chemical peels strip off the top layers of skin, and new, younger-looking skin grows back. The procedure is very effective for the upper lip, but it cannot be performed around the eyes. Partial peels are often done in conjunction with a face-lift. Another treatment includes a combinations of topical antioxidants, such as tretinoin and vitamin C, along with a chemical peel.
The patient's skin type should be categorized as this determines the type of acids and peeling methods used. A dermatologist can use the Fitzpatrick skin typing method to categorize the skin. Options can range from light to medium to deep chemical peels.
- A dermatologist applies chemicals to the skin, including trichloroacetic acid, high concentrations of alpha hydroxy or beta hydroxy acids, or combinations of all three.
- In some cases, tretinoin or alpha hydroxy is applied 4 - 6 weeks before, and starting one day after, the peel. Such treatments can enhance the effects of a peel and reduce the risk of discoloration in people at risk for this complication. Tretinoin is also being tested as a chemical peel.
- A crust or scab generally forms within 24 hours after surgery. You can remove this scab by gently cleansing with soap and water.
- The skin takes 6 - 7 days to heal.
- After the scab disappears, the visible skin is deep red but gradually lightens as it regenerates.
Complications. Complications include white heads, cold sores, infection, scarring, numbness, and permanent discoloration, particularly in people with darker skin. Earlier deep chemical peel solutions were associated with cardiac arrhythmias in some patients, leading to a newer line of combination peels and slower applications with increased ventilation. Refinement of chemical peel techniques are now permitting doctors to reach deeper skin, improvements which make it easier to apply peels to non-facial skin and to individuals with darker skin.
Dermabrasion affects deeper layers of skin than chemical peels, and may be useful for removing disfiguring marks, such as deep acne scars or deep wrinkles. As with chemical peels, it is effective for wrinkles on the upper lip and chin, and cannot be used around the eyes. Some doctors prefer dermabrasion to lasers for skin resurfacing of people with darker skin colors. The Glogau system may be used to categorize the patient's skin.
Standard Dermabrasion. Standard dermabrasion uses a rotating brush that removes the top layers of a person's skin. As with chemical peels, dermabrasion selectively strips away the upper layers of skin, leaving the underlying skin layers exposed. Similar to chemical peels, after the procedure, the treated skin oozes and forms a scab, a reaction that looks and feels uncomfortable, but is only temporary. Postoperative care is similar for both procedures. For full face dermabrasion, a local anesthetic or general anesthesia may be used.
Microdermabrasion. A gentler variation called microdermabrasion uses very tiny crystals to polish the skin and a vacuum technique to remove them. It has largely replaced the older dermabrasion. Results are similar to those of light chemical peels. Patients can have this procedure done on their lunch hour and return to work. Only mild redness occurs after treatment, although for best results five or six repetitive treatments are needed every 1 - 2 weeks. To date, overall patient satisfaction has been very high.
Lasers are the most effective exfoliation tools for eliminating wrinkles. Their unique advantage over other resurfacing methods is their ability to tighten the skin. A successful procedure can make patients look 10 - 20 years younger, and the results can last for up to 10 years.
The procedure is most beneficial for the following areas:
- It is best around the mouth and eyes. Recent evidence suggests lasers may be even better than dermabrasion for the upper lip.
- It is slightly less beneficial for the area around the nose.
When used alone, current laser therapy does not eliminate crow's feet, broken blood vessels, or dark circles under the eyes. Evidence on the effects of lasers on acne scars is incomplete.
Standard laser dermabrasion is too harsh for thinner skin layers, such as on the neck. Newer and gentler laser techniques, however, stimulate collagen without removing skin layers, and may prove useful for necklines.
The Laser Resurfacing Procedure. In general the procedure works in the following way:
- Lasers damage the top skin layers temporarily and promote the natural healing of new skin. Healing usually occurs in 7 - 10 days.
- Laser pulses penetrate the skin quickly, vaporizing water and surface skin without damaging the deeper layers, allowing new top skin to grow.
- The laser delivers enough heat to shorten collagen fibers, restoring some elasticity to the skin.
Choice of Lasers. The laser technology and source of laser beam used depend on the skin type and severity of the condition. These technologies can be combined for different areas of the face and are used to treat a variety of skin conditions:
- Continuous wave (CW) (sometimes referred to as CO2 laser). This laser delivers a constant beam of light. An older laser technology, it is largely being replaced by newer technologies below. CO2 lasers work well for skin resurfacing since the gas is absorbed by the water in skin tissue.
- Quasi-CW. This technology delivers a constant beam of laser with short interruptions.
- Pulsed laser (such as YAG, CO2 pulsed). This technology delivers high energy beams in rapid or slow pulses. A pulsed dye laser uses yellow light, which is easily absorbed by hemoglobin, the molecule that gives blood its red color. This laser is gentler than other alternatives, and is effective for mild wrinkles and for providing a smooth skin texture. It is also used to treat skin blemishes that result from blood vessel abnormalities, such as port-wine stains.
Some surgeons are using combination techniques with more than one laser technology in one session, to achieve different effects. Other treatments, such as dermabrasion, may also be combined with laser treatments.(A laser and dermabrasion combination is called Laserbrasion.) Pretreatment with botulinum (Botox) injections before laser resurfacing, for example, may also significantly improve the treatment of crow's feet.
Post-Procedure Recovery. The procedure itself is relatively painless, but the redness and irritation that occur during the healing process can be severe. Non-ablative laser resurfacing does not have the same severe after-effects as other laser treatments. For 8 - 9 days, the face looks skinned and swollen, and requires continuous moisturizing and gentle washing since infection can erupt during the healing stage. Some doctors suggest that people with very sensitive skin who cannot tolerate the necessary medications and lubricants avoid laser resurfacing. Redness and sensitivity can persist for 1 - 4 months. The patient must stay out of the sun as much as possible during this time, and should always avoid sunbathing and damaging their skin again. Early research suggests that silicone dressings may reduce post-procedure pain and crusting.
Complications. The risk of complications depends in part on the surgeon's experience. Scarring and infections develop in about 1% of procedures. People with a history of herpes simplex may experience flare-ups of fever, facial pain, and flu-like symptoms for 5 or 6 days after the procedure. In addition, people with darker skin may wish to avoid the procedure, because it can cause unpredictable and dramatic lightening of the skin.
Another technique, photodynamic therapy, appears to reduce the signs of aging even better than laser therapy alone. Photodynamic therapy uses a medication (such as 5-aminolevulinic acid) that is activated by laser light.
Other Exfoliation Procedures
Cold Ablation. Cold ablation, called coblation for short, delivers saline (salt water) to the skin, through which a cool electric current is passed. A subsequent reaction heats and vaporizes the top shallow layer of skin. The procedure is very specific and appears to minimize any damage to other areas of the skin.
Radiofrequency Resurfacing. A promising technique uses low radiowave energy to resurface the skin. Preliminary research indicates that this procedure may eventually be as effective as laser surgery in reducing severe wrinkles around the eyes and mouth, with minimal pain and a shorter recovery time.
Intense Pulsed Light. Intense pulsed light (IPL) uses filters to deliver different wavelengths of light to the skin. Doctors use it to treat a number of photoaging skin problems, and it appears to have long-term effects. Typically, four to six treatments are performed over a 4-month period. Each treatment takes 15 - 20 minutes. Unlike laser light, which uses one color wavelength (such as green or red), intense pulsed light starts with a full spectrum of light. It then allows the doctor to selectively block off specific wavelengths, depending on how shallow or deep the procedure goes. IPL machines are less expensive and safer than lasers.
Implants, also called injectable fillers, are becoming a common means of erasing wrinkles and folds. Several materials are being used for deep wrinkles, depressions under the eyes, lip enhancements, and acne scars.
After being banned from the market in 1992, silicone is making a comeback in research settings as a potential permanent wrinkle eraser. Scientists are looking into a new microdroplet technique (the use of very small drops) combined with purified silicone as a way to eliminate any danger. The past problems with silicone occurred when it was mixed with a foreign substance, such as mineral oil, or when it was injected in large doses.
The U.S. Food and Drug Administration (FDA) approved the Juvederm product line in June 2006. Juvederm is an injectable treatment for moderate-to-severe facial wrinkles and folds. Juvederm products are gels made from hyaluronic acid. They are injected into the face. Doctors report good results after a single treatment with Juvederm, and the results last for at least 1 year.
Most implants to date are not completely satisfactory. Collagen implants and biological fillers from animal, bacterial, or human sources may not provide long-lasting benefits. Synthetic fillers are permanent but may cause an allergic reaction, which can lead to chronic problems. Such reactions are rare, but they can be painful and unattractive. Nodules under the skin can form, and may require treatment with medication.
In 2008, the FDA recommended that women be informed of the health risks from cosmetic fillers such as Restylane, Juvederm, Artefill, and Perlane. These risks can include allergic reactions, swelling, pain, blisters, and cysts.
|Name and Material Used||Procedure||Specific Areas Affected||Benefits||Drawbacks|
Collagen implants. Collagen is the protein that forms the structures in the body (such as skin, bones, or cartilage).
The implant procedure has typically used bovine (cow) collagen. A form of human collagen (CosmoDerm, CosmoPlast) has been approved.
Injected into target wrinkles with needle and syringe. Several weeks after injection, cow collagen breaks down and is replaced by newly created human collagen.
Wrinkles around the eyes and mouth. It is used to give lips greater fullness.
Very simple, with faster recovery than many other implant techniques.
Wrinkles form again, and require repeat treatments 3 - 12 months later. Rarely, severe allergic reactions occur. Should not be used by children, pregnant women, and people with a history of autoimmune disease.
Microlipoinjection. Fat tissue from the patient's own thigh or abdomen.
Injected into target wrinkles with needle and syringe.
Deep wrinkles around the nose and mouth, folds in the forehead, and wrinkles on the hands.
No allergic or immune reaction because substance is patient's own fat.
Body eventually absorbs the fat, resulting in a need for multiple injections. Some studies suggest that 70% of the fat may still be in place after at least a year.
Gore-Tex. Highly porous (full of tiny holes) and inert (not chemically active) synthetic material.
Requires some surgery. Tiny patches are inserted under the skin to fill out wrinkles. Skin cells and blood vessels pass through the porous material easily, reducing the risk of severe irritation.
Material does not break down.
Possible scarring from surgical procedure. Allergic reactions are rare but can occur even with chemically inactive materials.
Artecoll. Contains PMMA, or polymethylmethacrylate, an inert substance, enclosed in tiny droplets of natural collagen.
Material is injected. Body absorbs collagen. PMMA remains and stimulates new collagen growth.
Although part of the implant is a natural collagen implant, it does not degrade as quickly as a full collagen implant.
Repeat treatments may still be needed. Possible allergic reaction.
Hyaluronic acid. Natural (non-animal) substance acts like a molecular sponge to absorb water. Treatments include Restylane, Captiva, Hylaform-Plus, Hylaform, and Juvederm.
Gel is injected under the skin.
Low risk for allergic reaction. May last longer than cow collagen. Commonly used.
Repeat treatments needed.
Poly-L-lactic acid. Synthetic polymer. Approved in U.S. as Sculpta and Sculpta Aesthetic. Approved in other countries as New-Fill.
Material is injected under the skin.
Approved in U.S. for patients with skin wrinkles or facial fat loss due to HIV.
Low risk of allergies. Treatment effects can last 18 - 24 months.
Doctors require special training.
Calcium hydroxyapatite (Radiesse/Radiance)
Injected under the skin; promotes collagen ingrowth.
FDA approved for the correction of oral and maxillofacial defects, vocal cord insufficiency and radiographic tissue marking.
Longevity is 2 - 5 years.
Nodule formation under the skin.
The popularity of Botox injections has skyrocketed in the United States. Botulinum, the deadly toxin found in contaminated, partly uncooked foods, is also a powerful muscle-relaxant. Tiny amounts of a purified form (Botox) are injected into wrinkles to relax the surrounding muscles. Botox may help with forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. Botox is also useful for treating involuntary muscle movements that can occur after a face-lift.
The injections need to be repeated every few months because the effects wear off. Recent evidence suggests that repeated use is safe and effective. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. When used for areas around the eyes, it produces a rounder appearance, which patients should be aware of before they undertake the procedure.
The drug does not cross the blood-brain barrier, and, to date, the only side effects reported have been temporary muscle weakness near the injection site. However, the FDA has warned that in rare cases, the toxin can spread beyond the injection site and cause potentially fatal side effects. Most of the adverse reactions involved patients taking Botox for therapeutic, rather than cosmetic reasons.
Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also causes headaches in about 1% of cases. In some cases, the headaches can be very severe and long-lasting (from 8 days to a month). Some researchers suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.
In 2010, nearly 9.5 million cosmetic surgeries were performed in the United States, up 9% from the previous year. Most of these surgeries were breast surgeries and liposuction, followed by eyelid surgery and abdominoplasty ("tummy tuck"). Facial plastic surgeries range from being fairly minimal, such as a brow lift, to a full face-lift.
Several face-lift procedures (called rhytidectomies) are available. Face-lifts can provide a more youthful look. The degree of improvement, however, depends on many factors, including age, bone structure, skin type, and personal habits, such as smoking and sunbathing.
The Procedure. When a face-lift is a relatively simple procedure, it can take about 2 hours under local anesthesia in a doctor's office. Complicated face-lifts are done under general anesthesia in a hospital and can take 3 - 6 hours. The face-lift procedure may be one of the following:
- Superficial musculoaponeurotic system (SMAS) is the most common face-lift procedure. The surgeon makes an incision at the hairline and separates the skin from the underlying tissue and muscles. The muscles are tightened and excess fat and tissue, such as fat under the chin and neck, are removed.
- The endoscopic subperiosteal or subgaleal face-lift is a less invasive surgical technique. The surgeon raises facial structures rather than cutting away flaps of skin. Only a few half-inch incisions are made, and scarring is minimal. Not all individuals are candidates for this procedure, however.
Neither SMAS nor the endoscopic version is effective for the middle part of the face, particularly the deep lines (nasolabial folds) that run down from the nose beside the mouth. Sometime after the SMAS face-lift, the upper face begins to age again while the lower area keeps its shape, causing the face to look unbalanced. Researchers are looking at other approaches, such as one called composite face-lift, that lift most muscles in the face.
Recovery Process. Recovery normally lasts from several weeks to several months. Swelling and discoloration are common. Some patients report tingling or numbing sensations after surgery. These sensations generally decrease as damaged nerves regenerate.
Complications. A face-lift is not without risks. A postsurgical hematoma is a collection of blood that can occur after a face-lift. Hematomas generally develop within 2 weeks of the surgery and require draining. Even minor hematomas need fast treatment to prevent greater complications. Such complications can include infection, changes in skin color, fluid buildup, and prolonged recovery time.
Other, less common complications may include the following:
- Excessive bleeding
- Imbalanced facial muscles
- Delayed healing
- Permanent injury to the nerves that control facial movements
These complications are rare, particularly with a skilled surgeon, but the more complex the face-lift, the greater the risk.
Procedures for the Eyes
Blepharoplasty. Blepharoplasty is the primary surgical procedure for eye lifts. Results usually last 5 - 10 years. Although simple, blepharoplasty has potential complications, including permanent difficulty closing the eyes or making a stern expression. Newer techniques, however, are preventing this complication. Assuming the surgeon is experienced, laser surgery is now preferred over the standard surgical scalpel approach. Laser surgery reduces bleeding and bruising, and both the operation and recovery are faster. Temporary blurred or double vision is common. More serious complications include infection, bleeding, dry eyes, difficulty closing the eyes, and pulling down of the lower lids. Rare cases of blindness have been reported. Laser therapy or chemical peel techniques are sometimes done after the procedure for remaining wrinkles around the eyes.
Transconjunctival Upper Blepharoplasty. An innovative procedure called transconjunctival upper blepharoplasty removes fat from the membrane that lines the eyelids (the conjunctiva) and is an effective technique for treating both the upper and lower eyelids. Unlike traditional blepharoplasty, this procedure does not cause scarring in the nasal area. Transconjunctival removal of fat can also make existing scars from previous surgeries less obvious. The long-term side effects and effectiveness of this procedure have not been studied.
Procedures for the Neck
Laser Liposculpture and Platysma Resurfacing. A procedure called laser neck and jowl liposculpture and platysma resurfacing may prove to be an alternative to face-lifts. The procedure uses a one-inch incision under the chin, through which excess fat is removed. After the fat is removed, the surgeon tightens the platysma, the thin muscular sheet under the skin of the neck, which improves the shape of the neck. Only a local anesthetic is needed, and the patient can return to normal activities in 2 days. The patient's skin should be elastic enough to be able to reform without sagging.
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Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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