Skincare 105: Wrinkles

This is the fifth in an ongoing series on caring for your skin.

Even though we grow older every day, it can still come as a shock when wrinkles start to become more prominent. Dr. Zeena Nawas, a dermatologist and assistant professor at Baylor College of Medicine, shares what causes those pesky lines and some ways to treat them at home and at the doctor’s office.

Q: What is the difference between fine lines and wrinkles?

A: Fine wrinkles, or fine lines, are superficial creases in the skin that are less than 1 millimeter in depth and width. Wrinkles are deeper, more than 1 millimeter in depth and width. Over time, fine lines can deepen and become more visible.

Q: How do wrinkles form?

A: They can be caused by a combination of factors. Some occur naturally as a result of genetics and others are caused by lifestyle and environmental factors. The most common factors are:

• Aging: in our 20s, our collagen production decreases by 1% per year. The elastin synthesis decreases in our 30s and this leads to loss of hydration and decreased skin resilience. The fat in the deeper layers of the skin decreases. Also, as we age, our skin is less able to produce oil and to retain moisture. All these factors cause fragile, saggy skin with visible wrinkles.
• Sun damage: excessive exposure to ultraviolet radiation from the sun can result in speeding the natural aging process of the skin, also known as photoaging. This is the main cause of skin damage and early wrinkling. UV radiation promotes the formation of free radicals in the skin, which can damage the collage and elastin fibers.
• Smoking: it can speed the natural aging process as it decreases the collagen production.
• Repeated facial expressions: when we move our facial muscles, creases form. As we age and our skin loses its elasticity, our skin is unable to return to its original form once the muscles relax. Over time, these creases become visibly permanent.

Q: What should people look for in over-the-counter products to prevent and reduce wrinkles?

A: Hands down, broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or more. This will protect from both UV-A and UV-B rays. You need to apply a generous amount and reapply every two hours or sooner if you get your skin wet (like swimming, sweating, etc.).

For “anti-wrinkle” creams, serums, etc., there is limited clinical data to support how effective they are. Since these “cosmeceuticals” are not considered drugs, they don’t undergo rigorous testing and regulation by local regulatory agencies such as the FDA. Some of the common ingredients in OTC “anti-wrinkle” products that may help with photoaging include retinol, which is part of the retinoid family. Others include vitamin C, which is an antioxidant that protects our skin from UV damage. Niacinamide is another potent antioxidant. Also, hydroxy acids (alpha and beta hydroxy acids) are great exfoliants. Peptides can stimulate collagen and improve skin texture and wrinkles.

Q: Which prescription products do you recommend for patients?

A: A topical retinoid is the first-line therapy for photoaging. It increases collagen production and promotes cell turnover. You need to try it out for at least 4 months to appreciate its benefits, and you can use it for life.

Q: What kind of in-office procedures can help diminish the appearance of wrinkles?

A: We have so many amazing procedures that help smooth out wrinkles. Neuromodulators (e.g. Botox) help relax the muscle movements. Chemical peels, laser resurfacing and dermabrasion improve skin texture. Other energy devices (e.g radiofrequency microneedling and ultrasound) can help tighten the skin and improve the skin quality and texture. Fillers are medicines injected in areas that needs lifting and filling. Plastic surgery (e.g. facelift) improves the visible signs of aging in the face and neck

Q: What do you want people to know about wrinkles/aging?

A: We are all going to age and these wrinkles and lines are part of it. Let’s all embrace what we have, and if you choose to enhance what you have then we are here for you. If you choose not to proceed with any topicals and procedures, then go and embrace your maturity and wisdom lines. Just like everything else in medicine, prevention is key. Make sure you take good care of your skin by practicing sun protection, including sun avoidance (UV peak hours tend to be from 10 a.m. to 4 p.m.), use of sunscreens and protective clothing. Also, eating healthy, sleeping well and avoiding smoking and pollution help in preventing photoaging.

Learn more about Baylor Medicine Dermatology’s services.

By Anna Kiappes