Wrinkles, character lines, wisdom lines; societies noted them as a mark of an elder. Yet in today’s society, youthfulness is revered and whole industries have been spawned to eliminate wrinkles. So lets look at what a wrinkle is, how they have been combated over time, and what the latest and greatest treatments are today. The skin basically consists of two layers, the outer layer called the epidermis, and the inner layer called the dermis. The epidermis itself contains five layers and these layers grow from inside out. This means the deepest layers move up from the deepest layer to the surface, eventually flatten out and die, and are shed. The epidermis functions as the barrier to the outside environment. As it ages, it tends to get thicker with a duller appearance. The dermis is the foundation of the skin. It contains several components that produce the elasticity or stretch-ability of the skin: collagen, elastin, glycosaminoglycans (Gags), and reticular fibers. The hair follicles, sweat and sebaceous glands, nerves and blood vessels are located in the dermis. As we age and as a result of environmental factors, the dermis loses its volume and the quantity of its structural fibers are decreased. These include collagen fibers, elastin fibers, as well as the quantity of Gags. Certain environmental stimuli have especially deleterious effects. These include excess sun exposure and tobacco smoke. The end result of this aging process is that the epidermis thickens and the dermis thins, so the skin literally falls in on itself producing a crevice. Thus the wrinkle is born. The skin also loses its elasticity so it does not snap back as much. Over the years, a variety of treatment protocols have been designed to eliminate wrinkling. These include dermabrasion, chemical peels, laser resurfacing, and microneedling. The key to rejuvenating the skin is to increase the quantity of elastic fibers in the dermis and to make it thicker. In order to do this, one needs to produce a controlled injury to the skin that promotes healing and the production of increased collagen. Unfortunately, technology has not yet produced treatments that increase elastin or Gags. Experience has taught us that the deeper and more significant the injury, the greater the healing response and the more successful the treatment. Therefore, treatments such as microdermabrasion that only remove a layer of the epidermis, produce no long lasting effects on the skin. They do make the skin appear nicer because they are removing the thicker, flaking, dead outer layer. Dermabrasion is mostly considered an old, imprecise, technology. Chemical peels are still useful but most consider the gold standard to be laser resurfacing. There are many different types of lasers that have been used, including CO2, erbium, and fractionated versions. Some purport to increase healing time however; the key is the amount and depth of penetration. Quicker healing lasers do not penetrate as deeply or their density of penetration is less. With less penetration, there is significantly less injury and thus significantly less final result. Deeper penetration and increased density of laser injury produces a greater controlled effect and significantly greater wrinkle resolution. The key to any successful treatment is for the patient to understand what they want, what you are willing to accept, and if the treatment will work for you. Hopefully, this will help expand your knowledge of wrinkle treatment.
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