Wrinkle treatments

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who are having cosmetic treatment for fine lines and wrinkles, or who would like information about it.

Wrinkles are folds or creases in the skin. There are many wrinkle treatments available and only the most common are discussed here.

About wrinkles

As you get older, your facial muscles slacken and your skin becomes less elastic, creating folds and lines called wrinkles. Wrinkles are often found where your facial muscles move. Examples include facial expression lines and wrinkles such as frown lines, forehead lines and squint lines at the corners of your eyes (crow's feet).

Causes of wrinkles

Wrinkles are part of the natural ageing process. However, environmental factors such as ultraviolet (UV) radiation from the sun and smoking can dry your skin and make wrinkles appear at a younger age.

Sun damage

Wrinkles usually appear on areas that are most exposed to the sun, such as your face, neck, backs of your hands and upper arms. This is because UV radiation from the sun damages the DNA in your skin cells causing your skin to age. Some sunlight is important because your skin uses it to produce vitamin D, which helps to build and maintain strong bones. But too much sun is harmful and people who spend a lot of time in the sun, particularly without protecting their skin, may develop fine lines and wrinkles at an earlier age.

Smoking

Cigarette smoke affects your skin in several ways. It dries your skin out and it constricts your blood vessels. This reduces the supply of oxygen and vital nutrients to your skin. Research suggests that smoking may also cause an increase in the production of an enzyme that breaks down collagen - the part of your skin that keeps it looking firm. As a result, people who smoke are more likely to have facial wrinkles at a younger age. Puckering up your lips when you smoke also causes lines to form around your mouth and eyes.

Other causes

An unhealthy diet, stress and drinking too much alcohol may also cause wrinkles to appear at a younger age.

Treatment of wrinkles

Protecting your skin from UV radiation, not smoking, looking after your health and taking good care of your skin may help to delay the appearance of wrinkles. But eventually the natural ageing process, plus the effects of environmental factors, will lead to unwanted facial lines and wrinkles.

Wrinkle treatments can help reduce the appearance of wrinkles, making your skin look smoother and more youthful. Some of the most common wrinkle treatments are discussed here.

Skin creams and gels

There are many creams that claim to reduce the appearance of wrinkles but most haven't been scientifically proven to work.

Fine wrinkles and some of the milder signs of ageing skin may be improved with over-the-counter or prescribed skin creams and gels containing retinoids (a form of vitamin A). These have proven to be effective. The creams help tighten your skin so that fine lines are less visible. However, these do have side-effects such as irritating your skin and making it more prone to burning in the sun.

Chemical peels

Chemical peels containing glycolic acid or lactic acid aim to improve and smooth the texture of the skin on your face. They remove the damaged outer layers of your skin, and may help reduce fine lines and wrinkles.

Laser facial resurfacing

Laser facial resurfacing is very effective at reducing mild scarring, or the effects of sun damage, including wrinkles.

A laser (a beam of high-energy light) is used to remove the outer layers of the skin on your face and stimulate the growth of new collagen fibres. As the area heals, new skin forms that is softer and less wrinkled or scarred.

Botulinum toxin injections

Lines and wrinkles are often found where your facial muscles move. Facial expression lines and wrinkles such as frown lines, forehead lines and squint lines at the corners of the eyes (known as crow's feet) can be reduced with botulinum toxin injections.

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. The protein is injected into specific facial muscles. It relaxes your muscles, reducing their effect on lines and wrinkles. Untreated areas of your face continue to move as normal and you will be able to laugh, smile and frown, but with less wrinkling of your skin in the treated areas.

Botulinum toxin injections will gradually take effect within seven to 10 days and the full results of the treatment will show after around two to three weeks. The treatment usually lasts three to four months. You will need to have repeat injections if you want to maintain the effects.

Botulinum toxin injections aren't recommended for pregnant or breastfeeding women or for people who have neurological disorders such as myasthenia gravis.

Dermal filler injections

Dermal fillers plump up your skin, making it appear fuller and smoother. Dermal fillers are often used to reduce and smooth nose to lip lines, lip to chin lines, lines and wrinkles around your lips, and to enhance your lip shape. There are a range of dermal fillers available. They can be permanent or temporary. Your clinician will usually recommend using non-permanent dermal filler made from a tissue-friendly gel that closely resembles a naturally occurring acid in the body. He or she will inject the dermal filler into the affected area with a tiny needle.

The effect of treatment with non-permanent dermal fillers can last from four to nine months, depending on the area you have treated. You will need to have repeat treatments if you want the effects to last.

Cosmetic surgery

Cosmetic surgery can help to reduce deep wrinkles and sagging skin. Facelift surgery involves lifting up your facial skin and tissues and/or the underlying muscle, to make your face tighter and smoother. The operation can be done on your whole face (a full facelift) or on your brow area (brow lift), lower face or neck only.

The effects of a facelift last for about seven to 10 years. The best results are achieved if you maintain a stable body weight, have skin with good levels of elasticity, and have a strong bone structure. In older people, or people who spend a lot of time in the sun, the results don't last as long.

Deciding on treatment for wrinkles

It's important not to rush into a decision to have cosmetic treatment. It's sensible to discuss your options with a clinician who is suitably qualified. Before deciding to have treatment, discuss what you're hoping to gain from the treatment and the result you can realistically expect with your clinician. It's important to note that:

• botulinum toxin injections won't improve deep wrinkles caused by ageing and sun damage
• dermal fillers can't correct sagging skin
• laser facial resurfacing can cause changes in your skin pigment (colour), so the treatment may not be suitable if you have a darker complexion
• cosmetic surgery is only a suitable option if you want to remove sagging skin, extra fat and deep wrinkles

There are many different places, such as clinics and beauty therapists, offering wrinkle treatments. However, many of the treatments available aren't regulated, so you need to do your homework. Find out as much as you can about any treatment you're thinking of having and what kind of training and experience the person who will give the treatment has. Speak to your GP, who may be able to recommend a suitably qualified cosmetic surgeon or a health professional trained in facial aesthetic treatments. It's important to remember the following.

• Botulinum toxin injections are prescription-only and must be prescribed by a doctor, dentist or a nurse.
• Clinics offering laser treatment have to be registered with the Healthcare Commission. Always ask for proof of registration before you have any treatment.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.