Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- One of the most reliable signs of aged skin is an increase in the number and depth of wrinkles. Other signs include irregular pigmentation, skin thinning, and laxity.
- Many of the changes found in older skin, but not all, are due to the exposure to ultraviolet light.
- Wrinkles can be divided into two functional categories: fine surface lines (caused by ultraviolet light) and deep furrows (caused by muscle contraction). Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques.
- Environmental factors that promote wrinkling include smoking, degree of pigmentation, heredity (some families wrinkle more), and most important, occupational and recreational sun exposure over the course of many years.
- Treatments available for wrinkles include topical medical treatments (such as vitamin A acid, alpha hydroxy acids, antioxidants, and moisturizer) and more invasive procedures (such as glycolic acids peels, deep peels, dermabrasion, laser resurfacing, surgical procedures, and Botox).
Introduction to wrinkles
Although wrinkles can signify wisdom, or at least some level of maturity, there is no question that newly born infants also have wrinkles. The real concern that most of us have is that certain types of wrinkling is associated with aging. Aging in our current "pop" culture is not viewed positively. Generally, the treatment of normal skin aging that does not result in a functional abnormality is termed "cosmetic." And most cosmetic procedures are not covered by health insurance.
Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce "the appearance of fine lines," which means that they don't reduce the lines themselves). Others can achieve a fair amount of success.
Although all of our skin ages, sun exposure dramatically enhances the rate at which this occurs. Changes brought on by sun damage (photoaging) include dryness (really roughness), sagginess, skin growths like keratoses, lentigos ("liver spots"), and wrinkles. Just compare the facial skin of a poorly pigmented farmer to the skin of his buttocks.
Most wrinkles associated with aging appear on the parts of the body where sun exposure is greatest. These sites are the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows that are related to muscular contraction. Some deep furrows are anatomical in nature and have little to do with aging. Generally, it is only the aging wrinkles that really bother people. There are two basic approaches to the amelioration of these signs of aging: prevention and treatment. Topical wrinkle treatments are, in general, much more effective for fine lines. Deeper creases may require more invasive techniques, such injection of fillers, local muscle paralysis, or plastic surgery. There is a special form of wrinkling called "cellulite" that produces a "cottage cheese-like" appearance to the skin. This is most commonly noted in the hips and buttocks of women and is due to fat deposition in certain anatomical areas in the dermis.
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