Wrinkle Treatments

There are so many anti-aging promises, find out which treatments are right for you.

Botox: Know the Facts

We may love our expression lines because they speak of our experiences, but let's face it, they can make us look tired when we're not. And they can make us look older than we feel.
More and more people are having their deep lines injected with Botox to wipe them away. But do results stand up to the hype? Apparently so. In 1997, about 65,000 Botox procedures were done; in 2001 1.6 million were performed. To determine if it's something you'd like to try, check out the facts we uncovered with help from Dr. Bruce Katz, Director of the Juva Skin & Laser Center:

What is Botox? "To be precise, it's a purified protein derived from clostridium botulinum bacteria," says Dr. Katz. "When injected into a muscle, it acts as a nerve impulse blocker; in other words, it keeps muscles from contracting, which makes them appear relaxed or smooth." He says this temporary paralysis literally freezes the expression muscles so that, depending on how much is injected, your ability to move your muscle will temporarily disappear along with your wrinkles.

Who can benefit most from these injections? "Botox works best for what are known as dynamic wrinkles, those that appear when you frown, smile or laugh," says Dr. Katz. Some doctors even inject it into neck muscles to tighten folds and some say they have good results with injections into lip lines.

Are the results permanent? "No. They last from 3 to 6 months and the procedure must be repeated to maintain results." Costs can range from $300 to $700 per treatment depending on how many injections you have.

How long does the procedure take and does it hurt? "Injections take a few minutes each. If a topical anesthetic cream is applied to the area prior to the procedure, the area becomes numb and there is no pain. Otherwise, patients just feel a needle prick." Additionally, injections can cause redness and swelling at the injection site and possibly bruise the area. Dr. Katz advises his patients to stay vertical for several hours after being injected so the Botox doesn't travel. In rare cases, Botox injections too close to the eyelid muscles can cause the eye area to temporarily droop.

How soon will I see results? Results take from 3 to 5 days to appear.

Skin Rejuvenation Techniques

Cosmetic products can go only so far in improving the appearance of wrinkles, acne scars, uneven pigmentation, broken blood vessels and age spots. Anyone seeking more dramatic improvements will have to look to other remedies -- some performed by aestheticians, but most by dermatologists and plastic surgeons.  
 
Today there's a wide choice of facial rejuvenation techniques, making it possible to tailor therapies to the exact needs of the client. A variety of methods are used to remove the topmost layers of the skin (epidermis) to reveal clear, unblemished skin below. These methods are called exfoliation or skin resurfacing. Newer techniques penetrate to the layers beneath (the dermis) to boost collagen production, which gives the skin a fresher, plumper, more youthful appearance. The medical term for these techniques is nonablative, which simply means that they work without destroying tissue. "Doctors often combine procedures so patients can get the maximum benefits from each," reports Tina S. Alster, M.D., a dermatologic surgeon in Washington , D.C. 

the Right Peel vs. Laser Treatment

"Anyone considering a skin treatment has to be realistic about the problem she has and the degree of improvement she hopes for," says plastic surgeon Helen S. Colen, M.D. "Certain procedures offer only superficial results and simply do not last long; to maintain results, repeated treatments are needed. At the same time, some of the most effective procedures are also the most aggressive, involving pain or considerable discomfort, periods of downtime (during which the patient is not presentable enough to appear in public), and expense. In the end, the procedure(s) an individual selects will depend not only on the skin problem she is seeking to correct, but also on how much discomfort she is prepared to tolerate and how much time and money she is willing to invest. Any course of action that goes beyond superficial 'freshening up' should be undertaken thoughtfully, in consultation with a doctor, who can explain each process, its risks and recovery time." 

Phenol Peels

What it is: The strongest chemical peel, this method uses carbolic acid for deep exfoliation. It is almost never used because it is so deep, mild sedation with a local anesthetic is usually given and there are many risks. New skin forms in one to three weeks and goes from red to pink and then to normal over six to eight weeks. A full-face peel takes one to two hours; smaller areas may take only 10 to 15 minutes. 

Costs: $1,500 to $3,000 for a full-face peel
Good for: deeper wrinkles and scars, sun-damaged skin
Reality check: While skin is eventually smoother and tighter, the procedure involves discomfort (the face is swollen and the skin is red and uncomfortable for about two weeks) and downtime (most patients will not be presentable enough to go out in public until about two weeks after the procedure). Other problems may include scarring, permanent skin lightening and differences in pigmentation between the peeled and unpeeled areas. It is not recommended for people with dark skin.

Nonablative Procedures

Among the newest skin-rejuvenating treatments are those that do not destroy outer tissue as they work their way down to stimulate collagen growth in the dermis. The two such noninvasive procedures now in use deliver controlled energy to the skin in slightly different ways. For both, the process is gradual and the softening of wrinkles occurs over time. They also spare patients long recoveries and downtime. Increasingly, doctors are starting to combine these nonablative procedures with chemical peels, microdermabrasion and even laser resurfacing.

Glycolic Acid Peel

What it is: The shallowest exfoliating technique, glycolic acid is a mild chemical solution used to remove dead surface cells on the top layer of the skin. (Doctors use a higher concentration of acid; milder preparations are used in skincare salons and given to patients to use at home.) Often referred to as "lunchtime peels," these treatments can be performed in about 10 to 15 minutes. Upon application, patients feel a slight stinging, which subsides after a few minutes. Any redness disappears by the end of the same day. Glycolic peels can be repeated as needed. 

Costs: $75 to $200 per peel
Good for: smoothing rough, dry and sun-damaged skin, giving it a brighter appearance and fresher texture; also for fine lines and age spots on face and hands
Reality check: Results are temporary and treatments must be repeated as needed. This procedure is for superficial skin problems only.
 
PhotoFacial

What it is: This 30-minute proedure, performed by trained medical professionals, uses a machine which emits intense pulses of light that penetrate to all levels of the skin, causing collagen and blood vessels under the top layer to constrict. The regimen calls for a series of five full-face light treatments at three-week intervals. Minor discomfort, described as similar to the feeling of a rubber band snapping against the skin, may be felt during treatment. A topical cream can be applied prior to the treatment to eliminate most discomfort. Redness following the treatment lasts less than 24 hours for most people (in rare cases, no longer than three days). Facial swelling for three to five days occasionally occurs in persons with severely sun-damaged skin. Visible reduction of fine lines and wrinkles occurs gradually, over the next few weeks after treatment.

Costs: $1,500 to $2,000 for the series of treatments

Good for: fine lines, particularly around the eyes and mouth, shallow acne scars, age spots, broken blood vessels, rosacea and sun damage. This procedure is thought to reduce large pores and dark circles around the eyes and is especially effective in subduing chronic facial redness. It also can be used to treat sun damage and weathered areas on the neck, arms and chest, as well as the back of hands.
Reality check: The biggest advantage is no downtime (the skin may be a bit pink for a few hours after the treatment). However, the procedure will not get rid of deeper wrinkles or frown lines, especially on the forehead and between the brows, "icepick" acne scars and other deep scars.

TCA Peel

What it is: A TCA peel uses trichloroacetic acids (which are stronger than glycolic acids and penetrate deeper into the skin) to destroy and remove outer layers of the skin. Because they penetrate into the dermis, these peels are thought to reconstitute the lower collagen and elastin layers of the skin. During the 10-to-15-minute procedure, the patient feels a burning sensation. There is moderate discomfort and swelling of the treated areas for about a week, and minimal scabbing which lasts for a few days. Healing and toughening of the new skin takes place for a few weeks following a TCA peel, but most patients look presentable enough to return to their normal activities after about a week. 

Costs: $1,500 to $3,000 for a full-face treatment

Good for: early wrinkling, mild scarring and age spots on the face and hands; also to counteract moderate sun damage, uneven pigmentation and weathered skin
Reality check: While new skin is noticeably fresher and smoother following a TCA peel, anyone considering this procedure must be prepared for some discomfort and a week or more of "hibernation." As with any strong acid or laser peel there's a risk of scarring and destroying the pigment, leaving the treated skin white, if the procedure is improperly performed.

CO2 Laser Treatment

What it is: The CO2 used to be the preferred machine for laser resurfacing and is still the most aggressive (and effective) treatment for severely aged or scarred skin. A qualified physician must perform this procedure, either in an outpatient setting under local anesthesia, or for more extensive procedures, in a hospital with general anesthesia. It can take from minutes to more than an hour.

Costs: $2,000 to $5,000 for full-face resurfacing, less for partial face treatment

Good for: removing lines and scars on the entire face or just in specific areas; especially effective in treating the area around the eyes and mouth (crow's feet and laugh lines), the cheeks and the fine vertical lines above the lip; also works well for getting rid of scars from moderate to severe acne, age spots, severe sun damage and irregular pigmentation, and for tightening the skin

Reality check: Postoperative recovery takes about 10 days, during which time the patient's skin is swollen, raw and oozing, with crusts forming and eventually falling off; the skin rebuilds itself from the bottom up. Pain, similar to that of a severe sunburn, is felt for several days. Immediate recovery time (during which a patient would not want to appear in public) can be as long as two weeks and the treated skin can remain bright pink for three to six months. Complete recovery can take up to a year. Because of the risk of abnormal pigmentation, it is not recommended for darker skin.

CoolTouch® Laser Treatment

What it is: Also referred to as cool laser or thermescent laser treatment, this special kind of machine shoots out a cooling agent to lower the temperature of (and thus protect) the epidermis, so that it is not burned by the beam directed to the collagen -producing layer below. The treatment can be performed on any facial area and takes only 15 to 30 minutes. It usually requires three to six treatments every two to four weeks; patients often start to see a tightening of the skin as well as a reduction of fine wrinkles and small scars after the third treatment. The minimal reddening of the skin usually fades in a few hours.

Costs: $250 to $500 per treatment

Good for: diminishing acne scars, especially on the cheeks, and fine lines around the mouth, upper lip and eyes.

Reality check: This is a gentle procedure that produces gradual, rather than dramatic, results. Patients are spared the prolonged redness and healing time that follows many skin resurfacing techniques. While it's not effective for brown spots or uneven pigmentation, this procedure does work on all pigmentation and skin types.

Dermabrasion

What it is: Dermabrasion is a deep mechanical peel, using a high-speed rotating sanding wheel or wire brush to peel away the skin and penetrating far deeper than microdermabrasion. In addition to sedation, a freezing spray is used. After treatment, the patient feels tenderness and the sensation of having severe sunburn, with oozing and scabbing for up to a week, until a new upper skin layer forms. Redness may be pronounced and can last several weeks or months, but can be covered up with post-operative cosmetics. 

Costs: several hundred dollars to $2,000, depending on the extent of the area treated

Good for: severe acne and other scars, wrinkles, sun damage and skin discoloration

Reality check: There's discomfort and downtime, which may last a few weeks, and residual redness, which may remain even longer

Laser Resurfacing

Laser resurfacing works by directing a precise and intense beam of laser light back and forth over areas of skin to be treated. Each pass of the light vaporizes the upper layers of damaged skin and causes the skin to contract. This results in tightening the collagen and elastic fibers of the dermis, producing a new skin layer that is tighter, firmer and more youthful looking.

There are two types of lasers: CO2 and erbium. Doctors often combine the two on different areas of the face. The results of laser resurfacing are long lasting.

Microdermabrasion

What it is: Microdermabrasion (also known as particle resurfacing and by other names, including Power Peels, Derma Peels and Parisian Peels) is a relatively new skin polishing technique, performed both by aestheticians in spas and salons as well as by technicians in dermatologists' and plastic surgeons' offices. The operator uses a handheld device that blasts fine particles of sandlike crystals (aluminum oxide or table salt) against the client's skin and vacuums away the used crystals, dirt and dead surface skin. Microdermabrasion is also called a "lunchtime peel," because it takes only 20 to 30 minutes for a full-face treatment. (The procedure also can be used on the neck and chest.) The patient can then return to work with only mild skin redness, which can be covered up right away with makeup. The redness will fade on its own after an hour or two. This procedure is not painful (patients feel a slight tingling as it is being done), requires no anesthesia and will not adversely lighten or darken African American skin, as some exfoliating treatments do. The treatment leaves the skin with a healthy glow. To achieve optimal benefits, five to 10 treatments, every seven to 10 days, are needed; most patients see improvement after the fourth or fifth session. After the initial series, periodic maintenance treatments (from once a month to once every three months, as needed) are often recommended.

Costs: $75 to $200 per treatment. Some places offer package deals, offering patients one free treatment if they sign up for a package offer.

Good for: smoothing away roughness and fine lines, improving leathery, sun-damaged skin and irregular, blotchy pigmentation and minimizing broken capillaries and age spots; also effective for cleaning out blackheads and whiteheads. Along with other doctors, David H. McDaniel, M.D., assistant professor of dermatology and plastic surgery at Eastern Virginia Medical School in Virginia Beach , Va. , has found that with repeated microdermabrasion treatments, collagen production below the skin's surface is increased.

Reality check: Microdermabrasion exfoliates skin faster and more efficiently than any salon facial or products used at home, and penetrates the skin more deeply than a glycolic acid peel. But it is still a superficial approach to skin resurfacing and, according to Michael S. Bumagin, M.D., a Fort Worth plastic surgeon, has to be repeated periodically. It won't help prominent acne scars, including "icepick" scars, other deep facial indentations, severe wrinkles around the mouth or furrows in the forehead; even fine wrinkles and scars may not disappear completely. "Nor is microdermabrasion indicated to erase crow's feet," cautions Dr. Bumagin, "because the crystals can cause eye irritation if blasted too close to the eyes and delicate eyelid skin can be damaged by the machine's suction."

the Erbium Laser

What it is: The erbium is similar to the CO2 in the way it works (vaporizing outer layers of skin and effecting some skin contraction underneath) but it resurfaces with less heat, so healing takes place in about a week, with most redness fading in one to two weeks. At one month, patients have little or no redness. The long-pulsed erbium laser is thought to be more effective (but is also more invasive) than the short-pulsed erbium.

Costs: $2,000 to $5,000 for full-face resurfacing, less for partial face treatment

Good for: wrinkles, acne scars, sun damage, and irregular pigmentation
Reality check: In general, the erbium is gentler, with fewer side effects and a shorter postoperative recuperation (one week instead of two), but it does not produce as much tightening of the skin and does not give the same dramatic results as the CO2. Still, it is becoming the machine of choice for many doctors, including New York City plastic surgeon Helen S. Colen, M.D. "With the erbium, we can get significant enough improvement without as much trauma to the patient and fewer post-op complications," she explains.

Target Products

Fran Wilson Anti-Wrinkle Facial Serum Nutra-Lift One Step Anti-Wrinkle and Skin Therapy