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Botox gets a lot of attention for its ability to smooth forehead lines, crow’s feet, and the creases that start to form at the sides of the nose as we age. But though Botox is one option when you’re considering wrinkle removers, it’s far from the only possibility out there—and may not even be the best fit for you and your skin. Here’s what you need to know about all the options at your disposal.
- Wrinkles start to form in our late 20s or early 30s as the underlying structure of our skin starts to break down.
- Lifestyle, genetics, and environmental factors all contribute to wrinkles, but roughly 80% of facial aging is due to sun damage.
- Wrinkle creams with retinoids, niacinamide, peptides, and vitamin C have all been proven to effectively combat the appearance of wrinkles.
- Improving the appearance of deeper creases may require stronger treatments or invasive medical procedures.
Essentially, wrinkles are just deeper fine lines. Wrinkles form when the skin creases—generally as a natural part of forming a facial expression—and has trouble returning to its original shape. This inability of your skin to bounce back like it did when you were younger is a natural part of the aging process. Although many things contribute to the formation of wrinkles, from lifestyle habits to genetics, the biggest external factor is photodamage from sun exposure (Avci, 2013).
Thankfully, most of us don’t have to worry about these pesky lines until our late 20s or early 30s. As we age, the underlying structure of our skin starts to break down. Under the top layer of our skin, known as the epidermis, is another layer called the dermis, which contains fibers made of collagen and elastin that are responsible for giving our skin its firmness and elasticity by supporting the epidermis above.
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Unfortunately, elastin and collagen fibers degrade as we age. That means the dermis can no longer give the kind of support to the surface of your skin that it once did, resulting in the formation of fine lines.
But that’s not the only way our skin ages that forms or increases the appearance of wrinkles. The dermis is also home to glycosaminoglycans, or GAGs. These molecules act as natural moisturizers by pulling water into the cells, which can also give your skin volume and firmness.
The problem is, GAGs can’t do this job effectively in photodamaged skin. As we age, our epidermis also loses hyaluronic acid, another natural substance made by our bodies that holds onto water in order to keep tissues hydrated (Ganceviciene, 2012). Together, these two processes contribute to dry skin as we age, which can make wrinkles appear more prominent than they might in hydrated skin.
How to get rid of wrinkles
With that many contributors to creases on our faces, how is anyone supposed to prevent or get rid of their crow’s feet? Luckily, there is a wide range of products from face anti-wrinkle creams to eye creams that boast powerful active ingredients backed by research. Dermatologists have also developed procedures to counter those pesky lines. Here’s what you need to know about each to figure out what might be right for you and your skin type.
Wrinkle creams, anti-aging creams, and other topical skincare products designed to target creases in the skin are a great first line of attack. Although deeper-set wrinkles may require a combination of skincare products and dermatological treatments (more on those in a second), consistent application of these products may help prevent future lines or deepening of current creases, according to Cosmetic Dermatologist Dr. Michele Green. It’s best to look for products that contain the following ingredients:
- Retinoids: Retinoids are a class of synthetic or naturally occurring substances products related to retinol, which is also known as vitamin A. Derivatives of vitamin A, such as tretinoin and retinoic acid, are also frequently used in the clinical treatment of various skin conditions. that are made from vitamin A, like retinol, or derived from it, like tretinoin and retinoic acid. Retinoids increase skin cell turnover, or how quickly your body makes new layers and sheds old ones. That means using these products regularly can help reveal younger-looking skin below. But they also boost your skin cells’ ability to replenish their collagen, supporting that structure that keeps skin plump and smooth (Mukherjee, 2006).
- Vitamin C: Vitamin C is a natural antioxidant. That means it’s great for combatting free radicals, which are substances that can cause all kinds of damage in our bodies, including skin aging and wrinkle formation. Topical vitamin C has been shown to significantly decrease the appearance of fine lines (Traikovich, 1999), improve photodamage (including lessening deep furrows in the skin) (Humbert, 2003), and boost the production of collagen (Nusgens, 2001).
- Hydroxy acids: This is a group of chemicals that includes alpha-hydroxy acids (AHAs) and beta hydroxy acids (BHAs) such as glycolic acid and lactic acid. Though they’re used in some chemical peels done by dermatologists to improve skin texture, they’re also available in over-the-counter skincare products at typical concentrations of 5-10%. Past research has shown that higher-concentration hydroxy acids can smooth wrinkles, increase skin cell turnover, restore hydration, and boost collagen synthesis (Moghimipour, 2012).
- Peptides: These compounds are essentially the building blocks of the elastin and collagen fibers that give your skin structure. One study done on human skin samples found that topical application of peptides successfully boosted collagen production. Researchers also believe that these peptides are integral for maintaining the dermal-epidermal junction (DEJ), the area where the epidermis meets the dermis, which is critical both for providing structure and allowing nutrients to reach the skin. Breakdowns in the DEJ have previously been shown to cause sagging, decreased wound healing, and dry skin (Jeong, 2020).
- Niacinamide: This form of vitamin B3 has anti-aging properties when applied topically. Fine lines and wrinkles were diminished in one study that aimed to confirm some of the benefits of niacinamide found by previous clinical trials. The participants applied topical 5% niacinamide to half of their faces for 12 weeks in order to compare treated skin to non-treated skin (Bissett, 2004). Even better? Niacinamide is commonly used as an acne treatment and may help prevent blemishes like blackheads that can be caused by excess oil.
- Hyaluronic acid: As we mentioned, this common skincare ingredient is naturally produced by the body and keeps skin moisturized. But as we age, our epidermis produces less of this hydrating compound, which is one of the factors leading to age-related dry skin (Ganceviciene, 2012). The good news is, it’s widely available in over-the-counter topical skincare products and is generally suitable for and tolerated by a wide range of skin types, Dr. Green says.
Which topical wrinkle treatment is right for you? Consider which skin concerns bother you the most and opt for creams or lotions that address these issues specifically. A dermatologist can also help you craft a skincare routine that fits your unique needs. Side effects should also be considered, however, especially if you’re debating between a product (such as a retinoid) that comes in an over-the-counter version and prescription strength.
Prescription treatments may cause more side effects since the concentration of their active ingredients may be higher. But you can also weigh the cost. Although over-the-counter products may use a lower concentration of an active ingredient and, therefore, may offer less dramatic results, it may be worth the time tradeoff based on how much money you’ll save compared to prescription medications.
If you’re looking for more dramatic results or have deeper-set wrinkles, dermatological procedures may be the way to go. Some of these treatments require very little downtime—neuromodulators, for example, like Botox, can be done over your lunch break—whereas others, like a facelift, require hospitalization and significant recovery time. These are the options that have been proven effective at treating wrinkles:
- Lasers: There is a wide range of laser surfacing treatments available, but the biggest difference is how harsh they are on the skin and the downtime they require for recovery. Non-fractionated lasers have been shown to counter photodamage and improve the skin’s appearance by helping the body reconstruct some of the supportive structures, such as collagen fibers, in the dermis. Dr. Green explains that these are better treatments to see all-over results since they work on large areas of skin. The problem is that these lasers come with longer downtimes (roughly four weeks) and an increased risk of side effects such as discoloration and scarring. Fractionated lasers limit the downtime and the risk of side effects while providing the same benefits. Both types of lasers create controlled stress that triggers the wound healing response, prompting the body to resurface the damaged area (Ganceviciene, 2012). Fractionated lasers are used for the treatment of problem areas, Dr. Green explains, adding that there’s no downtime with this targeted therapy.
- Neuromodulators: You likely know this treatment as Botox or botulinum toxin, though it’s far from the only neuromodulator on the market. These injections act on the nerves in the facial muscles, effectively freezing them and smoothing wrinkles in the process. Botox, in particular, has been shown to be effective on frown lines, crow’s feet, horizontal forehead creases, and wrinkles around the mouth (Satriyasa, 2019).
- Microneedling: This treatment is essentially exactly what it sounds like: A dermatologist uses needles to create thousands of pricks in the skin during this procedure, which may or may not be accompanied by the application of serums designed to address specific skin concerns. Research has found that microneedling effectively boosts the production of elastin and collagen fibers as well as the blood vessels leading to these supportive skin structures. The result is firmer, younger-looking skin after six microneedling sessions done at two-week intervals. But you may see even better results if your dermatologist uses tretinoin, a retinoid, or vitamin C serum during the procedures (Singh, 2016).
- Microdermabrasion: You can think of this as the professional-grade version of your at-home exfoliation. When your body creates new epidermal (skin) cells, they’re added as the bottom-most layer of your skin and slowly work their way toward the surface as the dead cells on the top are shed (Zasada, 2019). In order to reveal younger, tighter-looking skin, a dermatologist will remove the topmost layers of old and dead skin cells through abrasion or exfoliation. One small study that had participants undergo microdermabrasion sessions once a week for six weeks and showed that fine lines were improved by week three and further diminished by week six (Spencer, 2006). But further research has found that more than just the top layer of skin is affected by this treatment. Microdermabrasion causes an increase in collagen fiber density in the lower layers of skin, which may improve the suppleness of the skin and smooth the look of fine lines and wrinkles (Shah, 2020).
- Surgical options: There are several surgical procedures available to smooth wrinkles, including brow and facelifts. Different areas of the face are involved in each procedure, but they both involve manipulating the tissue and removing excess skin. There are several methods for both of these treatments, some less invasive than others.
- Acid peels: There are three different types of chemical peels: superficial peels, medium-depth peels, and deep peels. They each use the same active ingredients but at different concentrations in order to remove different amounts of the top layers of skin. Deep peels have been shown to increase collagen fibers, water, and GAGs in the dermis, though researchers aren’t quite sure how exactly they work (Ganceviciene, 2012). Restoring some of these structural elements of the skin may help decrease the appearance of wrinkles.
Ways to prevent wrinkles
Since the biggest external contributor to skin aging is sun damage, limiting sun exposure and wearing sunscreen with an SPF of at least 30 on exposed skin when going outside can make a big difference. Maintaining the structural integrity of the collagen and elastin fibers may go a long way toward preventing wrinkles. In fact, past research has found that roughly 80% of facial skin aging is due to damage from ultraviolet (UV) rays in natural light (Shanbhag, 2019).
Neuromodulators such as Botox or Xeomin have not only been proven to improve the appearance of fine lines and wrinkles but also have shown to prevent their progression by preventing repetitive movements of facial muscles that could cause future lines. These treatments must, however, be administered by a healthcare professional. Talk to your dermatologist to see if you’re a good candidate.