Our skin is the largest organ of the human body, and it is one of the body’s most important structures, not only functionally, but also aesthetically. When wrinkles appear, in aging, most of us struggle with hiding, or even erasing them. Crease lines form as the skin tension decreases; the aged and damaged skin displays more lines because the elastin fibers break and lose their effectiveness. The elastin fibers may be thought of as tiny rubber bands, which keep the skin supple and tight. When these fibers break into small pieces, they are no longer effective in keeping the skin attached to the underlying structures and assisting in the rebound after the skin is stretched or pulled. The aged skin thins and falls into folds according to its attachments to the muscles beneath.

The major problem associated with aging is probably caused by free radical damage. This damage results in the destruction of elastin fibers, collagen, and even the internal repair mechanisms within the skin itself. Thinking of the free radical as the villain, assists in understanding preventative measures, protective agents and even restorative procedures to combat the extremely harmful effects of this damage to the skin. The toxic effects of free radicals can, in part be mediated or reduced through the use of antioxidants, such as vitamin A, C, and E, which act as free radical scavengers. Additionally, protection from sun and tanning light exposure greatly reduces the damage resulting in the formation of fine lines and wrinkles. A sun block lotion of at lease 30, applied hourly to the sun exposed skin is the most cost-effective measure of UV-A and UV-B radiation protection.

In treating fine lines, most of the creams and lotions just plump the skin with fluid. This process reduces the appearance of fine lines, but they reappear when the product is discontinued. If lines are thought of as valleys, then lowering the surrounding skin can reduce the depth and severity of the wrinkles. This principle is applied to dermabrasion, a surgical procedure of dramatic skin sanding. Micro-dermabrasion, a non-surgical removal of the top layers of the skin and non-ablative laser treatments, remove the very top layer of the skin to freshen your appearance. In these treatments, the skin surface is smoothed, the bumps reduced and the lines are decreased. There are many lasers on the market and some are being developed to stimulate the regeneration of the skin’s own collagen.

Before and after Botox in the brow and Radiesse filler around the cheeks and mouth.

Botox is a popular treatment of rejuvenation, resulting in the weakening of facial muscles, not in their paralysis. The distinction is an important one as the active ingredient, in low doses, weakens the muscles but does not entirely prevent them from working. The wrinkles are softened with the injections, but do reappear in three to six months when the nerves recover. Of course, repeat injections are needed to sustain the results and lengthen the time between treatments.

Filling the lines with injectables has led to the development of over a dozen products with numerous uses and effects. Restylane is a non-animal, stabilized hyaluronic acid approved by the FDA to correct facial wrinkles and folds. Restylane has a low allergic potential, lasts six to twelve months and looks natural. Atrefill is a collagen product, suspended in a longer lasting microsphere solution. Silikon 1000 contains silicone and is an FDA off-label product for facial injections. The use of silicone in the face should be approached cautiously, considering the possibility of long-term complications. Sculpta is marketed in Europe as NewFill and is a biodegradable polylactic acid used in suture materials. Sculptra is not yet FDA approved for use in this country. Radiance is a solublized calcium product, used extensively in Europe for cosmetic filling of facial lines. This product is FDA approved and the longevity of Radiance is thought to approach two to six years.

Since wrinkles appear where the skin is in relative excess, reducing the skin, reduces the wrinkles. Most skin reducing procedures are surgical, involving the cutting away of the excess, supporting and lifting the facial skin. Facelifts, browlifts, necklifts and eyelid surgeries accomplish rejuvenation with incisions. Endoscopic lifts are minimal incision surgeries, which change the muscle attachments of the facial skin. These procedures require anesthesia and some one to three weeks of recovery before social engagement. The results are long lasting and in some cases, lifetime, but the aging process continues even after surgery, so touch-up surgeries are common in ten to twenty years.

Probably most important in maintaining beautiful skin includes a healthy lifestyle of good nutrition, adequate hydration, regular exercise, proper rest, minimal alcohol consumption and smoking cessation. Stress reduction and adequate sleep are also important in today’s world of busy schedules. In taking the time to care for yourself, you will reap the rewards of glowing, gorgeous skin.

What is this substance that has rapidly become one of the most widely used cosmetic agents and how does it work? Botox® is a powerful protein that works at the nerve endings to prevent the release of a molecule, responsible for muscle action. Without this molecule, the muscle does not function as effectively as it did, prior to the injection of Botox®. Eventually, the nerve fibers sprout new endings and become effective again, but this process could take three to twelve months. In the interim, the muscles responsible for creating fine lines, have been weakened enough to soften them. In some instances, even surgery cannot remove these fine lines.

Please refer to the photo above. The woman’s first photo demonstrates her pre-browlift appearance. Three years later, in the middle photo, the surgical effect is still present, but the fine lines of the mid-brow and crow’s feet areas have reappeared and troubled her. The last photo was taken just a week following the middle one, but after the injection of just thirty Units of Botox®. Notice how well the crow’s feet have softened and how much the brow is lifted by the unopposed action of the forehead muscle. In other words, with expert attention to the injection of the muscles of the face, responsible for lowering the brow, the brow elevators are more effective at lifting it. In time, she will need another injection, but she will not need as much, thereby saving her some expense and she will not need the injections as frequently, after three or four sessions.

Research has demonstrated that the correct use of Botox® is safe and effective, both in the short and long term. For over twenty years, this product has been in use in treating humans. In 1979 the FDA granted approval for the use of Botox® to treat a troubling eye muscle condition; in 2003, the approval was expanded to include the treatment of the forehead muscles. Since then, many muscles and conditions are being treated with Botox®, including excessive sweating of the underarms and palms, migraines, chronic pain, muscle spasm from cerebral palsy and Bells palsy, as well as a myriad of cosmetic uses. In 2003, the use of Botox® became the most commonly performed cosmetic procedure in this country. It, however, must be stressed, that a highly trained physician should be the only practitioner using this potentially harmful product; and that the setting for its use should only be in the physician’s office or clinic, where properly certified equipment is available.

There are certain patients with established conditions that make it impossible to safely receive Botox® injections. Those conditions include an allergy to eggs or albumin, an active infection of the face, especially with the Herpes virus, myasthenia gravis or neuromuscular functional disorders, pregnancy or lactation. Physicians are responsible for completely evaluating each patient’s suitability for treatment. Additionally, the patient’s expectations should be clearly defined. Thereby, optimal and satisfactory results can be achieved without the risks of unfavorable outcomes. Remember – safety first and beauty second!