Fine Lines, Wrinkles and Furrows

Level 1

Consider your skin-care regime. “We’re big proponents of good skin care—it can go a long way toward reducing fine lines and keeping your skin and face youthful,” says Lonergan. The deep-cleaning Clarisonic rotating brush gets a big thumbs up from several docs.

Sunscreen won’t tackle current lines, but it can prevent others. Also consider topical antioxidant
Vitamin C, which targets the sun-generated
molecules that cause damage, says Dr. Marguerite Thew, a North Wilmington dermatologist.

Skin-care products often contain retinol, an over-the-counter version of the Vitamin A derivative retinoid. These products deliver modest results. The prescription-strength version, Retin-A, however, “is the gold standard for treating fine lines and uneven complexion,” Thew says. (Your doctor may prescribe the generic tretinoin.) Originally created to treat acne, the product stimulates collagen production and cellular growth.

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The products can be drying, warns Dr. Susan Kirchdoerffer, medical director of Reflections Medical Spa in Brandywine Hundred. Retinoids also make the skin vulnerable to sunlight’s harmful effects. Use it regularly to get and maintain results.

Dr. Peter Coggins, an aesthetic surgeon in Centreville, often pairs Retin-A with glycolic acid. Part of a chemical group known as alpha hydroxy acids, glycolic acid—found in sugar cane—exfoliates the skin. With both products, patients often must start slow to see how well they tolerate them, he says.

Mild peels with glycolic or salicylic acid loosen the “cellular cement,” caused by the buildup of dead skin, which can emphasize wrinkles.


Level  2

Medium-strength peels, which include TCA (trichloroacetic acid), reduce the appearance of fine wrinkles. Your face will be red for a few days, after which the superficial layers of skin will grow stiff, crack, flake and peel. The process is usually complete in four to seven days. Because is stings, some patients ask for sedation.

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Because it involves a needle, Botox falls into this category. However, few say the injections are painful. A purified botulinum toxin, Botox blocks nerve impulses that cause muscle activity. It smooths fine lines and prevents them from getting deeper. “It’s the best bang for your buck,” Kirchdoerffer says. In 2011, more than 4 million Botox procedures were performed by doctors or their assistants, according to the American Society for Aesthetic Plastic Surgery.

Botox isn’t for established furrows, crevices or folds. For that you need soft-tissue fillers. The most popular are made with hyaluronic acid. Brand names include Restylane and Juvederm. These products can fill out the nasolabial folds, which run from the nostril to the mouth. (Dr. Abdollah Malek at the Centre for Cosmetic Surgery, which has offices in Newark and Rehoboth Beach, uses fillers for a “liquid rhinoplasty” to even out a nose bump.)

Many doctors combine the Botox and fillers, which are temporary. How temporary? Malek has seen fillers last for more than a year. “I have a little bit on my face that has been there for two years,” he says. Meanwhile, muscles continually treated with Botox can become weaker. “The muscles change their behavior,” he explains.

Dr. Mehdi Balakhani, who has Wilmington and Newark offices, remains enthusiastic about the CO2 laser, one of the first lasers to treat severely aged or scarred skin. In the past, patients put up with a lengthy downtime and the risk of skin whitening. Today’s generation of the laser lets him fine-tune the power. “It is still a good moderate-to-aggressive treatment for wrinkles,” he says.


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Level 3

The CO2 laser, therefore, can also be an intense treatment for wrinkles. Deep peels (phenol peels) also remove the top layer of the skin. “They’re very aggressive,” Balakhani says. The peel is usually administered while the patient is sedated, and there’s significant recovery time as the skin weeps and repairs itself.

Face-lifts, which are designed for certain areas of the face, such as the brow or lower face and neck, smooth out the skin, much like running your hand across a wrinkled bedspread. Results can last five to 10 years. But bruising and swelling can last for weeks after the procedure.


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