What cosmetic therapies are available for the treatment of wrinkles?
Face Lifts (Rhytidectomy). A number of face-life procedures (called rhytidectomies) are available. Facelifts can provide individuals with a more youthful, if not necessarily younger, look. The degree of improvement, however, depends on a number of factors including age, bone structure, skin type, and personal habits, such as smoking and sunbathing. The Procedure. When a face-lift is a relatively simple procedure, it can take about two hours under local anesthetic in a doctor's office. Complicated face-lifts are done under general anesthesia in a hospital and can take three to six hours. The face lift
procedure may be one of the following: SMAS (superficial musculoaponeurotic system) is the most common face-life procedure. The surgeon makes an incision at the hairline and separates the skin from the underlying tissue and muscles. The muscles are tightened and excess fat and tissue, such as fat under the chin and neck, are removed. The endoscopic subperiosteal or subgaleal face-lift is a less invasive surgical technique. The surgeon raises facial structures rather than cutting away flaps of skin. Only a few half-inch incisions are made, and scarring is minimal.
Laser resurfacing. Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the peel reaches the middle of the dermis, the skin's second layer. This helps stimulate the body's natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some doctors perform laser resurfacing under "conscious sedation," in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA or Ela-Max, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated once or twice at 6 to12 month intervals to maximize improvement. They are, however, associated with pain, lengthy healing times, and potential for permanent pigment changes and scarring.
Non-ablative laser resurfacing. Newer lasers attempt to stimulate collagen synthesis under the skin without peeling or damaging the epidermis. Data on their effectiveness are still preliminary at this point, but suggest that results for fine lines and wrinkles may approach those of invasive laser resurfacing. Treatment is almost painless and there is little or no redness, peeling, or "down-time" afterward. Noticeable improvement may involve several repeated procedures over a period of months.
Implantation. A number of materials are currently being used for deep wrinkles, depression under the eyes, lip enhancements, and for acne scars. None to date are wholly satisfactory, either because they don't last or because they provoke an immune response that seeks to reject these foreign implants. Such reactions are not common but they can be painful and unattractive, particularly with lip augmentation.
Botulinum. Botulinum, the deadly toxin found in uncooked foods, is also a powerful muscle-relaxant, and tiny amounts of a purified form (Botox) are being injected into wrinkles to relax the surrounding muscles. It may benefit forehead and frown lines, crow's feet, lower eyelids, lines on the side of the nose, and the area between the upper lip and the nose. It is also useful for treating involuntary muscle movements that can occur after a face-lift. Patients have even reported improvement of tension headaches after receiving botulinum injections. The injections need to be repeated every few months, since the effects wear off. The treatment decreases the ability to frown or squint and may cause the corners of the mouth to turn down. The drug does not cross the blood-brain barrier, and, to date, the only side effects are temporary muscle weakness near the injection site.