People's desire to retain and regain youth is strong and universal. The eternal wish for a "fountain of youth" can be seen in the innumerable products and procedures advertised in books, magazines, and other media that promise "younger-looking skin." Many claims for such youth-enhancing methods are unfortunately overblown or entirely nonexistent. Let the buyer beware! Still, effective techniques for softening and even removing wrinkles do exist.

Skin ages all over the body, but much more so where there has been sun exposure. Changes brought on by sun damage (photoaging) include "dryness" (really roughness), sagginess, skin growths like liver spots, and wrinkles.

Beautiful Face

Wrinkles in turn can be divided into two categories; fine, surface lines and deep furrows. Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques, such as cosmetic surgery.

1.) Factors Promoting Wrinkles

"There are two types of skin aging, intrinsic and extrinsic, and both contribute to wrinkling," says dermatologist Dr. Ellen Gendler in The Doctors Book of Home Remedies for Women. Intrinsic aging is something that happens as the genes we've inherited from our parents trigger a reduction of two connective fibers, collagen and elastin. Collagen supports the skin and elastin gives it flexibility. Together collagen and elastin give skin structure and tone. After age 30, connective fibers start to break down, and the skin starts to become more lax.

Extrinsic aging is aging that comes from environmental factors. Environmental factors that promote wrinkling include:

1.1) Smoking

If you need another reason to stop smoking, take a look in the mirror. Those wrinkles you're trying to keep at bay are getting a boost every time you take a puff.

Studying more than 1,000 sets of twins as part of research to identify genes behind a variety of diseases, the twin research unit at St. Thomas' Hospital in London found 50 sets comprising a nonsmoker and a lifelong smoker. On average, the smoking twin had skin 25 percent thinner than the nonsmoker. In a few cases, the difference was 40 percent.

Wrinkles occur as the skin thins. Identical twins, who have the same genes, would age at the same rate unless affected by external factors.

Smoking cigarettes activates a gene in the skin that causes it to age prematurely, according to scientist Anthony Young from St. John's Institute of Dermatology in London.

1.2) Sun Exposure

If you want to know how much genetics contributes to skin aging and how much is caused by the sun, just look down at the top of your forearm, then flip it over and check out the underside.

Genetics is responsible for the skin on the underside, while sun exposure is responsible for the skin at the top. In particular, ultra-violet A and B, the invisible rays of the sun, penetrate below the skin surface and encourage wrinkles, because they damage connective fibers. These are the same rays that stimulate production of melanin and produce a tan, a look that is, ironically enough, pursued in the interest of looking young and sexy.

Dr. Ellen Gendler advises women to use two sunscreens if they plan on spending the day outdoors. Sun protection factor, or SPF, only refers to the product's ability to screen ultra-violet B (UVB) rays. But UVB rays only penetrate the top layers of the skin. You also need to protect against ultra-violet A (UVA) rays, which penetrate to the deeper layers of skin, also causing wrinkles. There are not many products that specifically protect you from UVA, says Dr. Gendler.

1.3) Tanning Salons

Tanning salons should be called wrinkling salons. Tanning equipment produces rays that cause premature wrinkling of the skin. No woman who values her skin should set foot inside a tanning booth.

2.) Wrinkle Treatments

What can be done to treat wrinkles? There are several medical (topical medicines and creams) and cosmetic techniques available for improving (minimizing) the appearance of wrinkles and even removing them. Below is a description of these methods.

2.1) Medical Treatments

2.1.1) Vitamin A Acid:

Vitamin A acid, also known as tretinoin, was originally developed for the treatment of acne. Over the past decade we have learned that daily application of vitamin A acid is also useful for the correction of wrinkles and some other results of sun damage.

Creams containing this medication must be used on an ongoing basis. At first, they produce redness and peeling. Although this can be unpleasant for a while, it is essential to achieving improvement once the peeling stops.

2.1.2) Alpha Hydroxy Acids:

Alpha hydroxy acids are derived from fruit and milk sugars. The most commonly used alpha hydroxy acids are glycolic acid and lactic acid because they have a special ability to penetrate the skin.

Alpha hydroxy acids have been used for thousands of years as a skin-rejuvenating product. Cleopatra is reported to have bathed in sour mild (lactic acid) to improve her complexion. Now hydroxy acids are a common additive to numerous skin care products including moisturizers, cleanser, toners, and masks.

Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. The improvement they produce is, however, relatively subtle.

2.1.3) Antioxidants:

Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Free radical damage may lead to cancer. Antioxidants interact with and stabilize free radicals and may prevent some of the damage free radicals otherwise might cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances.

A study by a non-profit independent group of French scientists found that applying vitamins C, E and beta-carotene to the skin may significantly reduce the long-term damage caused by ultra-violet radiation, a key component of sunlight. It may also actually partially reverse damage already done, the scientists said. Studying 160 French women over an 18-month period, they found "a 23 percent reduction in the formation of new lines and wrinkles and an eight percent reduction in existing lines and wrinkles."

2.1.4) Ordinary moisturizers:

Regular creams, which don't contain any of the above substances, may make wrinkles look temporarily less prominent. This is what advertisers have in mind by products that "reduce the appearance of fine lines."

2.2) Cosmetic Procedures

2.2.1) Chemical Peels:

Three types of peels are performed, depending on the desired outcome: superficial peels, medium peels, and deep peels. Each has its advantages and disadvantages.

Superficial Peel

A superficial peel is just as it sounds: a lighter peel that does not penetrate as deeply into the skin. Superficial, or mild peels, are generally done with alpha hydroxyl acids (AHA), but trichloroacetic acid (TCA) may also be used. These peels have been dubbed 'lunch hour peels' because they take only 15 minutes to complete and the patient can then resume normal activities. However, the skin may flake and remain red for a few days. The patient will most likely need treatments over a longer period of time to reach the desired effect.

Medium Peel

A medium peel often contains trichloroacetic acid (TCA). Though this treatment will not correct deep lines and wrinkles, it will improve the texture of skin with fine lines and pigmentation problems. The procedure lasts up to one hour, and the patient may feel a slight burning or stinging sensation during the treatment. Within a week, the treated skin will crack and peel, revealing a fresh layer underneath. Redness may persist for up to two weeks, and several peels may be needed to treat the area(s), depending on the severity of the skin's damage.

Deep Peel

Deep chemical peels are often referred to as phenol peels. These are the most extensive of the three, and therefore recovery time is longer, pain is more severe, but the results are often superior to other techniques. The procedure can take up to two hours for a full-face peel, and since swelling of the eyes is common, it is suggested that the patient have someone to care for him or her for at least 48 hours after the procedure.

One downside to a deep peel is that the intensity of the peel can cause the skin to turn a ghostly white color, and this color may not change; so the best candidate for a deep peel is someone with a fair skin tone. After the procedure, the skin will be raw. Pain medication and antibiotics may be prescribed. After three months, the skin should lose the bright red tone. Generally, patients can return to normal activities after two weeks.

2.2.2) Dermabrasion:

Dermabrasion helps to "refinish" the skin's top layers through a method of controlled surgical scraping. The surgeon scrapes away the top layers of skin using an electrically operated instrument with a rough wire brush or diamond-impregnated burr. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.

Dermabrasion can result in excellent improvement, but can also produce significant side effects, including scarring and permanent changes in skin color.

2.2.3) Laser Resurfacing:

In laser resurfacing, sometimes called "laser peel," a carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure may be performed on the whole face or in specific regions. In many cases, facial wrinkles form in localized areas, such as near the eyes or around the mouth. The laser can be precisely controlled so that only these specific areas are targeted. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery.

Risks associated with laser resurfacing include: burns or other injuries from the heat of the laser energy, scarring, and obvious lightening or darkening of the treated skin. Also, laser resurfacing can activate herpes virus infections ("cold sores") and, rarely, other types of infection.

2.2.4) Non-ablative Laser Resurfacing:

Unlike "traditional" resurfacing procedures, in which the epidermis is sacrificed, leaving a raw surface that takes days to heal, non-ablative laser resurfacing or "photo rejuvenation" utilizes light energy to stimulate collagen remodeling and/or remove irregular pigmentation and enlarged blood vessels from the skin surface.

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.

2.2.5) Cosmetic Surgical Procedures:

Browlift

For persons who want to remove fine lines and wrinkles around the eye area, over the nose, and along the forehead, a browlift is a viable solution. Quick and uncomplicated under the masterful hands of a qualified plastic surgeon, a browlift can make a person look years younger . . . instantly!

Overall, recovery from browlift surgery is uncomplicated and quick. Most people can return to work or their regular daily activities within 10 days or less.

Facelift

With a 22% percent increase in cosmetic surgeries over the past year, facelifts are among the top 5 surgeries performed annually. Men and women in mid life and beyond are electing to have surgery to smooth out wrinkles, tone facial contours, and look younger.

The best candidates for a facelift are men and women 40 to late 60s in age, whose facial areas have begun to sag but the skin still has some elasticity. Deep lines or a fold of skin running from the corner of the nose to the mouth can be removed entirely, or else greatly reduced. More pronounced cheek bones and a better defined jaw-line can also be expected, as well as fatty pockets along the face and neck removed.

But even if a person's skin has lost most or all of its elasticity, and the person is well into their 80s, they might still be a good candidate, and be able to improve their appearance significantly.

Complications are, for the most part, minor. Risks include collections of blood under the skin (requiring surgical removal), nerve injury (usually temporary), infection, unexpected reactions to the anesthesia, and poor healing. The latter is most likely due to smoking, which inhibits a wound's ability to heal. Another possible risk is a visible scar; while most incisions heal nicely and are inconspicuous, it is possible for poor healing to enhance a scar line.

Remember, having a facelift cannot stop the clock of time. Your face will continue to age; many people have another facelift after 5 or 10 years. But the effects of the facelift will remain. You'll look younger than you really are.

2.2.6) Botox Cosmetic:

Botox Cosmetic is the number one non-surgical medical procedure for the removal of facial wrinkles. Botox works by paralyzing the muscles that create the wrinkles and that way lessening the appearance of frown lines, crow's feet or laugh lines. Improvement lasts several months and must be repeated to sustain improvement. Safety depends again on the experience of the physician.

Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

2.4) Natural Remedies

2.4.1) Drink Plenty of Water:

One of the best natural remedies to soften wrinkles on the face is to drink plenty of water. It is the least costly yet most effective thing a person can do to improve the skin.

2.4.2) Eat Healthily:

A diet with plenty of whole grains, fresh fruits and vegetables, and the use of healthy oils (such as olive oil) may protect against oxidative stress in the skin. In fact, a 2001 study reported that people over 70 years old had fewer wrinkles if they ate such foods. Diet played a role in improving skin regardless of whether the people in the study smoked or lived in sunny countries. Benefits from these foods may be due to high levels of antioxidants found in them.

Dr. Nicholas Perricone, author of The Wrinkle Cure, published in 2001, suggests a diet and products that can allegedly slow, or even reverse, the visible aging process. Some of his most notable recommendations are a diet high in salmon (primarily for its omega-3 fatty acids), supplementation of alpha lipoic acid, and topical application of vitamin C ester and DMAE.

2.4.3) Facial Massages:

Regular facial massages help to keep elasticity in the skin and keep wrinkles and fine lines at bay. Massage does this by relaxing the muscles and by stimulating the blood vessels under the skin.

2.4.4) Avocados:

This is a great way to give your skin a quick pick-me-up. Simply spread some avocado slices or pulp across the face, particularly on any very dry parts. The oil within the fruit should activate increased oil production within the skin, giving you a softer, younger look.

Other natural remedies that are also considered to help reduce wrinkles include grapes, cucumber, guava and ivy gourd (a hard, fleshy fruit related to marrows and cucumbers).

References and Bibliography:

* Faelten, S. (ed.), The Doctors Book of Home Remedies for Women (Emmaus, PA: Rodale Press, Inc., 1997).

* "Non-ablative laser resurfacing, photofacials, and skin photo rejuvenation," Shorelaser.com.

* "Preventing and treating wrinkles," Pinkfridge.com.

* Rockoff, A., "Wrinkles," MedicineNet.com.

* "Skin resurfacing," Plasticsurgery.org.

* "Skin wrinkles," About.com.

* "Twins study suggests smoking hastens wrinkles, aging process," The News & Record (Piedmont Triad, NC), 13 January 1997.

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