DESCRIPTION

Wrinkles form when the skin loses its elasticity. As long as the skin is supple, any creasing of the skin disappears as soon as you stop making the expression that caused it. But the skin that has lost its suppleness retains the lines formed by smiling or frowning, for instance, even after you have assumed a more neutral expression. Over time, these lines deepen into wrinkles.

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FREQUENT SIGNS & SYMPTOMS

Some amount of wrinkling is a result of aging and is probably inevitable; no matter what you do, you will develop some lines if you simply live long enough. The first signs of wrinkles usually appear in the delicate tissue around the eyes - smile lines or "crow's feet." The cheeks and lips show damage next. As we age, our skin becomes both thinner and dryer, both of which contribute to the formation of wrinkles. But other factors help to determine both the rate and the extent of wrinkling, including diet and nutrition, muscle tone, habitual facial expressions, stress, proper skin care (or lack thereof), exposure to environmental pollutants, and lifestyle habits such as smoking. Heredity probably also plays a role.

The most important factor of all is sun exposure, which not only dries out the skin but also leads to the generation of free radicals that can damage the skin cells. The sun is your skin's worst enemy. It is estimated that 90 percent of what we think of as signs of age are actually signs of overexposure. Furthermore, overexposure does not necessarily mean sunbathing or sunburn; approximately 70 percent of sun damage is incurred during such everyday activities as driving and walking to and from your car. The ultraviolet-A (UVA) rays that do this damage are present all day long and in all seasons. Worse, the effects of the sun are cumulative, although they may not be obvious for many years.

For more information about causes and treatments, see below.

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CAUSES

AGING PROCESS AND WRINKLES

As a person ages, skin undergoes significant changes:

• The cells divide more slowly, and the inner layer of skin (the dermis) starts to thin. Fat cells beneath the dermis begin to atrophy (diminish). In addition, the ability of the skin to repair itself diminishes with age, so wounds are slower to heal. The thinning skin becomes vulnerable to injuries and damage.



• The underlying network of elastin and collagen fibers, which provides scaffolding for the surface skin layers, loosens and unravels. Skin then loses its elasticity. When pressed, it no longer springs back to its initial position but instead sags and forms furrows.



• The sweat- and oil-secreting glands atrophy, depriving the skin of their protective water-lipid emulsions. The skin's ability to retain moisture then diminishes and it becomes dry and scaly.



• Frown lines (those between the eyebrows) and crow's feet (lines that radiate from the corners of the eyes) appear to develop because of permanent small muscle contractions. Habitual facial expressions also form characteristic lines.



• Gravity exacerbates the situation, contributing to the formation of jowls and drooping eyelids. (Eyebrows, surprisingly, move up as a person ages, possibly because of forehead wrinkles.)


Wrinkles can have a profound impact on self-esteem. Indeed, the stigma attached to looking old is evidenced by the fact that Americans spend more than $12 billion each year on cosmetics to camouflage the signs of aging. Our current society places a premium on youthfulness, and age discrimination in the workplace, although illegal, has stalled many a person's career. Indeed, the emotional ramifications of aging explain in large part why the cosmetics industry and plastic surgeons thrive.

ULTRAVIOLET RADIATION, SUNLIGHT, & PHOTOAGING

The role of the sun cannot be overestimated as the most important cause of prematurely aging skin (called photoaging) and skin cancers. Overall, exposure to ultraviolet (referred to as UVA or UVB) radiation emanating from sunlight accounts for about 90 percent of the symptoms of premature skin aging, and most of these effects occur by age 20:

• Even small amounts of UV radiation trigger process leading to skin wrinkles.


• Long-term repetitive and cumulative exposure to sunlight appears to be responsible for the vast majority of undesirable consequences of aging skin, including basal cell and squamous cell carcinomas.


• Melanoma is more likely to be caused by intense exposure to sunlight in early life.

Initial Damaging Effects of Sunlight. Sunlight consists of ultraviolet (referred to as UVA or UVB) radiation, which penetrates the layers of the skin. Both UVA and UVB rays cause damage leading to wrinkles, lower immunity against infection, aging skin disorders, and cancer. They appear to damage cells in different ways, however.

• UVB is the primary agent in sunburning and primarily affects the outer skin layers. UVB is most intense at midday when sunlight is brightest. Slightly over 70 percent of the yearly UVB dose is received during the summer and only 28 percent is received during the remainder of the year.



• UVA penetrates more deeply and efficiently, however. UVA's intensity also tends to be less variable both during the day and throughout the year than UVB's. For example, only about half of the yearly UVA dose is received during the summer months and the balance is spread over the rest of the year. UVA is also not filtered through window glass (as is UVB).

Both UVA and UVB rays cause damage, including genetic injury, wrinkles, lower immunity against infection, aging skin disorders, and cancer, although the mechanisms are not yet fully clear.

Processes Leading to Wrinkles. Even small amounts of UV radiation trigger the process that can cause wrinkles, like:

• Sunlight damages collagen fibers (the major structural protein in the skin) and causes accumulation of abnormal elastin (the protein that causes tissue to stretch).


• In response to this sun-induced elastin accumulation, large amounts of enzymes called metalloproteinases are produced. (One study indicated that when people with light to moderate skin color are exposed to sunlight for just five to 15 minutes, metalloproteinases remain elevated for about a week.)


• The normal function of these metalloproteinases is generally positive, to remodel the sun-injured tissue by manufacturing and reforming collagen. This is an imperfect process, however, and some of metalloproteinases produced by sunlight actually degrade collagen. The result is an uneven formation ( matrix) of disorganized collagen fibers called solar scars . Repetition of this imperfect skin rebuilding over and over again causes wrinkles.


• An important event in this process is the over-production of oxidants, also called free radicals. These are unstable molecules that are normally produced by chemical processes in the body, a process called oxidation. With environmental assaults, however, such as from sunlight, they are produced in excessive amounts and damage the body's cells and even alter their genetic material. Oxidation may specifically contribute to wrinkling by activating the specific metalloproteinases that degrade connective tissue.

There is a possible upside to wrinkles and sun exposure. A 2001 study reported that people with more wrinkles were less likely to develop basal cell carcinomas, even among high-risk groups. Some experts suggest that people prone to wrinkles may respond to sun exposure with biologic mechanisms that protect against basal cell carcinoma. More research is needed confirm this.

OTHER FACTORS RESPONSIBLE FOR WRINKLES

In addition to sunlight, other factors may hasten the formation of wrinkles:

• Cigarette Smoke. Smoking produces oxygen-free radicals, which are known to accelerate wrinkles and aging skin disorders and increase the risk for non melanoma skin cancers. Studies also suggest that smoking and subsequent oxidation produce higher levels of metalloproteinases, which are enzymes associated with wrinkles.


• Air Pollution. Ozone, a common air pollutant, may be a particular problem for the skin. One study reported that it might deplete the amount of vitamin E in the skin; this vitamin is an important antioxidant.


• Rapid Weight Loss. If weight loss occurs to rapidly, the volume of fat cells that cushion the face are also decreased before chemicals in the skin can react. This not only makes a person look gaunt, but can cause the skin to sag.

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RISK FACTORS

Age and Risk:

Exposure to Sun in Childhood. It is estimated that 50 to 80 percent of skin damage occurs in childhood and adolescence from intermittent, intense sun exposure that causes severe sunburns. In spite of this now well-known effect, many people still believe that a tan in children signifies health. And, even many parents who are concerned about sun exposure still rely too much on sunscreen and not enough on protective clothing.

The Elderly. Most people over 70 have at least one skin disorder and many have three or four. Everyone experiences skin changes as they age, but a long life is not the sole determinant of aging skin. Family history, genetics, and behavioral choices all have a profound impact on the onset of aging-skin symptoms.

Activities Leading to Overexposure to Sunlight and Ultraviolet Radiation. Of all the risk factors for aging skin, exposure to UV radiation from sunlight is by far the most serious. Indeed, the vast majority of undesirable consequences of aging skin occur in individuals who are repetitively exposed to the sun, including the following:

• Outdoor workers, such as farmers, fishermen, construction workers, and lifeguards.


• Outdoor enthusiasts.


• Sunbathers.


• People who regularly attend tanning salons or use tanning beds. A 2002 study indicated that regular use significantly increases the risk for non melanoma skin cancers. Fair women under age 50 were at particular risk.

Skin Types

Experts have devised a classification system for skin phototypes (SPTs) based on the sensitivity to sunlight. It ranges from SPT I (lightest skin plus other factors) to IV (darkest skin). [See Table] People with skin types I and II are at highest risk for photoaging skin diseases, including cancer. It should be noted, however, that premature aging from sunlight can affect people of all skin shades.

Tanning and Sunburn History

Skin Type	Tanning and Burning History
I	Always burns, never tans, sensitive to sun exposure.
II	Burns easily, tans minimally.
III	Burns moderately, tans gradually to light brown.
IV	Burns minimally, always tans well to moderately brown.
V	Rarely burns, tans profusely to dark.
VI	Never burns, deeply pigmented, least sensitive.

Gender

It is commonly believed that women are at greater risk for wrinkles than men are. Some evidence suggests, however that, given the same risk factors, men and women in the same age groups have comparable risks for skin photoaging. In fact, in one 1999 study, long-term sun exposure caused a greater number of wrinkles in men than in women. In a French study, the evidence of moderate to severe photoaging was observed in the following:

• In 22 percent of women and 17 percent of men between the ages of 45 and 49.


• In 36 percent of women and 38 percent of men by age 54.


• Nearly half of both men and women by age 60.

In fact, some studies report that men are more likely to develop non melanoma skin cancers.

Smokers

According to one study, heavy smokers are almost five times as likely to have wrinkled facial skin than nonsmokers. In fact, heavy smokers in their 40s often have facial wrinkles more like those of nonsmokers in their 60s. Studies of identical twins have found smokers to have thinner skin (in some cases by as much as 40 percent), more severe wrinkles, and more gray hair than their non-smoking twins. And even worse, cigarette smokers are more prone to skin cancers, including squamous cell carcinoma and giant basal cell carcinomas.

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PREVENTION

Staying out of the Sun

The best way to prevent skin damage in any case is to avoid episodes of excessive sun exposure. The following are some specific guidelines:

• Avoid exposure particularly during the hours of 10 AM to 4 PM when sunlight pours down 80 percent of its daily UV dose.


• Avoid reflective surfaces, such as water, sand, concrete, and white-painted areas. (Clouds and haze are not protective, and in some cases may intensify UVB rays.)


• Ultraviolet intensity depends on the angle of the sun, not heat or brightness. So the dangers are greater the closer to the summer-start date. For example, in the Northern Hemisphere, UV intensity in April (two months before summer starts) is equal to that in August (two months after summer begins).


• The higher the altitude the quicker one sunburns. (One study suggested, for example, that an average complexion burns at six minutes at 11,000 feet at noon compared to 25 minutes at sea level in a temperate climate.)


• Avoid sun lamps and tanning beds. They provide mostly UVA rays, and some experts believe that 15 to 30 minutes at a tanning salon are as dangerous as a day spent in the sun.

Sunscreens

The use of sunscreens is complex and everyone should understand how and when to use them. The bottom line is not that people should avoid sunscreens or sunblocks but that they should always use them in combination with other sun-protective measures. [See Box Sunscreen Guidelines.]

Sunscreen Guidelines SUNSCREEN TYPES: In choosing a sunscreen, look at the ingredients. Preparations that help block UV radiation are sometimes classified as sunscreens or sunblocks according to the substances they contain. In general, sunscreens have contained or organic formulas and sunblocks inorganic ingredients. However, the term sunblock is used less and less as sunscreens increasingly contain both kinds of ingredients: Organic formulas contain UV-filtering chemicals such as butyl methoxydibenzoyl-methane (also called avobenzone or Parsol 1789), benzophenones (dioxybenzone, oxybenzone), sulisobenzone, methyl anthranilate, octocrylene, cinnamates (octyl methoxycinnamate, ethylhexyl p-methoxycinnamate), and terephthalylidene dicamphor sulfonic acid, a UVA blocker. Para-amino benzoic acid (PABA), once a popular ingredient, is now used infrequently. PABA may actually break down in the presence of UV exposure and release harmful oxidants. (And many people have an allergic reaction to it.) Not all these chemicals block UVA, and in choosing an organic sunscreen, people should look for a wide spectrum of chemicals. Inorganic formulas contain the UV-blocking pigments zinc oxide or titanium dioxide. Zinc and titanium oxides lie on top of the skin and are not absorbed. They prevent nearly all UVA and UVB rays from reaching the skin. Older sunblocks are white, pasty, and unattractive, but current products use so-called microfine oxides, either zinc (Z-Cote) or titanium. They are transparent and nearly as protective as the older types. Microfine zinc oxide may be more protective and less pasty-colored than microfine titanium oxide. Inexpensive products work as well as expensive ones with the same ingredients. Unfortunately, there are still not standards for sunscreens, and even those claiming UVA protection may offer very little. In one study, the average UVA protection from a wide range of brands was only 23 percent. In fact, the average protection on brands not making the claim was 37 percent. Note: Organic formulas and inorganic microfine oxides do not protect against visible light, which is a problem for people who have light-sensitive skin conditions, including actinic prurigo, porphyria, and chronic actinic dermatitis. Inorganic sunscreens that protect against visible light and are still cosmetically acceptable are now available in Europe, but not yet in the US. CALCULATING THE SPF: The sun protection factor (SPF) on all sunscreen labels is a ratio based on the amount of UVB (not UVA) radiation required to turn sunscreen- or sunblock-treated skin red compared to non-treated skin. For instance, people who sunburn in five minutes and who want to stay in the sun for 150 minutes might use an SPF 30. The formula would be: 30 (the SPF number) times five (minutes to burn) = 150 minutes in the sun. Protection offered by sunscreens may be classified as follows: Minimal: SPF 2 to 11. Moderate: SPF 12 through 29. High: 30+. (Although some sunscreens claim SPFs higher than 30, the added protection at such higher levels is insignificant.) SPF LEVELS BY AGE GROUP: Certain groups should have higher or lower SPFs depending on age and other factors: Babies and young children should be well covered with clothing, sunglasses, and hats as the first line of defense against sunburn. Sunscreens should not be used on babies younger than six months without consulting a health care provider. Sunscreens should be used only if necessary in older children, since the long-term effects of the chemicals used in sunscreens are still unknown. For example, in two 2000 studies, one found greater numbers of moles and the other fewer numbers in children who used sunscreens. (Studies suggest that having numerous, normal moles may significantly increase the risk for melanoma.) Well-conducted studies on specific sunscreens are necessary to determine their safety in children. Older children and adults (even those with darker skin) benefit from using SPFs of 15 and over. Some experts recommend that most people should use SPF 30 on the face and 15 on the body. Adults who burn easily instead of tanning and anyone with risk factors for skin cancer should use at least SPF 30. TIMING AND AMOUNT OF APPLICATION Sunscreen or sunblock should be applied liberally as follows: Adults should include sunscreen with a daily skin regimen, even if going outdoors for only a short time. Apply initially 30 minutes before venturing outdoors for best results. (This allows time for the sunscreen to be absorbed. Then reapply every 15 to 30 minutes while in the sunlight.) Also reapply each time after exercise or swimming. (Choose a waterproof or water-resistant formula even if activities don't include swimming. Waterproof formulas last for about 40 minutes in the water, whereas water-resistant formulas last half as long.) Apply a large amount (equal to about one quarter of a four-ounce bottle) to all exposed areas, including ears and feet. Insect repellants reduce sunscreen SPFs by up to one-third. Use higher SPFs and very liberal application when applying both. POSSIBLE HAZARDS OF SUNSCREENS, SUN AVOIDANCE, OR BOTH When used generously and appropriately, sunscreen products and sun avoidance help reduce the severity of many aging skin disorders, including squamous cell cancers. There are certain concerns, however. Sunscreen Use May Not Protect against Basal Cell and Melanoma Cancers - and May Even Increase the Risk. Although sunscreens help prevent squamous cell carcinomas and other skin disorders, sunscreens do not appear to provide protection against melanoma and some basal cell cancers. In fact, some studies have reported a higher association with sunscreen use and these skin malignancies, though not all studies report such negative results. The reasons for this possible increased risk are unclear, though some theories include the following: Until recently, many sunscreens blocked only or predominantly UVB rays and not UVA, the more deeply penetrating rays now known to be especially dangerous. (Most major sunscreen brands now block both UVA and UVB, but the effect of this double action on melanoma is not yet clear.) People who apply sunscreens may feel safe and stay out longer during high sun-exposure hours than is safe. It should be strongly noted that even if a person doesn't sunburn, UVA rays can still penetrate the skin and do harm. People do not put on enough sunscreen. In fact, according to one survey most apply about one quarter of the amount needed to meet standard recommendations for sun protection. Some sunscreen products, notably those containing PABA, may actually break down in the presence of UV exposure and release harmful free radical particles, which theoretically could increase the risk for cancer, though the long-term effects are not known. (Still other evidence suggests that some sunscreen ingredients protect against such oxidants.) Sunscreens Use May Increase the Risk for Health Problems Related to Sunlight Deficiencies. There is some major concern that underexposure to sunlight, due to the use of sunscreens or sun-avoidance measures, may produce other health problems, such as the following: Vitamin D Deficiency. Vitamin D is found in foods, but it is primarily manufactured a chemical reaction to ultraviolet B sunlight. Vigorous sun-protection measures, then, may increase a person's risk for developing vitamin D deficiency. Vitamin D is important for prevention of rickets and osteoporosis and some cancers, including melanoma . People who need to avoid sunlight and whose diet is low in foods that contain vitamin D should take supplements. People with darker skin are at higher risk for deficiencies from sun protection than those with whiter skin. (Note: vitamin D is toxic in high doses.) Other Cancers. Although sunlight is implicated in skin cancers, it is also associated with lower risks for breast, prostate, ovarian, and colon cancers. Some protection against these cancers may be related to vitamin D production by sunlight. Depression. Many people suffer from SAD (seasonal affective disorder), a form of depression that generally occurs in winter and is associated with exposure to less sunlight. The bottom line is that some sunlight is important and even necessary for a healthful and high-quality life. Some experts recommend that adults may benefit from daily moderate tanning (20 to 30 maximum minutes of exposure during lower-risk hours) over a number of days to slowly build up pigment in the skin. PROTECTIVE CLOTHING Wearing sun-protective clothing is extremely important and protects even better than sunscreens. Special clothing is now available for blocking UV rays and is rated using SPF ratings or a system called the UPF (ultraviolet protection factor) index, with 50 UPF being the highest. (According to one study, this is a very reliable indicator of protection.) The clothing is expensive, however. The following are some tips for anyone: Everyone, including children, should wear hats with wide brims. (Even wearing a hat, however, may not be fully protective against skin cancers on the head and neck.) People should look for loosely fitted, unbleached, tightly woven fabrics. The tighter the weave the more protective the garment. Washing clothes over and over improves UPF by drawing fabrics together during shrinkage. An easy way to assess protection is simply to hold the garment up to a window or lamp and see how much light comes through. The less the better. Everyone over age one should wear sunglasses that block all UVA and UVB rays. CHEMICAL TANNERS Some research suggests that melanin and dihydroxyacetone (DHA), the active ingredients in many self-tanning lotions, may help filter out UVA and UVB radiation and so be protective against sun damage. More research is underway.

TREATMENT

MEDICAL PROFESSIONAL PROCEDURES
FOR SKIN WRINKLE TREATMENT

The outward manifestations of age represent hard-won experience and character, and those who wear its natural signs with a healthy and happy outlook should be regarded with respect as role models. Before embarking on an expensive and ultimately futile attempt to keep time at bay, consider the real bases for self-esteem and the pursuit of a lifestyle that will bring true health and youthful vigor rather than an imitation of it.

For people who make the decision to pursue intensive treatments, individuals should consider the following factors, among others, and discuss them with their dermatologist or plastic surgeon:

• The ability of the procedure to safely reduce wrinkles.


• The ease and safety record of the procedure.


• The skill of the health care provider.


• The length of recovery.


• Possible complications.


• The duration of the benefits.

A person's age also helps determine the procedure:

• For people in their thirties, a simple chemical peel is sufficient.


• After age 40, people may benefit from collagen or fat implants.


• At age 50 and over, plastic surgeons recommend laser resurfacing and customized treatments for individual needs.

In older individuals, combination procedures may be beneficial. Some examples include the following:

• Laser surgery may be used for deep lines (such as those around the mouth) and chemical peels used over the rest of the face.


• For enhancing the eye by correcting droopy eyelids and bags and raising the brow, combinations of blepharoplasty (eye lift), Botox, and laser resurfacing may be used.

RESURFACING CHOICES

There are many choices for skin resurfacing (also called exfoliation) and the patient must discuss a number of different factors that affect the choice. Resurfacing can achieve the following:

• Removal of abnormal tissue and rough skin.


• Stimulation of new skin growth.


• Stimulation of collagen and elastin production.

In addition to determining the skill of the surgeon and the safety of the procedure, the patient must discuss the desired depth of the resurfacing and the capability of each procedure to reach this safely. All resurfacing procedures require a healing period afterward, during which the skin is red and sensitive. And it should be noted that the deeper the procedure, the higher the risk for complications, including delayed healing, infection, loss of pigment (skin color), and scarring.

CHEMICAL PEELS

Chemical peels, also known as chemosurgery, help restore wrinkled, lightly scarred, or blemished facial skin. Much like chemical paint strippers, chemical peels strip off the top layers of skin, and new, younger-looking skin grows back. The procedure is very effective for the upper lip. It cannot be performed around the eyes. Partial peels are often done in conjunction with a face-lift.

The Procedure:

• Dermatologist applies chemicals to the skin. They include trichloroacetic acid, high concentrations of alpha hydroxy or beta hydroxy acids, or combinations of them.



• In some cases, tretinoin (vitamin A derivative) or alpha hydroxy is applied four to six weeks before and starting one day after the peel. Such treatments can enhance the effects of a peel and reduce the risk of discoloration in people at risk for this complication. (Tretinoin itself is being tested as a chemical peel. In one small 2001 study, it effectively reduced wrinkles with no side effects.)



• A crust or a scab generally forms within 24 hours after surgery, which can be removed by gentle cleansing with soap and water.



• The skin takes six or seven days to heal.



• After the scab disappears, the visible skin is deep red but gradually lightens as it regenerates.

Complications:

Complications include white heads, cold sores, infection, scarring, numbness, and permanent discoloration, particularly in people with darker skin. Refinement of chemical peel techniques are now permitting doctors to reach deeper skin, improvements which make it easier to apply peels to non-facial skin and to individuals with darker skin.

DERMABRASION

Dermabrasion affects deeper layers of skin than chemical peels, and may be useful for removing disfiguring marks, such as deep acne scars or deep wrinkles. As with chemical peels, it is effective for wrinkles on the upper lip and chin and cannot be used around the eyes. Some experts prefer dermabrasion to lasers for skin surfacing of people with darker skin colors.

The Procedure:

• Standard dermabrasion uses a rotating brush that removes the top layers of a person's skin. As with chemical peels, dermabrasion selectively strips away the upper layers of skin, leaving the underlying dermal layers exposed.



• As with chemical peels, after the procedure, the treated skin oozes and forms a scab, a reaction that is both unsightly and uncomfortable, but only temporary.



• Postoperative care is similar for both procedures.

A gentler variation called microdermabrasion uses very tiny crystals to polish the skin and a vacuum technique to remove them. Results are similar to light chemical peels. Patients can have this procedure done on their lunch hour and return to work. Only mild redness occurs after treatment, although for best results five or six repetitive treatments are needed every one or two weeks. To date, overall patient satisfaction has been very high.

LASER RESURFACING

Lasers are currently the most effective exfoliation tools for eliminating wrinkles. Their unique advantages over other resurfacing methods are their ability to tighten the skin. A successful procedure can make patients look 10 to 20 years younger, and the results can last up to 10 years. It should be noted, however, that a 2002 study indicated that this procedure may not protect against skin cancers.

The procedure is most beneficial for the following areas:

• Best around the mouth and eyes. Recent evidence suggests CO2 lasers may be even better than dermabrasion for the upper lip.


• Slightly less beneficial for the area around the nose.


• Used alone, current laser therapy does not eliminate crow's feet, broken blood vessels, or dark circles under the eye.


• Standard laser dermabrasion is too harsh for thinner skin layers, such as on the neck. Newer and gentler laser techniques, however, stimulate collagen without taking off skin layers and may prove to be useful for necklines.


• The evidence of the effects of lasers on acne scars is unknown.

The Laser Resurfacing Procedure. In general the procedure works in the following way:

• Laser pulses penetrate the skin quickly, vaporizing water and surface skin without damaging the deeper layers, allowing new top skin to grow.


• In addition, enough heat is applied to shorten collagen fibers, restoring some elasticity to the skin.

Choice of Lasers. The lasers used depend on skin type and severity of the condition:

• The carbon dioxide (CO2) laser is the most powerful laser treatment and is used for deep wrinkles and skin imperfections. People who have had silicone injections should not have CO2 procedures, which can burn and scar the skin over the implanted area.


• The erbium:YAG (Er:YAG) laser is gentler than the CO2 and is effective for mild wrinkles and for providing a smooth texture. It has a shorter recovery time. Some experts have even found the YAG laser as effective in removing deep wrinkles as CO2 when used to sufficient depth. A so-called variable pulse YAG laser can shift between pulses that destroy skin to tissue to those that heat the skin; this process effectively resurfaces the skin with fewer side effects than CO2 laser therapy.


• A gentle laser procedure called non-ablative laser resurfacing (NLite), also called photorejuvenation, is now approved for the treatment of all facial wrinkles. The procedure uses light energy to gently stimulate new collagen, and possibly elastin, without removing the skin tissue itself. Its effects are less pronounced than those of other laser procedures. However, because it does not injure the external layers of skin, it can be used on delicate skin areas, such as the neck and around the eyes. It also causes very little irritation afterward.

Some surgeons are using combination techniques that employ more than one laser technology in one session to achieve different effects. For example, one combination technique uses CO2, YAG, pulsed-dye laser, and one other laser technology to both improve wrinkles and clear under-eye dark circles and acne scarring. Pretreatment with botulinum injections before laser resurfacing significantly improved the treatment of crow's feet in one 2001 study.

Post-Procedure Recovery:

The procedure itself is relatively painless, but the redness and irritation that occur during the healing process can be severe. (Non-ablative laser resurfacing does not have the same severe after effects as other laser treatments.) For eight to nine days, the face looks skinned and swollen and requires continuous moisturizing. (Some experts suggest that people with very sensitive skin who can not tolerate the medications and lubricants should avoid laser resurfacing.) Redness and sensitivity can persist for one to four months. The patient must stay out of the sun as much as possible during this time and should always avoid sunbathing and damaging their skin again. Early research suggests that silicone dressings may reduce post-procedure pain and crusting.

Complications:

Scarring and infections can occur in about 1 percent of procedures, with risk increasing or decreasing depending on the experience of the surgeon. People with a history of herpes simplex may experience flare-ups of fever, facial pain, and flu-like symptoms for five or six days afterward. In addition, people with darker skin may wish to avoid the procedure because it can cause unpredictable and dramatic lightening of the skin.

OTHER EXFOLIATION PROCEDURES

Cold Ablation. Cold ablation, called coblation for short, delivers saline (salt water) to the skin through which a cool electric current is passed. A subsequent reaction heats and vaporizes the top shallow layer of skin. The procedure is very specific and appears to minimize any damage to other areas of the skin.

Radiofrequency Resurfacing. A new technique uses low radiofrequency energy to resurface the skin. Preliminary research indicates that this procedure may eventually be as effective as laser surgery in reducing severe wrinkles around the eyes and mouth, with minimal pain and a shorter recovery time.

IMPLANTS

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. Biologic fillers from animal, bacterial, or human sources do not last. Synthetic fillers are permanent but may provoke an allergic reaction, which can cause chronic problems. Such reactions are not common but they can be painful and unattractive.

Implant Procedure & Material Used	Procedure	Specific Areas Affected	Benefits	Drawbacks
Microlipoinjection: Fat tissue from the patients' own thigh or abdomen.	Injected into target wrinkles with needle and syringe.	Deep wrinkles around the nose and mouth, folds in the forehead, and wrinkles on the hands.	No allergic or immune reaction because substance is patient's own fat.	Body eventually absorbs the fat, so multiple injections are needed. Some studies suggest that 70% of the fat may still be viable after at least a year.
Collagen implants. Collagen is the protein that forms the structures in the body (e.g., skin, bones, cartilage). The implant procedure uses bovine (cow) collagen. A form of human collagen will be available soon.	Injected into target wrinkles with needle and syringe. Several weeks after injection, the cow collagen breaks down and is replaced by newly created human collagen.	Wrinkles around the eyes and mouth; used to give lips greater fullness.	Very simple with faster recovery than many other implant techniques.	Wrinkles reform and repeat treatments are needed three to 12 months later. Rarely, severe allergic reactions. Should not be used by children, pregnant women, and people with a history of autoimmune disease.
Gore-Tex. Highly porous and inert (not chemically active) synthetic material.	Requires some surgery. Tiny patches are inserted under the skin to fill out wrinkles. Skin cells and blood vessels penetrate the porous material easily, reducing the risk of severe inflammation.	Deep wrinkles.	Material does not degrade.	Possible scarring from surgical procedure. Allergic reactions are rare but can occur even with chemically inactive materials.
Artecol. Highly porous and inert (not chemically active) synthetic material.	Material is injected, enclosed in tiny droplets of natural collagen.	Deep wrinkles.	Although part of the implant is natural collagen implant, it does not degrade as quickly as a full collagen implant.	Repeat treatments still may be needed. Possible allergic reaction.
Hyaluronic acid (Hylaform, Restylan). Natural substance acts like a molecular sponge to absorb water.	Material is injected under the skin.	Deep wrinkles.	Low risk for allergic reaction (but still can occur). May last longer than bovine collagen.	Repeat treatments needed.

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.

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. When used for areas around eyes, it produces a rounder appearance afterward, which patients should be aware of before they undertake the procedure.

The drug does not cross the blood-brain barrier, and, to date, the only side effects are temporary muscle weakness near the injection site. Although there have been some reports that Botox can reduce migraine and tension headaches, Botox also causes headaches in about 1 percent of cases. In some cases, the headaches can be very severe and long lasting (from eight days to a month). Some experts suggest that either a contaminated batch of Botox or a specific injection technique may be the cause, but additional investigation is needed.

PLASTIC SURGERY FOR WRINKLES

Face Lifts (Rhytidectomy): A number of face-life procedures (called rhytidectomies) are available. Face lifts 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.

Neither SMAS nor the endoscopic version is effective for the middle part of the face, particularly the deep lines (naso-labial folds) that run down from the nose beside the mouth. Some time after the SMAS face lift, the upper face begins to age again while the lower area still retains its shape, causing the face to look imbalanced. Other approaches, such as one called composite face lifts that lift most muscles in the face are being investigated.

Recovery Process. Recovery normally lasts from several weeks to several months. Swelling and discoloration are common. Some patients report tingling or numbing sensations after surgery, which generally subside as damaged nerves regenerate.

Complications. Rhytidectomy is not without risks. A postsurgical hematoma is a collection of blood that can occur after a rhytidectomy. In one study major hematomas occurred in 2.2 percent and minor hematomas in 6.65 percent of patients. They generally develop within two weeks of the surgery and require drainage. Even minor hematomas need fast treatment to prevent greater complications, including infection, changes in pigmentation, fluid buildup, and prolonged recovery time.

Other less common complications may include the following:

• Infection.


• Excessive bleeding.


• Asymmetrical facial muscles.


• Delayed healing.


• Scarring.


• Permanent injury to the nerves that control facial movements.

It should be noted that these complications are rare, particularly with a skilled surgeon, but the more complex the face lifts, the greater the risk.

Procedures for Eyes

• Blepharoplasty. Blepharoplasty is the primary surgical procedure for eye lifts. Results usually last between five and ten years. Although simple, it has potential complications, including permanent difficulty in closing the eyes or making a stern expression. Newer techniques, however, are preventing this complication. Assuming the surgeon is experienced, laser surgery is now preferred to the standard surgical scalpel approach; bleeding and bruising are reduced, and both the operation and recovery are faster.


• Transconjunctival Upper Blepharoplasty. An innovative procedure called transconjunctival upper blepharoplasty removes fat from the membrane that lines the eyelids (the conjunctiva) and is an effective technique for treating both the upper and lower eyelids. Unlike traditional blepharoplasty, this procedure does not cause scarring in the nasal area. In patients who have scars from previous surgeries, transconjunctival removal of fat can also make existing scars less obvious. Long-term side effects and efficacy of this procedure have not been studied.

Procedures for the Neck

• Laser Liposculpture and Platysma Resurfacing. A procedure called laser neck and jowl liposculpture and platysma resurfacing may prove to be an alternative to face lifts. The procedure requires only a one-inch incision under the chin and removing excess fat. After the fat is removed, the surgeon tightens the platysma, the thin muscular sheet under the skin of the neck, which improves the shape of the neck. Only local anesthetic is needed and the patient can return to normal activities in two days. The patient's skin should be elastic enough to be able to reform without sagging.

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HOME TREATMENT FOR SKIN WRINKLES

HEALTHY LIFESTYLE

Needless to say, the best long-term prevention for overly wrinkled skin is a healthy lifestyle including the following:

• Eat Healthy. 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 anti-oxidants found in them. (See more about Nutrition and Holistic Recommendations below.)



• Exercise. Daily exercise keeps blood flowing, which brings oxygen to the skin, an important ingredient for healthy skin.
  
  
• Reduce Stress. Reducing stress and tension may have benefits on the skin.
  
  
• Quit Smoking. Smoking not only increases wrinkles, but smokers have a risk for squamous cell cancers that is 50 percent higher than nonsmokers' risk. Smokers should quit to prevent many health problems, not just unhealthy skin. (For more detailed information, see Smoking and Smoking Cessation & Weight Gain: Quit & Keep The Pounds Off.)

DAILY PREVENTIVE SKIN CARE

Some daily measures for skin protection are as follows:

• Don't wash face too often with tap water. (Once a day is enough.) It strips the skin of oil and moisture. In addition, chlorinated water, particularly at high temperatures, poses special risks for wrinkles.


• Wash the face with a mild soap that contains moisturizers. Alkaline soaps, especially with deodorant, should be avoided.


• Pat the skin dry and immediately apply a water-based moisturizer.


• Always apply sunscreen, even if going outdoors for short periods.


• Avoid drinking alcohol within three hours of bedtime. Alcohol increases the risk for leaks in the capillaries, which allows more water in and causes sagging and puffiness. Capillary leakage increases when one is lying down.
• Lie on the back when sleeping. This helps offset the effects of gravity.

ANTIOXIDANT PRODUCTS: General Information

Antioxidants are substances that act as scavengers of oxygen-free radicals, the unstable particles that can damage cells and which are implicated in sun damage and even skin cancers. Antioxidants in the skin are depleted when exposed to sunlight and must be replaced. Antioxidant topical products (such ointments, creams, and lotions) may help reduce the risk of wrinkles and protect against sun damage. Unlike sunscreens, they accumulate in the skin and are not washed away, so the protection may last. The antioxidants marketed for skin protection include vitamins A, C, E, selenium, coenzyme Q10 (CoQ10), and alpha-lipoic acid.

Some research has been conducted on the effects on wrinkles using oral antioxidant supplements. One small study found that taking a combination of vitamins oral C and E supplements may help reduce sunburn reactions, although the protection is much less than from sunscreens. (Taking the vitamins singly does not appear to have the any effect.)

ANTIOXIDANTS: Vitamin A Topical Products

Vitamin A is important for skin health and UV radiation produces deficiencies in the skin. Topical products containing natural forms of vitamin A (retinol, retinaldehyde) or vitamin A derivatives called retinoids (tretinoin, tazarotene) have proven to be beneficial for skin damaged by the sun and also by natural aging.

Tretinoin (Retin-A). Tretinoin (known commercially as Retin-A) is the only topical agent approved for treating photoaging and is available in prescription form (Avita, Renova, Differin). This agent produces a rosy glow and reduces fine and large wrinkles, liver spots, and surface roughness. It also may help prevent more serious effects of ultraviolet radiation. Tretinoin may be applied to face, neck, chest, hands, and forearm and should be applied at least twice a week. Noticeable improvement takes from two to six months. Because Retin-A increases a person's sensitivity to the sun, a thin coat is best administered at bedtime. A sunblock should be worn during the day, and overexposure to the sun should be avoided.

Almost all patients experience redness, scaling, burning, and itching after two or three days that can last up to three months. In women who experience irritation, a daytime moisturizer or low-dose corticosteroid cream, such as 1 percent hydrocortisone, may help. There is some concern that overuse of high-dose tretinoin may cause excessive skin thinness over time. Studies now suggest that low concentrations (as low as .02 percent) of tretinoin can produce significant improvements in wrinkles and skin color, with less irritation than at higher doses. Oral tretinoin causes birth defects, and women should avoid even topical Retin-A when pregnant or trying to conceive.

Retinol. Retinol, a natural form of vitamin A, could not, until recently, be used in skin products because it was unstable and easily broken down by UV radiation. Stable preparations are now sold over the counter. In the right concentrations, retinol may be as effective as tretinoin and studies indicate that it has fewer side effects. An animal study suggests that adding antioxidant creams (such as those containing vitamins C or E) may offer added protection against degradation of retinol, but not tretinoin. The FDA warns that over-the-counter retinol skin products are unregulated; the amount of active ingredients is unknown, and some preparations, in fact, may contain almost no retinol.

Tazarotene. Tazarotene (Tazorac, Zorac) is a retinoid used for acne and psoriasis. One short-term study suggested that it may be as effective as tretinoin and even slightly better at high doses. At such high doses, however, it can cause very severe irritation. Redness and peeling may be reduced by administering tretinoin first to get the skin acclimated. More research is needed to determine if it produces any long-lasting significant benefits. As with any vitamin A derivative, it should be avoided by pregnant women and those who may become pregnant.

ANTIOXIDANTS: Other Topical Products

Although there are wide claims about the benefits of antioxidants for wrinkles when used in skin creams, to date, only vitamins E and C and selenium applied topically have been proven to have any benefits for reducing sun damage in the skin. Even with these antioxidants, however, most available brands contain very low concentrations of them. In addition, they are also not well absorbed and they have a short-term effect. New delivery techniques, however, may prove to offset some of these problems.

Vitamin C, or ascorbic acid. This is a very potent antioxidant and most studies on the effects of antioxidants on the skin have used this vitamin. In laboratory studies, large amounts reduced skin swelling and protected immune factors from sunlight. It may even promote collagen production. Vitamin C by itself is unstable, but products that solve the delivery problem are now available (e.g., Cellex-C, Avon's Anew Formula C Treatment Capsules, and others). One 2002 study using Cellex-C reported reduction in wrinkles around the mouth, on the cheek, and around the eyes. The product also appeared to improve skin thickness.

Vitamin E. Studies suggest that topical vitamin E, particularly alpha tocopherol (a form of vitamin E) cream decreased skin roughness, length of facial lines, and wrinkle depth. Studies on mice have also reported reductions in UV-induced skin cancer with its use.

Selenium. In the form of L-selenomethionine, selenium has protected against sun damage and even delayed skin cancer in animal studies. It is not known if such benefits apply to people.

One 1999 study found that topical application of the antioxidant Coenzyme Q10 (CoQ10) improved the skin's resistance to the oxidative stress of UV radiation, and when applied long-term, could reduce crow's feet.

ALPHA HYDROXY ACID & HOME EXFOLIATION

One of the basic methods for improving skin and eliminating small wrinkles is exfoliation (also called resurfacing), which is the removal of the top layer of skin to allow regrowth for new skin. Methods for doing this run from simple scrubs to special creams to intensive peeling treatments, including laser resurfacing. People with darker skin are at particularly higher risk for scarring or discoloration with the more powerful exfoliation methods.

Abrasive Scrubs. Scrub gently with a mildly abrasive material and a soap that contains salicylic acid to remove old skin so that new skin can grow. The motion should be perpendicular to the wrinkles. Use textured material or cleansing grains with microbeads. Organic materials, such as loofahs or sea sponges may harbor bacteria. Avoid cleansing grains that contain pulverized walnut shells and apricot seeds, which can lacerate skin on a microscopic level. Cleansing grains with microbeads don't have sharp edges and remove skin without cutting it. Exfoliation using scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels.

Topical Alpha Hydroxy Acid and Similar Substances. Alpha hydroxy acids facilitate the shedding of dead skin cells and may even stimulate the production of collagen and elastin. They are found naturally as follows:

• Lactic acid (milk).


• Glycolic acid (sugar cane).


• Malic acid (found in apples and pears).


• Citric acid (oranges and lemons).


• Tartaric acids (grapes).

Lactic and glycolic acids are used most often in commercial products. The preparations containing lactic acid may be slightly more effective than those made with glycolic acid. Products have also been developed that are made from larger molecules called poly-alpha-hydroxy acids and others from beta-hydroxy acids or BHAs (usually containing salicylate acid, the primary ingredient in aspirin). Manufacturers claim that such products are less likely to irritate the skin.

Acid concentrations in over-the-counter AHA preparations are 2 to 10 percent. One clinical study suggested that 8 percent concentrations showed modest improvement. Some examples include Avon's Anew Intensive Treatment (8 percent glycolic), Pond's Age Defying Complex (8 percent), Elizabeth Arden's Alpha-Ceramid Intensive Skin Treatment (3 to 7.5 percent), and BioMedic's home product (10 percent). Prescription strength creams contain at least 12 percent glycolic acid, and glycolic acid peels of 30 to 70 percent concentration may be administered in a health care provider's office at weekly or monthly intervals.

Response to AHA varies, and the treatment is not without risk, particularly in high-concentration products. Side effects from over-the-counter creams, prescription products, and professional AHA peels can include burns, itching, pain, and possibly scarring. Studies also suggest that AHA may increase sun damage, even at concentrations as low as 4 percent. Experts advise that people should purchase products with AHA concentrations of 10 percent or less. If any adverse effects occur, the product should be stopped immediately. In all cases, people are advised to avoid sunlight or use proper sun protection when using them.

Experts are further concerned because part of the wrinkle-reducing effects of alpha hydroxy involves calcium loss, which in turn may promote cell growth and impair differentiation. Theoretically, this might increase the risk for skin cancer. There is no evidence of this at all, but more research is warranted on long-term effects of AHA.

MOISTURIZERS

Moisturizers help prevent dryness, bruising, and tearing but have no effect on wrinkles by themselves. They should be applied while the skin is still damp. These products retain skin moisture in various ways:

• Occlusives, such as petroleum jelly, prevent water from evaporating.


• Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin generally should use the humectant type.


• More powerful compounds, such as one called monolaurin (Glylorin), contain mixtures of fatty molecules called lipids, which may help restore the skin's natural barriers against moisture loss and damage.

Most moisturizers contain combinations of these and usually have other ingredients, such as AHA, sunscreens, collagen, and keratin. (Collagen and keratin leave a protein film and temporarily stretch the skin.) They range widely in price, and a major consumer organization found little difference in general between the more and less expensive products.

UNDER-EYE CREAMS

The skin under the eyes is very thin and does not produce as much of the protective oils that keep skin soft and supple. Under-eye gels are aimed at reducing puffiness and dark circles. They typically work in one of two ways:

• Temporarily constricting blood vessels to prevent the build-up of fluids.


• Firming the skin with an invisible film.

Never rub under the eyes, as this may cause more wrinkles to form. Instead, apply these products with a light tapping motion to stimulate the skin.

OTHER SKIN TREATMENTS

Other Natural Anti-Wrinkle Remedies. The following natural substances have antioxidant properties and are being tried for wrinkle-protection.

• Both green and black tea and ginger appear to have properties that may provide some protection against skin cancers and photoaging. A 2001 study using extracts of topical green tea suggested that it might protect against ultraviolet damage. More research is warranted. Green tea skin care products are now available, but their quality is unregulated.


• The substance silymarin, found in the milk thistle family (which includes artichokes), may inhibit UVB-promoted cancers in animals.


• Aloe, lemon oil, grape seed extract, and coral extracts contain antioxidants and are promoted as being healthy for the skin, although evidence of their effects on wrinkles is weak. Warning Note: A wide range of herbal products, both oral and topical, may contribute to dermatological problems. Some Chinese herbal creams have been found to contain corticosteroids, and some may contain mercury or arsenic contaminants have been reported in some Ayurvedic therapies. In addition, a number of oral herbal remedies used for medical or emotional conditions may produce irritation in reaction to sunlight (photosensitivity). The include but are not limited to St. John's Wort, kava, and yohimbine. St. John's Wort, in fact, has been associated with severe toxicity in a patient who had laser treatments.


• Furfuryladenine. Furfuryladenine (Kinetin, Kinerase) is a naturally occurring growth hormone found in plant and animal DNA; it has antioxidant and anti-aging properties. Some small laboratory studies suggest that it may both delay the onset and decrease the effects of aging on skin. However, no well-conducted human trials have been performed.


• Vitamin K. Microsponge-based vitamin K is being promoted to clear bruises spider veins, and other small blood vessel damage. Vitamin K is important for blood clotting.

COSMETICS

Cosmetics, if properly applied, can be surprisingly effective in camouflaging the signs of aging skin, including wrinkles and age spots. Moreover, they offer additional benefits by retarding water loss and providing a physical barrier to UV radiation. However, as women age, less is more. Here are some suggestions for older women:

• Moisturizers. Moisturizers should be applied before foundation. If reddish discoloration is extensive or the skin is sallow, tinted moisturizers may be helpful and can be worn alone or under foundation.


• Foundations. Caking on make-up will cause cracks at the wrinkle lines and only increase the appearance of aging. Large areas of the face are best covered with a moderate-coverage foundation with a matte or semi-matte finish. Facial powder reflects light and thus minimizes wrinkles but should be avoided by people with dry skin.


• Correcting Color. When blemishes are especially prominent, applying color correctors under the foundation can be very effective:
  • Green neutralizers mask red lesions.
  
  
  • Yellow will camouflage dark circles and bruises.
  
  
  • Mauve (a purplish-pink color) helps neutralize sallow skin or yellowish blemishes.
  
  
  • A white, pearled base helps to minimize wrinkles.
  
  
• Blushes. Blushes and color washes can help conceal the spidery network of dilated capillaries on the nose and cheeks. Powder blushes are preferred because they blend easily on top of foundation.


• Eyes. Powder eye shadows applied on top of a moisturizer are preferred to cream-based shadows. The appearance of deep-set eyes is best offset with light-colored shadow, which should be applied along the upper eyelid crease and above the iris. A slightly deeper shade of the same color should then be applied to the lower part of the eyelid and drawn out to the corner.


• Lips. A lip-setting cream or facial foundation should be applied before lipstick to help prevent it from bleeding into surrounding wrinkles. Try using a stiff bristle brush instead of a lip pencil. The brush will help keep the lipstick on and prevent bleeding. (Some women use the pencil itself for the full lip, which gives color but appears natural.) Some make-up artists recommend cream lipsticks instead of matte.

Skin, Face, Lip Wrinkles Supplements, Information & Products

Information, supplements and products on wrinkles on the skin, face and lips.

	Macadamia Nut Oil, MacNut Oil, 100% Organic Nature's Way - 16 fl. oz. (474ml) Nature's Way MacNut Oil has zero net carbs, is ideal for low carb diets and endorsed as part of the popular book THE HAMPTONS DIET.
	Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000mg - 250 Vcaps Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
	Skin Formula, Antioxidant Skin Care System with Lipoic Acid, DMAE, Vitamin C Ester & Tocotrienol - 60 Caps This antioxidant formula supports and enhances your body's natural defense mechanisms against free radical damage from the inside, where caring for your skin starts.
	Face Creme, Tissue Revitalizing, Antioxidant Skin Care System with Lipoic Acid, DMAE, Vitamin C Ester & Tocotrienol - 2 fl. oz. Tissue Revitalizing Face Creme contains all four key ingredients, DMAE, Alpha Lipoic Acid, Vitamin C Ester and Tocotrienol, to rejuvenate your skin and reduce the signs of aging.
	Super Skin Serum, Antioxidant Skin Care System with Lipoic Acid, DMAE, Vitamin C Ester & Tocotrienol - 1 fl. oz. Unique to Super Skin Serum is the healing power of beta glucan, a complex carbohydrate. Oat beta glucan, found in the bran part of the oat, stimulates renewal of skin cells and is used by burn surgeons worldwide to treat burn victims.
	Cocoa Butter, 100% Pure, NOW Foods - 7 oz. Cocoa butter is used in confections and in the manufacture of tobacco, soap, and cosmetics. By itself, it is used to improve skin elasticity and to reduce wrinkles.
	Hyaluronic Acid Hydraplenish with MSM and BioCell Collagen Nature's Way - 60 Vcaps Hydraplenish contains the patented BioCell Collagen II complex for healthy connective tissue and synovial fluid plus OptiMSM to support healthy hair.
	Hyaluronic Acid Hydraplenish with BioCell Collagen Nature's Way - 60 Vcaps Hydraplenish contains the patented BioCell Collagen II complex for healthy connective tissue and synovial fluid.
	Facial Cleanser, Natural Foaming w/ Organic Aloe Vera, Lipoic Acid & DMAE - 3.4 fl. oz. Foaming Natural Facial Cleanser provides a luxurious foam and gentle, effective cleansing without drying your skin or making it feel taut.
	Facial Mist FRAGRANCE FREE Hydrating Oil-Free w/NaPCA Organic AloeVera, Lipoic Acid & DMAE - 2 fl. oz. This light moisturizing spray provides your skin with a refreshing antioxidant treatment that will protect your skin and leave it feeling fresh and revitalized with no oil. Contains the added benefits of NaPCA and organic aloe vera gel.
	Hair and Skin w/ MSM & Glucosamine Nature's Way - 100 Caps Nature's Way Hair and Skin with MSM and Glucosamine combines MSM, glucosamine and more to bring you the best combination for Hair and Skin health.
	MSM Lip Balm with Jojoba Oil (Methysulfonylmethane), SPF 15 Sun Protection, All Natural - 0.15 oz. MSM lip balm helps promote smooth moisturized lips all day long, helps heal chapped lips and offers SPF 15 sun protection.
	MSM Supplement (Methylsulfonylmethane) 1000 mg - 120 Caps Pure Lignisul with Free 4 oz. Lotion Buy MSM Supplement caps and get a 4 oz Lotion free, MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.
	Alfa Max, Alfalfa Extract, Nature's Way 525mg - 100 Caps Nature's Way Alfa-Max is much more digestible than raw alfalfa because the plant cellulose has been removed. Eight Alfa-Max capsules contain approximately 43% protein (by weight) and 2,600 IU of Vitamin A (as natural beta-carotene). Alfa-Max delivers 52% of the USRDA for vitamin A.
	Cellfood Oxygen Gel, Skin Treatment - 1.7 oz. (50ml.) This mask forming, nutrient rich topical gel helps renew skin texture rendering it softer, smoother, and firmer.
	Fruit Oil Cleanser, Oxygen Skin Treatment CELLFOOD - 4 fl. oz. (118ml.) The perfect introduction to any skin care program. The deep cleansing process will leave your skin feeling smooth as silk while you enjoy increased dermal vitality.
	Pureaskin Urea Lotion, Unscented - 4 fl. oz. Pureaskin Urea Lotion promotes smooth, beautiful, wrinkle-free, younger-looking skin.
	MSM Lotion with Aloe (Methylsulfonylmethane) (15%) - 4 fl. oz. MSM lotion with aloe vera supports healthy skin, helping to keep it moisturized and smooth throughout the day.
	Pasca-Balm Bentonite Ointment & Skin Softener - 5 oz. For minor skin irritations, cuts scrapes, bug bites, itchy rashes, dry and cracked skin. Rub into or dab on skin as desired or several times daily.
	Pasca-Glow Bentonite Glycerin Soap - 4 oz. (1 Bar, Hand Made, All Natural) A total body soap for use in shower or bath. Good for oily or sensitive skin. Exfoliates. A potent skin cleanser and conditioner.
	Pasca-Pak Bentonite Poultice & Facial Treatment - 5 oz. An Easy to use and ready to go paste with strong drawing power, hand made and developed as a soothing facial treatment to cleanse and revitalize the skin, drawing oils and unwanted toxins.
	Black Seed Oil, Premium Cold Pressed - 8 fl. oz.(240mL) Black Seed Oil is an excellent healer, and its areas of application range from external skin care (psoriasis, eczema, dry skin, joints & scalp massage) and to internal use as a treatment for various complaints (asthma, arthritis, immune system).
	Cream of COCO, All Natural, Hair & Body Shampoo, 2 bars - 6.35 oz. Preserves and protects the natural color of hair, softens and heals skin, revitalizes skin cells, stops hair loss, prevents dandruff and lathers in hard water.
	Beauty Mate Herbal Tea - 20 Tea Bags Beauty Mate herbal tea is especially designed for Women. It is very effective in regulating cycles and improving blood circulation, maintaining a good skin texture and a clear complexion.
	Ribonucleic Acid RNA Phytonutrient, Vegan, Approximately 86 Servings - 9.5 oz. Ribonucleic Acid is responsible for building proteins and protein synthesis in the body.
	Burt's Bees Cucumber Chamomile Complexion Mist - 4 fl. oz Soothing Complexion mist is specially formulated for sensitive skin.
	Aloe Vera Skin Gel, Herbal Aloe Force, Organically Grown Unprocessed Whole Raw Aloe Vera - 4 fl. oz. Can keep your skin looking clean, clear, smooth, toned, hydrated and glowing with health. Can also reduce the appearance of fine lines, wrinkles and sun damage.
	Lizard Lips SPF 22 Natural Lip Balm Lizard Lips Natural Lip Balm Protects Against Sun, Wind, & Cold.

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HERBAL & HOLISTIC RECOMMENDATIONS

HERBS

Alfalfa, burdock root, chamomile, horsetail, oat straw, and thyme are all good for general nourishment of the hair, skin, and nails.

Aloe vera has soothing, healing, and moisturizing properties. Apply pure aloe vera gel to dry skin as directed on the product label.

Other herbs that are beneficial for skin tone include borage seed, flaxseed, ginger root, lemon grass, parsley, and pumpkin seed.

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CONSIDERATIONS

Selecting good skin care products can be confusing. You should seek out products containing natural ingredients and avoid those that contain petroleum, mineral oil, or any hydrogenated oils. Do not use any product if you have allergic sensitivities to that product. Some good ingredients to look for in skin care products include the following:

• Allantoin, a soothing agent derived from comfrey.


• Alpha-hydroxy acids, natural fruit acids that encourage the shedding of dead surface skin cells and the formation of fresh, new skin cells.


• Aloe vera, which is rich in nutrients and softens the skin.


• Arnica, an herb with astringent and skin-soothing properties.


• Burdock, an herb that helps the body eliminate poisons from the skin.


• Calendula, an herb that promotes skin cell formation and stimulates tissue growth, and also soothes and softens sensitive skin.


• Chamomile, an anti-inflammatory, antibacterial herb that is good for sensitive skin.


• Collagen, a protein found in healthy young skin tissue.


• Comfrey, an herb that aids healing and soothes chapped, irritated, or blemished skin.


• Cucumber, which contains amino and organic acids that cool and refresh the skin and tighten the pores.


• Essential fatty acids, (including linolenic, linoleic, and arachadonic acids), which smooth rough skin, protect against moisture loss, and prevent invasion by free radicals.


• Ginkgo biloba, an antioxidant that helps skin stay younger looking.


• Glycerine, a soap byproduct that attracts and holds moisture in the skin.


• Ivy, an herb that stimulates circulation and aids other ingredients in penetrating the skin.


• Liposomes, microscopic bubbles that deliver active ingredients deep into the skin.


• Panthenol (provitamin B5), a nutrient that builds moisture and soothes irritation.


• Retinoic acid, a form of vitamin A that soothes skin, promotes cell renewal, and improves circulation to the skin.


• Sage, an herb with astringent properties that tones the skin.


• Witch hazel, a natural astringent that tones the skin.


• Yarrow, an astringent herb that acts as an anti-inflammatory and tightens and firms saggy skin.

There are many excellent home facial treatments that can help with specific skin problems. Do not use any item that you may have allergic sensitivities. Some of the best include:

• To add color to sallow skin, mash 1/2 cup or so of strawberries in a blender and apply them to your face. Leave them on for ten minutes, then rinse with tepid water.


• To alleviate puffiness in the eye area, place cool cucumber slices over your eyes for ten minutes or more, as needed.


• To cleanse the pores, rub mashed tomato over your face.


• To help protect your skin from free radical damage, add a few drops of green tea extract to your lotions, astringents, and other beauty products.


• To moisturize your skin, mash together grapes (a natural source of collagen and alpha-hydroxy acids) with enough honey to make a paste, and apply the mixture to your face as a mask. Leave it in place for twenty to thirty minutes while you relax, then rinse it off.


• To remove dead surface skin cells and improve skin texture, gently rub a small handful of dry short-grain rice against your face for a few minutes. This technique has been used by Japanese women for centuries.


• To soften and nourish the skin, mash half of an avocado and apply it to your face. Leave it on until it dries, then rinse off with warm water. Avocado contains essential fatty acids and other nutrients that help prevent premature wrinkling.


• To tighten and refine pores, whip up the white of an egg with a pinch of alum and apply it to your face as a mask. After fifteen to twenty minutes, rinse it off with lukewarm water.

Herbs are available in bulk form from Mountain Rose Herbs. See link near bottom of page.

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RECOMMENDATIONS

Eat a well-balanced diet that includes many and varied fruits and vegetables, preferably raw, to provide your skin with the nutrients it needs. Also eat whole grains, seeds, nuts, and legumes.

Drink at least 2 quarts of water every day, even if you do not feel thirsty. This helps to keep the skin hydrated and to flush away toxins, discouraging the formation of wrinkles.

Obtain fatty acids from cold-pressed vegetable oils. Avoid saturated and animal fats.

Do not smoke, and avoid alcohol and caffeine. All of these substances dry out the skin, making it more vulnerable to wrinkling. In addition, the smoking habit means pursing one's lips hundreds of times each day. The creases that form when you inhale from a cigarette often develop into wrinkles at a comparatively early age.

No matter what your age or skin type, protect yourself from the sun. Always apply a sunscreen with a sun protection factor (SPF) of at least 15 to all exposed areas of skin, especially your face, regardless of the season or the weather. Sun exposure is the single greatest source of skin damage.

Get regular exercise. Like other organs of the body, skin gets its nourishment from the bloodstream. Exercise increases the circulation of blood to the skin.

Exercise your face. Sit in a chair and extend your jaw in an exaggerated chewing motion. Stretch the muscles under your chin and the front of your neck. Lying on a slant board for fifteen minutes a day is also good.

Avoid alcohol-based toning products. Use witch hazel or an herbal/floral water instead.

Pay attention to your facial expressions. If you find yourself squinting, raising your eyebrows, or making some other potentially wrinkle-producing expression over and over again, you can make a conscious effort to stop. If you must make facial expressions, it is always better to have smile lines than frown lines around your mouth. So smile and laugh frequently.

Practice good skin care and keep your skin well lubricated, especially if it is dry. See Dry Skin for more information.

Avoid using harsh soaps or solid cleansing creams such as cold cream on your face. Use natural oils such as avocado oil instead to remove dirt and old makeup. Apply it gently to your face and rinse it off with warm water. E-Gem Skin Care Soap from Carlson Laboratories is also good. Use a facial sponge or loofah several times a week to remove dead, dry skin cells and stimulate circulation.

After cleansing your skin, apply a moisturizing lotion, preferably while the skin is still damp. Vitamin A Moisturizing Gel from Derma-E Products is a good nongreasy moisturizer that is quickly absorbed and diminishes the appearance of fine lines. It is available in health food stores.

Open a capsule of ACES+Zinc from Carlson Labs and add the contents to your moisturizing cream before applying. This will help protect the skin from free radical damage. Do the same with your sunscreen.

Do not apply heavy oils around the eye area before going to bed. This may cause eyes to be puffy in the morning.

Limit your use of cosmetics, and choose the ones you do use carefully. Do not share your cosmetics, and replace them every three months.

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Nutrients
Supplement	Suggested Dosage	Comments
Very Important
Primrose oil Or Black currant seed oil	1000 mg 3 times daily. As indicated on label.	Good healers for dermatitis, acne, and most other skin disorders. These oils contain linoleic acid, which is needed by the skin. Evening Primrose Oil, Cold Pressed, Nature's Way, 500 mg, 250 Softgels
Vitamin A	25,000 IU daily for 3 months, then reduce to 15,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily.	Necessary for healing and construction of new skin tissue. Nature's Way Natural Vitamin A, 10,000 IU, 100 Softgels, Nature's Way Natural Beta Carotene 25,000 IU, 100 Softgels
Plus Natural carotenoid complex (Betatene)	As directed on label.	Antioxidants and vitamin A precursors. Nature's Way Natural Beta Carotene 25,000 IU, 100 Softgels, Nature's Way Multi-Carotene Antioxidant, 60 Softgels
Vitamin B complex Plus extra Vitamin B12	As directed on label. 300 - 1,000 mcg daily.	Anti-stress and anti-aging vitamins. Sublingual forms are best. Nature's Way Vitamin B Complex, 100 Caps, Vitamin B-12 Complex Liquid, Now Foods, 2 fl oz (60 ml)
Important
Kelp	1,000 - 1,500 mg daily.	Supplies balanced minerals needed for good skin tone. Nature's Way Kelp Supplement, 100 Caps, Certified 650 mg
Selenium	200 mcg daily.	An antioxidant that works synergistically with vitamin E. Nature's Way Selenium, 100% Natural, 200 mcg, 100 Caps
Silica	As directed on label.	Important for skin strength and elasticity. Stimulates collagen formation. Now Foods Silica Complex, Vegetarian, 500 mg, 90 Tabs, Cellfood Silica Liquid Drops, 4 fl oz (118 ml), Original Silica Gel Caps, Nature's Way, 90 VCaps
Vitamin C with bioflavinoids	3,000 - 5,000 mg daily, in divided doses.	Necessary for the formation of collagen, a protein that gives the skin its flexibility. Also fights free radicals and strengthens the capillaries that feed the skin. Nature's Way Vitamin C w/bioflavonoids, 100% Natural, 500 mg, 250 Caps, Nature's Way Vitamin C w/bioflavonoid, 100% Natural, 1000 mg, 250 VCaps, Now Foods Vitamin C Complex Powder, Vegetarian Formula, 8 oz
Vitamin E	Start with 400 IU daily and increase slowly to 800 IU daily..	Protects against free radicals that can damage the skin and contribute to aging. Nature's Way Vitamin E, d-alpha tocopherol, 400 IU, 100 Softgels
Zinc Plus Copper	50 mg daily. Do not exceed a total of 100 mg Zinc. 3 mg daily copper.	For tissue strength and repair. Use zinc gluconate lozenges or OptiZinc for best absorption. Needed for collagen production and healthy skin. Also needed to balance with zinc. Complete Zinc w/Copper Minerals, 90 Tabs, Trace Minerals
Helpful
Ageless Beauty from Biotec Foods	As directed on label.	Protects the skin from free radical damage. Super Skin Serum, Antioxidant Skin Care System with Lipoic Acid, DMAE, Vitamin C Ester, & Tocotrienol, 1 fl oz
Aloe vera	Apply pure aloe vera gel to dry skin as directed on the product label.	Soothing, healing, and moisturizing properties. Neem Leaf & Aloe Vera Gel, 8 fl oz, Aloe Vera Gel & Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter
Calcium And Magnesium	1,500 mg daily. 750 mg daily.	Deficiency contributes to fragility of skin. Needed to balance with calcium. Cal-Mag Pre-chelated Calcium & Magnesium, Vital Earth, 800 mg / 400 mg, 240 Gelcaps, Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl oz
Collagen cream	Apply topically as directed on label.	Good for very dry skin. A nourishing cream. Hyaluronic Cream, Life-Flow, 3 oz, ShiKai Eye Renewal Cream, 0.5 oz
Elastin cream	Apply topically as directed on label.	Helps smooth existing wrinkles. Prevents formation of new ones. Radiant Skin Anti-Aging & Skin Care Moisturizer, Life-Flo, 3 oz, Hyaluronic Acid, Resilience Rescue, Day Wrinkle Remedy, Now Foods, 2 oz
Flaxseed oil capsules Or Liquid Or Ultimate Oil from Nature's Secret	1,000 mg daily. 1 teaspoon daily. As directed on label.	To supply needed essential fatty acids. Fresh Flax Seed Oil, 100% Organic, Pure & Unfiltered, 32 fl oz, Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps
GH3 cream from Gero Vita	Apply topically as directed on label.	Excellent for the prevention of wrinkles. Also good for any discoloration of the skin. Procaine Ultra GH9 (Ultimate 9), 100 mg, 60 Caps
Glucosamine sulfate Or N-Acetylglucosamine (N-A-G from Source Naturals)	As directed on label. As directed on label.	Important for the formation of healthy skin and connective tissue. Glucosamine Sulfate (FlexMax) Nature's Way, 750 mg, 80 Tabs, Now Foods Glucosamine Sulfate Powder, 6 oz
Herpanacine from Diamond-Herpanacine Associates	As directed on label.	Contains antioxidants, amino acids, and herbs that promote skin health.
Pycnogenol	As directed on label.	A free radical scavenger that also strengthens collagen. Pycnogenol w/Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs
Superoxide dismutase (SOD)	As directed on label.	A free radical destroyer. Also good for brown age spots. GliSOD Antioxidant Catalyst, Now Foods, 100 mg, 90 VCaps
Tretinoin (Retin-A)	As prescribed by health care provider.	Removes fine lines and smooths out wrinkles; also excellent for age spots, precancerous lesions, and sun-damaged skin. Available by prescription only. Takes about 6 months to show results.
Vitamin D	400 IU daily.	Deficiency can contribute to aging of the skin. Dry Vitamin D, 400 IU, Nature's Way, 100% Natural, 100 Caps

NOTIFY YOUR HEALTH CARE PROVIDER IF...

You want further information about the various medical procedures available that may help you to treat wrinkling of skin.

You have any pain, swelling, inflammation or other signs of infection of skin tissue.

You have any unexpected or unusual symptoms. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain herbs or other treatments. If you have reactions to any product, herb, or treatment, immediately discontinue treatment and consult with your health care provider or dermatologist.

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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements

-- by Phyllis A. Balch, James F. Balch

HELPFUL INFORMATION

American Society of Plastic and Reconstructive Surgeons, Inc., 444 East Algonquin Road, Arlington Heights, IL 60005. Call (888-4PLASTIC) or (http://www.plasticsurgery.org/).

This group offers educational materials on choosing a qualified surgeon and referral listings of plastic surgeons. They will also verify the credentials of a plastic surgeon.

American Academy of Dermatology and American Society for Dermatologic Surgery, 930 E. Woodfield Rd., Schaumburg, IL 60168-4014. Call (847-330-0050) or to locate a dermatologist (888-462-3376) or (http://www.aad.org/) and (http://www.asds-net.org).

FDA Office of Consumer Affairs, Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5100 Paint Branch Parkway, College Park, MD 20740-3835. On the Internet (http://vm.cfsan.fda.gov/~dms/cos-toc.html).

The Food and Drug Association (FDA) offers good, reliable information on a number of skin products and cosmetic procedures.

The Environmental Protection Agency provides information on the UV Index. Call (202-564-9361) or (http://www.epa.gov/sunwise/overview.html)The UV index ranges from 1 to 10+; the higher the index number the greater the exposure to UV rays. This index is valid for about a 30-mile radius around the city from which the broadcast originates. Currently, the computation of the UV Index does not include the effects of variable surface reflection (e.g., sand, water, or snow), atmospheric pollutants, or haze.

Society of Cosmetic Chemists, 120 Wall St., Suite 2400, New York, NY 10005-4088. Call (212-668-1500) (http://www.scconline.org/).

American Society for Aesthetic Plastic Surgery, 11081 Winners Circle, Suite 200, Los Alamitos, CA 90720. Call (888-272-7711) or (http://www.surgery.org).

American Society for Laser Medicine and Surgery Inc., 2404 Stewart Square, Wausau, WI 54401. Call (715-845-9283) or (http://www.aslms.org).

The following two companies offer sun-protective clothing. Other companies also offer similar products.

Sun Precautions, Inc., 2815 Wetmore Avenue, Everett, Washington 98201. For a catalog call (800-882-7860) or (http://www.solumbra.com/).

Sun Protective Clothing, 598 Norris Court, Kingston, Ontario K7P 2R9. . Call (613-384-3230) or (800-353-8778) or on the Internet (http://www.sunprotectiveclothing.com).

Heather Kleinman's Cosmetic Connection. A site for objective reviews of skin care products (http://www.cosmeticconnection.com/).

National Association of Physicians for the Environment (http://www.cehn.org/cehn/resourceguide/nape.html).

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