Stories of the Fountain of Youth has been recounted all around the world for thousands of years. Based on these legends, people for centuries have longed to find the elusive Fountain of Youth, a mythical spring, that has the ability to restore the youth of anyone who drinks or bathes in its water. Nowadays, the Fountain of Youth is attainable with a little bit of cosmetic magic!
A common question in my office is… how can I be rid of wrinkles? The answer is there is a lot that can be done noawadays to restore youth and fade away signs of aging.
Let’s begin with creams…
The cream that has the most evidence in reducing wrinkles is tretinoin, also known as Retin-A. It is in the family of topical vitamin A medications called retinoids – used initially as an acne treatment, but was later found to be helpful in treatment of dyspigmentation (dark spots), scars, pre-skin cancers (actinic keratoses), and more. Retinoids reduce signs of aging by increasing collagen production, stimulating new blood vessel production, fading dark spots, softening rough patches of skin, and more. But it does not happen overnight… the cream can take some time to work, about 3 months to start to see its effect, and 6-12 months for best results. However, as aging is an ongoing process, it is recommended to continue using the cream indefinitely.
But what about other forms of vitamin A creams – i.e. over the counter retinol or retinaldehyde. These other forms of retinoids are weaker and has to undergo more chemical conversion before becoming active, which makes it not as effective as tretinoin. Nevertheless, one of the more common side effects of tretinoin is dryness and sun sensitivity, so if you find that prescription strength tretinoin is too much, you can try the over-the-counter options first, and once your skin gets used to these products, you can go up on the strength.
How to work retinoids into your regular routine
Start with getting a prescription from your dermatologist. Usually, I recommend patients to begin using the cream once a week. The weakest prescription strength cream is tretinoin 0.025% cream, although lower strengths are available at compounding pharmacies.
How to start:
- Wash face at night. Pat dry. Wait a few minutes until skin is dry.
- Squeeze pea-size amount of cream onto index finger, dot 6 dots to following locations: forehead, left cheek, right cheek, chin, and neck. Rub evenly into skin.
- Start once a week i.e. Wednesday night. If skin is not too dry, then increase to twice weekly i.e. Monday and Thursday night. Keep increasing by one day each week until you can use it daily.
- Wear sunscreen in the morning and reapply every 2-3 hours when outside. Wear hat and protective clothing. Retinoids can put you at higher risk of sunburns.
- During winter months, you may need to scale back to every other night. Retinoids can make your skin very dry and winter weather can make your skin dry as well.
- If there is dryness around eyes/mouth, apply Vaseline to area prior to doing tretinoin.
- If there is dryness on the whole face and skin peeling occurs (aka retinoid dermatitis), apply moisturizer before and after tretinoin (like a sandwich); also consider going down on daily applications i.e. from daily to every other day.
What else can be done?
Procedures with neuromodulators like Botox, Dysport, Xeomin, or Jeaveau can be done. These are names of different versions of botulinum toxin that when injected in small doses into underlying muscles of the face to paralyze muscular function preventing furrowing of the skin, and thereby preventing folds in the skin (aka wrinkles). The procedure lasts about 2-3 months. On a positive note, studies show that not being able to frown can also improve your mood.
Fillers can also be used to fill in areas of volume loss, thus, making wrinkles disappear. The most common type of fillers used is hyaluronic acid filler as it can be easily dissolved with hyaluronidase if necessary. Depending on the type of filler, the procedure can last 3-24 months depending on the product being used and where on the body the product is being injected.
Lasers and microneedling are also good at removing finer wrinkles and dark spots, which all contribute to aging. All of these creams and procedures are cosmetic and out-of-pocket, and not covered by insurance. Furthermore, they all require maintenance as aging is an ongoing process.
Finally, no matter what cream or procedure is being used, the most important thing to do is prevention, and the best anti-aging treatment of all is daily sunscreen use. So before you drop thousands of dollars on creams and procedures, spend a few bucks on sunscreen first!
I am a board certified dermatologist at Cedars-Sinai in Los Angeles. I am a comprehensive dermatologist caring for families. I love seeing children and adults. My youngest patient was 0 days old and my oldest was 110 years old. I have had psoriasis since the age of 8 and considered an expert in psoriasis and psoriasis treatments. I have lectured locally and nationally and published numerous papers on other topics such as skin manifestations of eczema, hidradenitis suppurativa, systemic lupus erythematous, granuloma annulare, microbiome, skin cancers, and more. My expertise includes knowledge in managing complex skin diseases. I am experienced with surgical treatment of skin cancers, as well as non-surgical methods to treat skin cancer and precancerous lesions. I run a full medical, cosmetic, and surgical dermatology practice. I am experienced with the use of complex dermatologic therapy, including biologic therapy, immunosuppressive medications, and phototherapy. I also treats fine lines and wrinkles non-surgically with combinations of botox, fillers, chemical peels, lasers, and radiofrequency. I perform minor surgeries such as excisions for cysts, lipomas, basal cell skin cancer, squamous cell skin cancers, and early stage melanoma. I am physician expert for Kopa for Psoriasis, part of Happify. I have been featured on podcasts and quoted in numerous online and print publications. I am honored to be named “Top Doctor” in Los Angeles magazine. In my free time, I volunteer for community events such as skin cancer screenings and at the local free clinics. I also teach internal medicine and dermatology residents at several academic centers. I try to do yoga every day and every year, I run a half-marathon at the Golden Gate Bridge.