Get rid of my wrinkles, please…

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:

  1. Wash face at night. Pat dry. Wait a few minutes until skin is dry. 
  2. 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. 
  3. 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. 

Few tips: 

  • 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!

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