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Facial Wrinkles:
Turn Back Time On Your Skin

By Dr. Jonathan Hoenig

You may have noticed that one of the very first signs of aging are the tiny lines on the cheeks and eyelids that are accentuated with smiling. With each passing year, these facial wrinkles become progressively deeper and new lines begin to appear. Before deciding on the ideal wrinkle treatment, it is important to understand the difference among facial wrinkles, and their various causes. Once the underlying cause is identified then the appropriate wrinkle treatment can be applied, virtually turning back time on your skin.

There are three types of wrinkles: dynamic wrinkles, static wrinkles, and wrinkle folds. Dynamic wrinkles are caused by contraction of muscles that are attached to the overlying skin. Each muscle contraction causes the skin to bunch together, forming lines between the bulk of the muscle. The most common locations for dynamic wrinkles are between the eyebrows, across the forehead, and on the cheeks near the outer corners of the eyes, referred to as “crow’s feet”. It follows, then, that weakening these muscles will cause a reduction in the severity of the facial wrinkles, or can prevent them altogether when muscle weakening is done before wrinkles form. Some of the muscles can be weakened permanently through surgery alone, or in combination with eyelid surgery (blepharoplasty), a brow lift or forehead lift. An alternative dynamic wrinkle treatment is injection of Botox into specifically targeted muscles to temporarily decrease the muscle action for approximately 3-4 months, preventing wrinkle formation.

Static wrinkles are due to lack of elasticity of the skin caused from sun damage, smoking, genetics, poor nutrition, or from prolonged dynamic wrinkling. Static facial wrinkles are visible regardless of muscle contraction; they stay (hence the name “static”) even when the muscles are not contracting. This leads to the classic “crepiness” and multiple cross-hatching as is often seen in wrinkles on the cheeks and around the eyes. Techniques that increase the thickness of the skin or that remove the damaged skin are effective wrinkle treatments. Laser skin resurfacing and deeper chemical peels remove the damaged skin and stimulate new collagen formation to improve the skin’s appearance, elasticity and thickness. Topical creams and ointments such as Tretinoin (Retin-A), Vitamin C serum, and new collagen growth factor formulas are good maintenance systems to restore and maintain the skin’s youthfulness. Of course, daily sun protection is essential in preventing further sun damage and skin cancer. Multiple treatments of intense pulsed light or light chemical peels and other non-ablative lasers can increase the thickness of the skin and collagen level without significant downtime.

The third type of wrinkles, called wrinkle folds, is often due to sagging of the underlying facial structures, most notably causing the deep grooves between the nose and mouth known as the naso-labial groove. Surgical procedures such as midface lifts, cheek lifts, and neck lifts offer the best corrective measures for these problems. Alternatively, the folds can be camouflaged temporarily by plumping up the groove from beneath with substances like collagen or soon to be FDA-approved hyaluronic acid derivatives like Restylane and Perlane. These materials typically last for anywhere from 3 to 9 months, depending on the material used and the location of the injection. Fat transfer, whereby your own fat is removed from one area and then injected into the area where fullness is desired, is an excellent alternative to fillers from outside sources, and is one of the more permanent wrinkle treatments.

Most people have a combination of all three types of facial wrinkles, especially with advanced age. Regardless of your wrinkle type and your desired degree of correction, there is a solution available for you.

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Dr. Jonathan Hoenig provides the most advanced and innovative techniques in facial plastic surgery and facial rejuvenation today. To learn more about facial plastic and reconstructive surgery, visit us on the web at http://www.la-plastic-surgery.com, email info@drhoenig.com, or phone toll free 866-HOENIG9.

Copyright © 2002-2004, Jonathan Hoenig, M.D., All Rights Reserved
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