Human skin, like all other organs of the body, undergoes changes with aging. In addition to intrinsic or chronologic changes, environmental exposure can be a major cause of skin damage and wrinkling.
Over time, the skin’s network of elastin and collagen fibers which provide elasticity to the skin is altered. The thickness of the skin (epidermis and dermis) and the underlying layer of fat decreases. There is a decrease in the number of pigment-forming cells, immune cells, and blood vessels. Superficial skin lines form due to repetitive contractions of the small muscles of the face. These universal and presumably inevitable changes in the skin along with the exacerbating factor of gravity lead to wrinkling and sagging of the skin.
Ultraviolet light emanating from sunlight also plays a major role in causing wrinkles in exposed skin. Unlike intrinsic aging, which depends on the passage of time, damage due to ultraviolet light, or photoaging, depends primarily on the degree of lifetime sun exposure and skin pigment. Individuals who have outdoor lifestyles, live in sunny climates, and are lightly pigmented will experience the greatest degree of photoaging. In pho-todamaged skin there is an abundance of deranged elastic tissue and disorganized collagen, blood vessels are dilated, and immune cells are decreased. Research has shown that the overproduction of oxidants or free radicals is a crucial factor in causing such changes. These unstable molecules are normally produced by chemical metabolism in the body; however, with environmental assaults, they are produced in excessive amounts that can damage cellular and even genetic elements. Cigarette smoke and air pollutants such as ozone are other environmental factors that may promote wrinkles by increasing production of free radicals.
An abundance of antiaging therapies are available to women today. The most widely available of these are antiaging or antiwrinkle creams. The choice of creams depends on many factors, but the consumer is cautioned to consider whether the efficacy of the cream has been proven and documented in scientific, peer-reviewed journals. Many creams are not classified as drugs and are therefore not held to the rigorous standards of documenting efficacy. Currently, retinoic acid, a natural form of vitamin A, is the only cream approved by the FDA as safe and effective for treating some signs of photoaging. Alpha hydroxy acids have also shown considerable evidence in laboratory studies in reversing effects of the sun.
Professional treatments for wrinkles include chemical peels, implants, dermabrasion, laser resurfacing, botulinum toxin injections, and plastic surgery. The choice of treatment is highly individualized and is dependent on the person’s age, degree of photoaging, and chronologic aging among other factors. For example, fine wrinkling and textural changes commonly seen with photoaging may be best treated with chemical peels or laser resurfacing. In contrast, lines caused by facial expression and movement of the muscles of the face (frown lines) may be best treated with botulinum toxin injections or implants. In addition to the above treatments, prevention remains the easiest means of decreasing wrinkles. Recommendations include avoidance of excessive sun exposure, sunscreen use, and smoking cessation.