Jonathan M. Sykes, M.D.

Eliminating or reducing the amount of facial wrinkles creates a healthy, rested, and youthful face. Successful wrinkle treatment requires an in-depth look at the cause of the wrinkles and a treatment plan designed to lessen the number and depth of these skin irregularities.

Causes of Wrinkling

The most common cause of wrinkles is a loss in the elasticity of the collagen layer. Collagen is a connective tissue layer that supports the outer layer of the skin (the epidermis). As we age, there is a loss of collagen elasticity and support of the overlying skin. This causes facial wrinkling. Although our genetic make-up predisposes us to have either relatively smooth or wrinkled skin, we clearly can do things to affect our skin texture, hydration, and overall health.

There are many detrimental environmental agents that negatively affect the health of our skin. Smoking clearly decreases the microcirculation to the skin and increases the amount of facial wrinkles. Many chronic tobacco users have a marked increase in the number wrinkles around their mouth (particularly on their upper lip). Exposure to the sun or in tanning beds also decreases the elasticity of the skin, dehydrates the skin, and increases wrinkles in the skin. Harmful UVA and UVB solar rays deplete the skin of moisture and thin the dermal layer of the skin.

Treatment of Wrinkles

Unfortunately, we cannot control our genetic make-up. However, avoidance of tobacco, sun, and tanning beds decreases exposure to agents in the environment that can harm the skin. If sun exposure is unavoidable, a sunscreen with SPF greater than or equal to 15 (sun protection factor) is important to protect the skin. This will minimize the sun exposure to toxic solar radiation and decrease the chance of acquiring a skin malignancy. A daily moisturizer will also keep the skin hydrated and prevent the loss of water when the skin is exposed to environmental irritants.

Topical medication can also help to thin the epidermis (outer cell layer of skin) and thicken the dermis (inner cell layer of skin). These agents remove, or exfoliate, the dead superficial skin layer, producing a healthier revitalized skin texture. Medications such as Retin-A or Renova, as well as topical alpha-hydroxy acids, improve the quality of the skin and reduce fine wrinkles.

There are many types of skin wrinkles or folds. These include superficial wrinkles that are increased by sun and smoking. Deep folds, such as the grooves adjacent to the corner of the mouth, are increased by sagging of facial tissue. Lastly, muscle related wrinkles, such as in the forehead or in the corners of the eyes (crow's feet) are increased by facial expression. The specific treatment of these wrinkles is related to the cause and location of the wrinkle. Filling the wrinkle, smoothing the tissue next to the wrinkle, or weakening the muscle that causes the wrinkle are all methods to decrease skin irregularities. The treatment chosen should be carefully considered. In the next few articles, I will go into detail about specific wrinkle treatments.

Jonathan M. Sykes, M.D., F.A.C.S. is the director of facial plastic and reconstructive surgery at the University of California, Davis Medical Center.  He has an active practice in facial plastic and reconstructive surgery and is involved in the teaching of other plastic surgeons state of the art plastic surgery techniques. Dr. Sykes has published over 80 medical articles and has recently designed new instrumentation to simplify the endoscopic browlift procedure.  For information or a consultation please contact his office at (916) 734-2831.

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