Draw the Line on Wrinkles

[gissell]

Frowning with concentration, you're all business when you put on your
makeup. You squint gently as you glide on a touch of eyeshadow. You
raise your eyebrows as you stroke on mascara and a sweep of blush.
Then you pucker for lipstick. Nice. You reward yourself with a smile
in the mirror.

Then it hits you. The frown is still there, along with the squint and
the smile lines.

Wrinkles--already? Character is great, and you've always admired women
who age with grace, but these lines feel premature--like a message
from the future delivered too soon. You're just not ready for
wrinkles.

Suddenly, you feel old. And maybe less attractive. You worry that a
big smile will show your big wrinkles. You keep your eyes wide open,
to erase those crow's-feet.

The Roots of the Ruts

Doctors say that the inevitable wrinkles from genetics and gravity
really shouldn't arrive until you near your sixties. But they come a
lot earlier--in the late twenties and thirties--for many of us. Here's
why.

During the 1920s, French designer Coco Chanel came back from the
tropics bronzed and glowing--and the centuries-old tradition of
keeping skin in the shade was lost in the glare of the news. Fashion-
conscious women everywhere began to bask in the sun. In search of
elegant tans, they started a new tradition: of sunburns and tanning
booths--and skin cancer and early wrinkles. Even in naturally dark
skin, sun damage causes 80 to 90 percent of the visible signs of
aging.

, including wrinkles, doctors say.

The number-two cause of wrinkles is smoking, which speeds your skin's
aging by up to ten years. Smoking reduces blood flow to the skin,
blunting its ability to repair damage. It also sets off enzymes that
attack the tissues of your skin the way meat tenderizer weakens the
fibers of meat. And because skin gets a "memory" when it's folded in
the same place over and over again, the mechanics of smoking cause
wrinkles, too. Constant puckering to draw on a cigarette forms lip
creases, and squinting against the smoke carves crow's-feet.

Some lines will form simply because we express emotion--with a ready
smile or worried frown. The way you sleep can leave a wrinkle memory
in your skin, too, especially if you snooze facedown.

But what can you do if you already have years of wrinkle-promoting
habits behind you? Can the damage be undone? Yes, it can. You can
prevent most new wrinkles from forming and remove the worst of the old
ones with help from your doctor.

A New Wrinkle on Prevention

If you're determined to fight wrinkles, even if it means abandoning
bronze for a paler, healthier beauty, here's where to begin.

Put up a chemical parasol. Sunscreen is your number-one weapon against
further sun damage, says Albert M. Kligman, M.D., professor of
dermatology at the University of Pennsylvania School of Medicine in
Philadelphia. Use a full-spectrum sunscreen that blocks both kinds of
ultraviolet radiation (UVA and UVB), and use it every day, year-round,
Dr. Kligman says. After you cleanse your skin in the morning, leave it
slightly damp and apply pea-size dabs of sunscreen on your cheeks and
forehead, working it into the skin all over your face. Don't forget
the backs of your hands, neck and décolletage.

You need to use a sunscreen of SPF 15 or higher. SPF stands for sun
protection factor, and SPF 15, which most doctors recommend, means
that you can stay out in the sun 15 times longer than you normally
could before burning. Remember, too, that although daily use of SPF 15
sunscreen will protect you adequately while you dash in and out of
buildings, for long hours in the outdoors you'll need to use higher-
SPF products and reapply frequently.

Doctors disagree on how high to go with SPF numbers, however. Some say
that numbers over 25 may give a false sense of security. While higher
numbers do screen out the burning UVB rays, they may let in more UVA
radiation. The UVA rays penetrate deeper into skin and cause most age-
related changes such as wrinkles, says Melvin L. Elson, M.D., medical
director of the Dermatology Center in Nashville.

Joseph Bark, M.D., a dermatologist in Lexington, Kentucky, and author
of Retin-A and Other Youth Miracles, disagrees. He says research shows
that skin will burn somewhat even with SPF 15 sunscreens, and he
recommends using the highest SPF you can find, even for everyday use.

And read the sunscreen's contents. "The best of the broad-spectrum
sunscreens contain titanium dioxide--fine particles that stay in your
skin and resist washing or rubbing off," says Dr. Kligman. An example
is Sundown.

Don't rely on cosmetics. Your favorite cosmetic counter may offer
foundations and moisturizers that contain low-SPF sunscreens, but
these are too weak for real protection, Dr. Kligman says.

Protect your eye area. While you exercise, you don't want sunscreen to
sting your eyes when you sweat. Try this workout tip from Dr. Elson.
"Take a wax-based sunscreen made for lips and apply it around and over
your eyes. It won't run," he says. You should also protect your eyes
with a good pair of shades, preferably the wraparound kind. Make sure
they shield UV radiation.

Dress for the sun. Innovative clothing manufacturers have come out
with basic collections of shirts, swimsuits and casual wear that are
specially knit to prevent the sun's radiation from reaching your skin.

Dump that nasty habit. Yeah, yeah, you've been told before that
smoking isn't cool anymore. Now you have one more reason to quit.

Feed your face. For general skin health, eat a balanced diet full of
fruits, whole grains and vegetables. You may also want to try
supplements that have been proven to reduce sun damage to skin, says
Karen Burke, M.D., Ph.D., a dermatologist in private practice in New
York City. She recommends daily supplements of 100 micrograms of
selenium (best taken as l-selenomethionine) plus 400 IU of vitamin E.
Use the d-alpha tocopheryl acetate, d-alpha tocopheryl acid succinate
or d-alpha tocopherol form of vitamin E--not the "dl tocopherols"
form, which is far less active. You should have no side effects from
these safe doses, Dr. Burke says. Although research has not been
designed specifically to link these nutrients with wrinkle repair,
they may help, she adds.

Take your measure in the mirror. Set a small hand mirror beside your
telephone for a few days and watch yourself in conversation. You may
have a few face-wrinkling habits you're not aware of, such as frowning
or squinting while you mull something over. The mirror will help you
learn to relax the facial muscles you're working overtime and to
reduce expression lines.

No aerobics for your face. Although facial exercises have been touted
in many beauty books, most of them actually increase wrinkling, says
Dr. Burke. When you grimace or contort your face through exercises,
you wind up working the same muscles that caused wrinkles in the first
place, she says.

Sleep on your back. "It's the best position for a younger-looking,
unlined face," says Gary Monheit, M.D., assistant professor of
dermatology at the University of Alabama School of Medicine/University
of Alabama in Birmingham. If you've been burrowing into your pillow
face-first for years, lying on your back every night with a pillow
under your knees may help you to change the habit.

The ABCs of Wrinkle Repair

Now that you're committed to preventing new wrinkles, are you stuck
with those you've already acquired? Not at all. There are many new
developments in dermatology and plastic surgery that can remove your
wrinkles. They range from prescription peeling lotions and creams to
surface repairs and surgery.

But remember this: "You can't go out and get an unlimited amount of
plastic surgery. Do as little as possible to get the maximum amount of
improvement possible," says plastic surgeon Geoffrey Tobias, M.D., of
Mount Sinai School of Medicine of the City University of New York.
"You're never going to be 21 years old again or take 20 years off your
face. But if two or three wrinkles bother you, take care of them.
You'll look and feel better."

Consider this.

Smooth them with Retin-A. Tretinoin (Retin-A), derived from vitamin A,
has earned its reputation as an excellent wrinkle smoother,
particularly for the fine lines caused by years of indulging in the
sun. But be warned: Retin-A cream is available only by prescription.
The legions of similar-sounding ingredients in many cosmetics and
lotions are only that: sound-alikes. See your dermatologist. (For tips
on using Retin-A, see chapter 106.)

Try AHA lotions. Your dermatologist has a gentle new approach to
wrinkle reduction, says Dr. Elson. Highly concentrated lotions made
from alpha hydroxy acids (AHAs), derived from wine, milk, apples,
lemons or sugarcane, will gradually peel off the top layers of dead
skin. "Over time, they will make crow's-feet and fine wrinkles less
visible," says Dr. Elson. Some of the most popular lotions contain
glycolic acid from sugarcane, which has small molecules that are easy
for skin to absorb. Low-concentration AHAs are also available at your
drugstore or cosmetics counter in some cleansers and moisturizers such
as Avon's Anew Alpha Hydrox Skin Treatment System and Eucerin Plus
Alphahydroxy Moisturing Lotion, but these are less effective than the
higher-strength products your dermatologist can provide.

So far, AHAs offer the only real competition for Retin-A's wrinkle-
fighting ability. AHA lotions give less dramatic results than Retin-A,
but they are also less likely to irritate your skin.

Peel away the lines. Though the name may sound drastic, chemical
peeling can be a fairly gentle procedure, says Sorrel S. Resnik, M.D.,
clinical professor of dermatology and cutaneous surgery at the
University of Miami School of Medicine. The dermatologist wipes your
face with acetone, a strong cleansing solvent, and then applies acid
to your skin with a swab. The skin turns white and stings briefly as
the acetone penetrates; then several layers of skin (and fine
wrinkles) peel off a day or two later. Many doctors offer a series of
three to six light acid peels at intervals of several weeks, for
results that are only a little less effective than a medium or deep
peel. With the series, you'll have less discomfort and a quicker
healing time, usually only a few days. Trichloroacetic acid has a good
record for safety and effectiveness, and glycolic acid, which is less
penetrating, is also popular.

Very deep peels can be dangerous, says Dr. Resnik, and are usually
offered only to people with extremely weathered, leathery skin. The
chemical most often used for deep peels is phenol, which may cause
cardiac or kidney problems. Phenol must be applied in the operating
room because it requires close heart monitoring.

Ask about fillers. Plumping up the skin beneath a wrinkle is an
alternative to peeling off wrinkles from the surface, says Dr.
Monheit. Dermatologists use several substances as wrinkle fillers, but
the best known is cattle-derived collagen. Collagen is a fibrous
tissue that forms a supporting network just under the surface of the
skin. The doctor injects the collagen into your wrinkle, and a lump
appears above the skin surface. When the lump fades (in as little as
six hours), the wrinkle will have been smoothed away.

The problems with collagen? It's temporary--results last from 4 to 15
months, Dr. Monheit says. And some people may be allergic to this form
of collagen, so the doctor must first perform an allergy test.

If you do prove allergic to cattle collagen, ask about a newer method
called autogenous tissue implant, says Dr. Elson. A patch of skin
harvested from another part of your body is sent out to a company that
processes your own collagen from the skin. The processor then returns
to your doctor a syringe filled with the collagen for an injection.

A wrinkle filler called Fibrel may last up to five years, says Dr.
Monheit. Fibrel is a gelatin-based material that is mixed with your
own blood serum and injected beneath a wrinkle. Your body responds by
making its own collagen, which, in turn, fills out the wrinkle.
Drawbacks? Fibrel injections hurt more than collagen shots, and the
procedure is more time-consuming, Dr. Monheit says.

"The best filler would be something natural from your own body," says
Michael Sachs, M.D., a plastic surgeon in private practice in New York
City. A technique for wrinkle filling that's still in the experimental
stage is called fat transfer, or microlipoinjection. The doctor
extracts a tiny amount of fat from another part of your body, such as
your belly or buttock, and injects it beneath the wrinkle. There's no
danger of an allergic reaction, since this is you being injected into
you. However, results are short-lived. Researchers aren't sure why,
but the fat cells just don't seem to last long in their new location.

Surgical thread can plump up a wrinkle, too, says Dr. Sachs. "The
surgeon places a protein-based thread directly under the wrinkle line,
where it stimulates local cells to produce their own collagen. In
about six months or so, the thread dissolves, and the remaining
collagen will fill out the wrinkle for two to five years." Dr. Sachs
developed this procedure. Check with your doctor about its
availability.

Scrape them away. A procedure called dermabrasion, which is often used
to remove acne scars, can also be very effective on wrinkles around
the mouth but not on areas where the skin is very thin, such as around
the eyes, Dr. Sachs says. A special instrument called a dermabrader
literally sands away the top layer of skin, leaving a scab that will
heal within about ten days, he says. A drawback is that dermabrasion
often removes pigment from the skin, adds Dr. Resnik. So if you choose
this method of wrinkle removal, you'll need to always wear makeup on
the treated areas.

Resetting the Clock with Retin-A

Retin-A is not just for acne.

"I don't know how to treat a patient for wrinkles without a
prescription for Retin-A," says Melvin L. Elson, M.D., medical
director of the Dermatology Center in Nashville. "Retin-A cream works
by changing the skin to make it normal and smoother." It increases
blood flow in the skin to give it a youthful, pink tone again and also
attracts collagen-making cells closer to the surface of the skin,
which tend to fill in wrinkles.

The effects of tretinoin (Retin-A) on wrinkles were discovered by
Albert M. Kligman, M.D., professor of dermatology at the University of
Pennsylvania School of Medicine in Philadelphia. Many of his patients
who were using Retin-A for severe acne pointed out their noticeably
smoother, firmer skin. Since then, Retin-A's anti-aging effects have
been proven in numerous studies, and Dr. Kligman recommends using it
early in life to get a head start on wrinkle prevention.

"If you have a lot of wrinkles and you're young, even in your
twenties, don't wait until you are 40 or 50 and have deep wrinkles and
a lot of blotches," he says. "If you're a light-skinned person who had
a normal childhood in America, you should start Retin-A early and get
into a program that will last you the rest of your life."

Retin-A for wrinkles is sold in gel and cream forms in various
strengths, and you and your dermatologist may need to experiment to
find out which is right for you. At first, your skin may become
irritated and flaky, but within a month or two, it should adapt. If
you have very sensitive skin, try applying it once every third day and
then every second day once your skin adjusts, or start with the lower
strength (.025 percent cream) and increase gradually to higher
concentrations, Dr. Kligman suggests. A less irritating form of Retin-
A, called Renova, is awaiting approval of the Food and Drug
Administration.

If you're committed to wrinkle fighting with Retin-A, you need to know
that it's a lifelong relationship. If you stop using the drug, your
fine wrinkles will return. And because Retin-A increases your skin's
sensitivity to the sun, a daily regimen of sunscreen with a high SPF
(sun protection factor) is vital.

* This is my beauty secret* I'm the #1 fan of Retin-A. I have used
Retin-A since i was 20 years old.. No Wrinkles!