Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
What are wrinkles?
Wrinkles are creases, ridges or folds formed in the skin. They are most prominent on the sun exposed skin including face, neck, hands and forearms. Pollutants and smoking also contribute.
Wrinkles can be natural or pathological. Natural wrinkles are formed in older individuals and their skin becomes less elastic. Appearance of wrinkles can be reduced by using prescribed creams, laser therapy, botox and other treatments. One can prevent wrinkles by avoiding exposure to the sun.
Some wrinkles can become deep crevices or furrows. These are mainly noticeable around the eyes, mouth and neck.
Where are wrinkles formed?
Face wrinkles – Wrinkles are common on the skin of the face. The skin on the face naturally folds during facial expressions. The first wrinkles tend to appear in the areas of these folds. The reasons for these wrinkles are – the skin becoming thinner and less elastic over period of time.
Wrinkles appear on the –
- face
- neck
- back of the hands
- arms
These are the parts of the body that are most exposed to the sun.
Wrinkles are indicators of ageing process and are natural part of becoming older. Almost everyone gets wrinkles.
The cosmetic scare – Most people do not accept getting wrinkles on their face or anywhere. Thus it becomes an important issue for these people and they would like to get rid of them or prevent them happening. This ‘too much beauty or look consciousness’ would open big doors for anti-aging markets, beauty and cosmetic industries and clinics and business involving millions of dollars.
Causes of Wrinkles
Ageing – ageing and formation of wrinkles are two sides of the same coin and they go hand in hand. Old age comes with wrinkles naturally.
The skin gets thinner, drier and less elastic as the person gets older. Due to this the skin would not be capable of protecting itself from the damages. This leads to formation of wrinkles, creases and lines on the skin.
Also decreased production of natural oils dries your skin when you get older. This makes the skin appear more wrinkled. On the other hand fat in the deep layers of the skin diminishes. This causes loose and saggy skin. It would also make more pronounced lines and crevices.
Expressions – Facial movements and expressions form the backdrop of developing wrinkles. These expressions include smiling, frowning or squinting. These expressions of the face lead to the development of wrinkles and fine lines at a young age. As the person gets older, these lines deepen.
Wrinkles differ in different people – Wrinkles differ with different skin tones. This is because of structural and functional differences in the skin. As per research the compact dermis is thicker in the skin of Black and Asian people. This forms a protective barrier against facial wrinkles.
Factors influencing / affecting wrinkle development include –
- exposure to the sun
- dehydration
- smoking
- environmental factors
- genetic factors
- certain medications
- exposure to UV light from sunbathing, tanning booths and outdoor sports
UV light – Ultraviolet Rays are damaging to the skin. UV radiation speeds up the natural ageing process and exposure to it is the primary cause of early wrinkling. It breaks down the elastin and collagen fibers which form the connective tissue and supports the skin. This leads to weakness of the skin and the skin becomes less flexible. It loses strength and flexibility. The skin starts sagging / drooping and the wrinkles would appear prematurely. Darker skin has immunity towards harmful effects of UV radiation since they contain more melanin in them.
Exposure to sunlight – Chances of getting early wrinkles are higher in those who work for longer hours in sunlight. They can be delayed or prevented by wearing clothes that entirely covers the skin like long sleeves and hats.
Excessive and regular smoking – Smoking has bad impact on the skin. In those who smoke regularly and excessively the blood supply to the skin gets reduced. This leads to acceleration of ageing process of the skin leading to early formation of wrinkles.
Excessive and regular alcohol consumption / addiction – Alcohol addiction too is harmful for the skin just like smoking. Alcohol causes dehydration of the skin. This leads to development of wrinkles.
Symptoms of Wrinkles
Formation of lines, creases or folds on the skin are themselves the symptoms of wrinkles.
The skin in these people may be loose and or droopy.
They appear as a natural part of ageing, mostly over the sun-exposed areas of the body including face, neck and dorsum of hands.
They can be noticed in areas utilized while making certain facial expressions such as the forehead, beneath and all around the eyes, smile lines and naso-labial folds. During early stages they appear as fine lines. They can form deep folds or crevices in the skin in later stages of life.
Though not a harmful skin condition, they can signify premature ageing.
Pathogenesis
Due to natural ageing process the skin becomes thinner over period of time. This happens due to lower production of elastin and collagen proteins. This makes the skin to become less resistant to damage.
Reasons why the lines deepen at old age to form wrinkles – As we have discussed facial wrinkles form wrinkles and lines on the skin of the face. In young age these lines are temporary and short lived. Once the expressions are over, the skin springs back to normal and the lines disappear. But when the person gets older the skin loses its flexibility and as a reason it becomes very difficult for the skin to spring back to normal. This results in the lines to be left over in the form of permanent grooves leading to wrinkles.
Differential Diagnosis
Below mentioned conditions might look like wrinkles and may have similar symptoms / signs –
- Cutis laxa
- Werner’s syndrome (progeria, pangeria)
- Xeroderma pigmentosum
Prevention of Wrinkles
Below mentioned are few tips to prevent or reduce the development of wrinkles –
- Sun protection – Skin damage would be reduced by avoiding exposure to UV rays. For this, one should not get too much exposed to the sun and also use sun protection. The best methods to achieve this is to wear a wide brim hat, wear clothing to protect the skin especially with long sleeves, dark sunglasses and using a sunscreen (of SPF 30 or higher) everyday. Mainly mid-day sun exposure should be avoided.
- Moisturizer – should be used regularly. It prevents dryness of the skin and also reduces the chances of formation of wrinkles. Moisturizing the skin traps water in the skin. It helps in masking tiny lines and creases. Improvement may be seen in few weeks of using the moisturizer.
- Give up Smoking – since it would hasten the ageing of skin leading to the formation of wrinkles.
- Drink less alcohol – since it causes dehydration of skin which is once again responsible for skin damage over a period of time.
- Eat good, healthy and balanced diet – This is very much essential for the skin health. Plenty of vegetables and fruits shall be included in the diet. Some evidences tell that certain vitamins in the diet help in protecting the skin.
- Limit usage of sugar – Foods having plenty of sugar or refined carbohydrates can accelerate ageing. Hence they shall be avoided. Foods and drinks devoid of these would protect the skin from wrinkles.
- Antioxidants – Healthy foods rich in antioxidants help in reduction of wrinkles. Antioxidants protect the skin from free radicals which can cause wrinkles and skin damage. Antioxidant rich foods include beets, spinach, kale, blueberries and dark chocolate to name a few.
- Avoid stress – A hormone called cortisol is released when one is stressed. This would break down collagen in the skin. Therefore one should deal with his or her stress.
- Face wash – One should wash his or her face at least two times in a day using a gentle facial cleanser. Skin should not be rubbed. If done, it would irritate the skin and also would hasten the ageing of skin.
- Deal sweating of face – Excessive sweating of face can irritate and hence damage the skin over a period of time. It might happen in those who regularly wear a hat or helmet. One should take care of this.
- Avoid getting a tan – Getting a tan (from sun or tanning bed) causes exposure to harmful UV rays. These rays accelerate ageing causing wrinkles, age spots, blotchy complexion and skin cancer.
Treatment of Wrinkles
Treatment to reduce the lines of wrinkles on the skin depends on how fine or deeper the creases are. Fine lines forming on the skin may be dealt with wide array of interventions. More aggressive techniques like plastic surgery or injections of fillers are needed to deal with deeper creases of wrinkles.
Medications
Topical retinoids – Creams containing retinoids would reduce fine wrinkles, roughness of the skin and hyperpigmentation by enabling the body to increase collagen production. These retinoids are derived from vitamin A. On the other hand retinoids can cause skin burns in sunlight. Therefore it is essential to protect the skin while using the cream. Burning sensation, tingling sensation, itching sensation, discolored areas of skin and dryness of the skin are some of the possible adverse effects. Depending on the type and concentration of wrinkle creams, their active ingredients would vary. Prescribed ones always have an advantage over OTC creams. How well a given cream works for wrinkle depends on its concentration.
The other medications which are used include retino, kinetin, antioxidants, copper peptides, and coenzyme Q10 and alpha ydroxyl acids. Results with these would vary.
Dermabrasion
Dermabrasion – It is a surgical procedure. In this method a rapidly rotating device is used to cause controlled abrasion of the upper layers of the skin. It removes fine wrinkles, tattoos, acne scars (other scars also) and moles. Results vary. Immediate results may not be seen. In some cases improvements will not be noticed for several months.
Microdermabrasion
It is a less invasive procedure. In this microcrystals of aluminum oxide are sprayed across the surface of the skin. Alternatively a device with fine diamond crystals and a powerful vacuum is used. The aim is to provide smoother and fresher appearance to the skin and also to reduce the appearance of wrinkles and lines. It also prevents / reduces the enlarged pores, coarse skin and sun damage from occurring. Results are not too promising and are temporary. Repeated treatments may be required.
Laser / light source therapy treatments – These treatments destroy the outer skin layers to decrease wrinkles.
RF treatments (Radiofrequency)
It causes tightness of the skin and decreases wrinkles by heating the underlying dermis and stimulating the development of new collagen fibers.
Botox
Botulinum toxin therapy is a non-invasive procedure. It helps in diminishing signs of ageing by relaxing the muscles of the face. Small doses of Botox injected into the targeted muscles by a cosmetic professional will reduce wrinkles by blocking the chemical signals that cause muscle contraction. It can also decrease the lines on the forehead, the ‘frown lines’ and ‘crow’s feet’ around the eye corners. Results can be noticed after few days to a week and the changes usually would last for 3-4 months. Repeated injections may be required to keep up the effect.
Chemical peels
It involves applying a chemical solution to the desired areas. This eventually causes the dead skin to shed and peel off. In comparison to the old skin, the newly regenerated skin tends to be smoother. Chemical peels work by removing layers of the skin and can be used on face, hands, neck and chest and remove signs of ageing.
Facelift
Facelift is a kind of cosmetic surgery. Following this, people look more youthful. It is also called as rhytidectomy. In this some facial skin and fat are removed with or without tightening the underlying tissues.
Fillers
Fillers help in restoring fullness to the face, lips and hands. Fat, collagen or hyaluronic acid is included among the soft tissue fillers. The fillers are injected into deeper face wrinkles. This would act by plumping up the depressed areas of the skin and smooth them out adding more volume to the skin.
Photodynamic rejuvenation (PDT)
It is used to treat fine wrinkles caused by sun exposure. This might have to be repeated often. Recovery is shorter than it is with laser resurfacing.
Home Remedies
Moisturizing the facial skin regularly
Daily skin care- One should moisturize the facial skin regularly and at the same time should be careful so as to not use too many skin products at a time. More than one product will irritate the skin which will make signs of ageing more evitable and noticeable.
Sleep properly – According to some studies certain sleep positions would contribute to formation of wrinkles on the face. Sleeping flat on the back, using special pillow that reduce facial deformation during sleep and using a silk pillowcase are said to minimize the risk of developing ‘sleep induced wrinkles’.
Micro-needling – It is a procedure wherein small needles are used to create small punctures in the skin which in turn would renew the skin cells and trigger a healing response.
Deeper wrinkles would definitely need medical treatment. One should see his or her doctor / dermatologist or cosmetic surgeon as soon as possible if the home remedies would not yield satisfactory results.
Other places of the body where wrinkles occur
Wrinkles on the hands
Wrinkles forming on the skin can be prevented by everyday application of sunscreen to the hands. Other treatments include using retinol containing lotion or glycolic acid containing lotion before bedtime or taking a light chemical peel once in every 1-3 months or having laser treatment.
Decolletage wrinkles
Skin of the chest is thinner than the skin of the other parts of the body. This makes it prone to sun damage. All treatments useful for face wrinkles are also safe for the chest area and can be done. These include lasers, chemical peels, micro-needling and certain fillers.
Study – ‘Lifestyle and Physiological Factors Associated with Facial wrinkling in men and women’ – showed that men and women show different wrinkling patterns yet the lifestyle and physiological factors underlying these sex-specific patterns are relatively unknown. This study investigated sex specific determinants for facial wrinkles and recommended that skin ageing-reducing strategies should incorporate the sex differences found in this study.
Another study – “Sleep wrinkles: facial aging and facial distortion during sleep” explores the possibility that compression during sleep not only results in wrinkles but may also contribute to facial skin expansion.
Study – “Relationship between the depth of facial wrinkles and the density of the retinacula cutis” – showed that in both the wrinkle specific and wrinkle inclusive areas, the retinacula cutis became lower in the forehead and in the lateral canthus area.
Study – Dietary Aloe vera supplementation improves facial wrinkles and elasticity and it increases the type 1 procollagen gene expression in human skin in vivo.
Ayurveda Understanding of Wrinkles
Vali is the closest word used in Ayurveda that describes ‘wrinkles’. ‘Akala Vali…’ i.e. premature wrinkles has been mentioned amongst the symptoms of ‘rasa pradoshaja vikara’ i.e. symptoms of contamination of rasa tissue. Apart from that Vata and Pitta would contribute towards wrinkles and so does ageing.
Related Reading – ‘Wrinkles – Ayurveda Understanding’
