Wrinkle

Anatomy or system affected: Skin

Definition: Lines in the skin caused by structural changes over time.

Causes and Symptoms

All human body fibers are formed by specialized cells in the tissues and can be classified as inelastic or elastic. Inelastic fibers are rigid and provide support to the surrounding tissue, while elastic fibers are more malleable. With the passage of time, inelastic fibers tend to become even tougher because of structural changes that occur in collagen, the major protein found in skin, bones, and ligaments. The dermis, the inner layer of the skin, contains large amounts of collagen, which is responsible for the skin’s mechanical characteristics, such as strength and texture. The skin cells that make and reproduce damaged collagen are called fibroblasts.

As a person ages, collagen tends to form cross-links between different parts of the molecule or between similar molecules that are near each other, thus creating a rigidity that leads to skin sagging and wrinkling. Moreover, the recoiling ability of elastic fibers appears to be reduced, a condition that is often enhanced by calcification. Skin wrinkling is much more pronounced with prolonged exposure to wind and ultraviolet light. The effect appears to be cumulative, along with collagen degeneration and epidermis thinning, as seen with people of outdoor professions. Other studies suggest that heavy cigarette smoking contributes to the risk of wrinkling.

Treatment and Therapy

Application of collagen-containing creams does not seem to create a desired change because the applied collagen molecules are too large to penetrate the dermis. Such applications only temporarily cover wrinkles. Injecting collagen under the wrinkles in a way that pushes the groove up, causing it to become smooth, has some positive cosmetic effect but also serious drawbacks. The main problem comes from the animal source of the collagen, which may lead to serious allergic reactions by the immune system and may, in rare cases, trigger a long-lasting autoimmune disease. Moreover, the smoothing effect of the injections appears to be brief because of the inability of the animal collagen to integrate itself into the skin’s collagen mesh.

Better results are observed when biotechnology-synthesized collagen is used or when the patient’s own fibroblasts are removed, grown in a laboratory, and reinjected into the body. The careful administration of vitamin C, collagen amino acids, or very small quantities of copper peptides appears to stimulate the skin to produce more collagen. In addition, the topical application of growth factors and hormones that enhance the collagen-forming process of cells seems to give favorable results. Another product, Retin-A, is a prescription-strength vitamin A formula that effectively helps lessen the appearance of wrinkles by boosting the amount of collagen in one's skin. With regular use, one tube of Retin-A can last about ten months.

By the early twenty-first century, two treatments were gaining widespread attention as new “fixes” for wrinkles: Botox and Artefill. Botox is a laboratory-refined strain of botulinum toxin, the cause for botulism and a highly poisonous substance, which is given in very small doses. It is injected into the facial muscles that cause wrinkling and works by paralyzing them. The effect lasts for approximately three to six months, and side effects can include numbness and swelling. The Food and Drug Administration (FDA) approved Botox for cosmetic use in 2002, and in the early 2020s, it was still a very popular wrinkle preventative.

Artefill, approved by the FDA in 2006, works by combining collagen with tiny plastic beads of polymethyl methacrylate (PMMA), which is injected into wrinkled areas. PMMA spheres, about the thickness of a human hair, settle in wrinkles as the collagen gradually absorbs into the body. The spheres then stimulate the body’s own collagen to encapsulate them. The effects are more permanent than those of Botox; researchers have found that they can last around five years or more. Patients have reported some problems with lumps on the face following the procedure, and critics note that the treatment’s long-term effects have not been studied enough.

Other injectable fillers include hyaluronic acid gel (such as Restylane and Juvederm), which, when applied, binds with water to help plump the skin; calcium hydroxylapatite (such as Radiesse), a biosynthetic formula of calcium and water that acts as a scaffold for collagen to grow on; and poly-L-lactic acid (or PLLA, such as Sculptra), a man-made biodegradable polymer that helps the skin replace lost collagen. PLLA treatments can last up to two years, while hyaluronic acid gel and calcium hydroxylapatite treatments can last up to one year.

Chemical peels have been used to correct facial wrinkling in face-lift or eyelid surgeries. A mixture of chemicals is applied to the skin, leading to extreme swelling and consequent peeling of the old skin, thus providing a fresh skin in one week after a light peel or two weeks after a deep chemical peel. Over-the-counter alpha-hydroxy acid (AHA) formulations also encourage cell turnover. Another technique is dermabrasion, which is considered best for those with darker skin tones. Dermabrasion affects deeper layers of the skin than a chemical peel, though it produces similar results. In microdermabrasion, tiny crystals are used to polish the skin, and then a vacuum technique is used to remove them.

Carbon dioxide lasers, used in skin resurfacing, were first developed in 1964, but experiments that combined them with computer technology did not begin until the 1990s. This resurfacing technique, which affects an area of skin no more than one hair in thickness for no more than one-thousandth of a second, works in a way similar to chemical peel. It is considered best for patients of fair to medium complexion who have good healing qualities, and the results can last up to ten years.

Bibliography

"Aging Changes in Skin." MedlinePlus, 2022, medlineplus.gov/ency/article/004014.htm. Accessed 20 Apr. 2023.

"Chemical Peel." Mayo Clinic, 21 Jan. 2022, www.mayoclinic.org/tests-procedures/chemical-peel/about/pac-20393473. Accessed 20 July 2023.

Freinkel, Ruth K., and David T. Woodley, eds. Biology of the Skin. Parthenon, 2001.

Lewis, Wendy. The Beauty Battle: The Insider’s Guide to Wrinkle Rescue and Cosmetic Perfection from Head to Toe. Laurel Glen Books, 2003.

"Skin Care and Aging." National Institute on Aging, 1 Oct. 2017, www.nia.nih.gov/health/skin-care-and-aging. Accessed 20 Apr. 2023.

Turkington, Carol, and Jeffrey S. Dover. The Encyclopedia of Skin and Skin Disorders. 3rd ed., Facts On File, 2007.

Wadyka, Sally. "The Thing about Retin-A: It Works." New York Times, 30 Nov. 2006, www.nytimes.com/2006/11/30/fashion/30skin.html. Accessed 20 July 2023.