As a person ages, the epidermal cells become thinner and decrease in number by as much as 10% every 10 years. They also become less sticky, as the sebaceous glands start to manufacture less oil (sebum), and the quantity of sweat glands decrease. Aging likewise causes a decline in collagen production, the fibrous protein-based connective substance found in our skin. This reduction in collagen causes the skin’s elasticity to weaken.
Combined with the decrease in stickiness, the skin loses more moisture instead of absorbing it. A loss of sebum, collagen and moisture lowers the rate of nutrients needed by the skin to repair itself. The structure of the skin changes and it becomes dryer and more fragile. All these factors result in sagging and the appearance of wrinkles.
WRINKLES SYMPTOMSSymptoms of wrinkles include the presence of deep lines, creases or grooves, particularly in areas of the skin which are subject to folding or constant motion. Skin that has had prolonged exposure to the sun will also appear to be tough and leather-like. There are likewise fine surface crinkles resembling crosshatch marks. While these fine lines may be temporary, they are prone to deepen and become more permanent with age.
Wrinkles begin as faint, barely visible lines less than a 10th of a centimeter in length and about the same measurement in depth. Aging causes these lines become deeper. Wrinkles are more perceptible on a person’s face, particularly in places known as expression lines: across the forehead, in between the eyebrows (frown lines), around the eyes (crow’s feet) and mouth (marionette lines), on the upper lips and cheeks, and just before the ears. Lines may also appear on the anterior of the neck and at the backs of the hands.
Wrinkles due to excessive sun exposure also exhibit additional features, such as mottling, a condition where there are patches of skin that are differently colored compared to its surrounding areas; liver spots or lentignines, which resemble freckles, and solar keratoses, flaky patches of skin that are tougher and differently colored. Skin-damaged skin may also exhibit sagging, roughness and dryness.
WRINKLES RISK FACTORApart from aging, other factors can cause wrinkles. Prolonged exposure to sunlight can hasten the breakdown of collagen fibers. Ultraviolet light, UVB or UVA rays streaming from the sun causes approximately 90% of premature skin aging. This process is called photoaging. When the skin is damaged by the sun, enzymes known as metalloproteinases work double time to repair these injuries by producing more collagen. However, this collagen reformation is disorganized in sun-damaged skin, causing the appearance of solar scars. This defective reconstruction repeats itself again and again, resulting in uneven surfaces that promote the development of wrinkles.
WRINKLES CAUSESWrinkles may also be caused by free radicals, unstable molecules of oxygen that can cause damage to healthy cells by disrupting their functions and genetically altering cell make-up. Free radicals stimulate metalloproteinases into disintegrating collagen instead of building it up. This collagen break down due to free radicals is caused by exposure to UV radiation from the sun, smoking or secondhand smoke, and air pollution.
When a woman reaches menopause, there is a decrease in the production of the hormone estrogen. A lack of estrogen may also cause collagen levels to fall by as much as 2% a year. It can also thin out the skin by as much as 1% annually. This loss of estrogen may result in the formation of wrinkles.
Other causes of wrinkles include the constant use of muscles in facial expressions, which result in a loss of skin elasticity and a formation of wrinkles. Gravity also loosens up the skin and causes it to sag, as in the case of jowls and eyelid drooping.
People have a higher risk for acquiring wrinkles if they smoke, a habit which causes free radical damage and rapid skin thinning. Age is also a risk factor as elderly skin is more prone to skin disorders. Gender plays a part in vulnerability to wrinkles, with more women than men at risk. Fair skin is likewise more susceptible to wrinkles, as are people with blue eyes whose skin burns easily and can incur extensive sun damage. Unprotected sun exposure during childhood or adolescence causes as much as 80% of skin damage that may show up in early adulthood.
Wrinkles are also hereditary, and if a person is descended from a family whose skin tends to have more wrinkles, this person has a higher risk of developing wrinkles, as well. A short hairstyle, or one that exposes more areas of the face to the sun can also increase the chances of wrinkling, so can wardrobe preferences that eschew the use of hats or long-sleeved garments. People whose work or hobbies require excessive sun exposure, such as farming, fishing, construction work, golfing, swimming, sailing, sunbathing or the use of tanning beds, can also promote the development of wrinkles due to sun damage.
While treatments for wrinkles have been proven to work better on fine lines, deeper groves and creases may require more drastic methods, such as injectible fillers or even aesthetic surgery.
WRINKLES TREATMENTThese medical treatments include tretinoin or Retin-A prescription creams. These creams may cause redness and peeling as the Vitamin A acid sloughs off surface skin to get rid of fine lines. Alpha-hydroxy acids (AHA) are fruit acids containing lactic and glycolic acids that can subtly improve the appearance of fine wrinkles. Antioxidants which include Vitamins A, C, E and beta-carotene are prepared in cream form to protect the skin from the sun and prevent wrinkles. Common moisturizers may also reduce the prominence of fine wrinkle appearance.
Wrinkles may also be remedied by cosmetic procedures such as glycolic acid peels, and deeper dermal peels with salicylic acid or trichloroacetic acid that smooth away fine lines through deeper skin penetration. Sanding the skin using microdermabrasion will cause facial skin to feel smother, while dermabrasion will require the use of general anesthesia during the sanding procedure, which involves the use of a rotating machine.
Other procedures include laser resurfacing which is similar to dermabrasion but is more precise and reliable; fractional resurfacing which treats only damaged surfaces of the skin; non-ablative laser resurfacing which strives to mimic collagen production in the epidermis, and heat and radiofrequency, a noninvasive procedure using skin tissue heating, radiofrequency signals and infrared light.
Plastic surgery procedures are invasive techniques which have long-term effects. Some examples are face-lifts which remove excess skin and facial fat, as well as tighten up facial tissue and musculature; botox, or botulinum toxin injections act by causing paralysis in the facial muscles to smoothen out deep and fine lines; hyaluronic acid fillers (Restylane, Juvederm) are likewise injected into the skin where more volume is needed, or where folds and wrinkles need to be evened out.
People who are considering these wrinkle treatments will need to remember that the more invasive the procedure is, the greater the risk is in terms of scarring or changes in the skin’s pigmentation.
Using broad-spectrum sunscreens with high Sun Protection Factors (SPF) can shield the skin from the damaging effects of the sun. They work by physically preventing radiation from penetrating the epidermis. Sunscreens which have UVA and UVB protection against ultraviolet rays are likewise effective.
Other effective preventive measures to delay the development of wrinkles include a good skin care regimen; avoiding sun beds or tanning salons; wearing protective clothing when outdoors; smoking cessation; drinking lots of water to help hydrate the skin; refraining from yoyo dieting that causes fluctuations in weight and result in loss of skin elasticity; eating nutritious food; relaxing the facial muscles by avoiding frowning, grimacing and jaw clenching, and getting a regular facial massage to stimulate blood flow and improve skin elasticity.
Wrinkles are not considered a serious medical condition, and they do not require immediate treatment or medication. However, the focus on maintaining a youthful physical appearance, especially in some societies and cultures which place importance on looking young, has increased the demand for products, medications and procedures geared at maintaining the appearance of youth. This anxiety about aging has reached a point such that it has adversely affected people’s interpersonal relationships, employment chances, and self-esteem.
At the Tennessee Clinical Research Center, a study on how collagen breaks down causing lines and wrinkles is currently underway. This clinical study will focus on how facial expressions like squinting, smiling or frowning can cause stress on skin collagen fibers and hasten the formation of wrinkles.