Retinols, CO2 Lasers, & Hyaluronic Acids: What Really Works Against Wrinkles

FaceliftFrom the New York Times Health section. What really works for fighting wrinkles?

  • Prescription strength retinols (tretinion, a vitamin A derivative)
  • Carbon dioxide (CO2) lasers
  • Hyaluronic acid filler injections (Juvederm, Restylane, etc)

Read the entire article below.

Wrinkle Removers, Backed by Science

Published: August 18, 2008

Nostrums that promise to smooth wrinkled skin are a staple of snake-oil salesmen everywhere, but now there is strong evidence that certain kinds of treatment are effective. Over the past decade, researchers have been learning which treatments work, and why.

The key is a growing understanding of the skin’s connective tissue, called the dermal collagen, and a recognition that damage to the mechanical properties of the collagen outside the skin cells, and not necessarily genetic damage to the cells themselves, causes wrinkled skin.

A recent review in The Archives of Dermatology concludes that three anti-aging treatments are proven clinically effective: the topical application of retinol; carbon dioxide laser resurfacing; and injection of hyaluronic acid, a moisture-retaining acid that occurs naturally in the skin. Each depends on the same mechanism, the interaction of skin cells called fibroblasts with the collagen they produce.

“This is an area where there’s a lot of hype and not much substance,” said David J. Leffell, a professor of dermatology and surgery at Yale who was not involved in the review. But, he said, this study is “good science.”

Theory and experiment back these treatments, the authors write. Fibroblasts — connective tissue cells — secrete a complex group of polysaccharides and proteins that creates collagen, which gives the skin shape and elasticity and supports the blood vessels that permeate it. The network of collagen tissue is maintained by its mechanical tension with these skin cells.

Skin deteriorates as it ages, but its exposure to sunlight inhibits the ability of fibroblasts to produce collagen. The hands, face, neck and upper chest all suffer more than unexposed skin, and light-pigmented people wrinkle more readily than others. This damage, the authors write, is essentially an accelerated version of chronological aging. Ultraviolet radiation induces production of the same enzymes that degrade collagen with age.

Collagen fibers last as long as 30 years. But with age and ultraviolet exposure, they deteriorate and fragment, and fragmented collagen impairs the collagen-producing function of the fibroblasts that created it. As the fragmented collagen accumulates, new collagen production declines, the connections between the fibroblasts and the collagen weaken, and the skin, now lacking support, begins to wrinkle.

But there are treatments that counter this process. Topical application of retinol, a form of vitamin A, was the first to be proved useful. Although the molecular pathways are not well understood, retinol causes new collagen to form in chronologically aged skin and in skin damaged by ultraviolet light.

Skin creams with retinol are available over the counter, but many do not indicate the concentration of the active ingredient. “Many products just refer to retinol or vitamin A as a buzzword,” said Gary J. Fisher, the lead author of the review and a professor of dermatology at the University of Michigan.

Concentrations of 0.2 to 0.6 percent are enough, Dr. Fisher said, but preparations strong enough to have an effect can also have a side effect, a rash called retinoid dermatitis. Dr. Fisher’s advice is to stop using it if a rash occurs. The rash can sometimes be avoided if the concentration is increased gradually.

Retinol also makes the skin more sensitive to damage from ultraviolet light, so protection from the sun while using it is essential. “O.T.C. products tend to try to walk the line between effects and side effects,” Dr. Fisher said. “But many intentionally keep the concentration too low to have any benefit.”

Dr. Robyn S. Gmyrek, an assistant professor of dermatology at Columbia University, is also skeptical of over-the-counter wrinkle creams. “If something shows true biological activity, it’s regulated as a drug,” she said. “A cream bought over the counter is certainly not going to do what prescription-strength retinol will do.” Dr. Gmyrek was not involved in the study.

Carbon dioxide laser resurfacing is another well-tested treatment for wrinkles. The laser removes thin layers of skin without damaging surrounding tissue. As the wound heals, new collagen is produced. The treatment works first by inducing high levels of matrix metalloproteinase, or MMP, an enzyme that destroys fragmented collagen. Then it reduces MMP and increases the production of new and undamaged replacement material. The procedure is also used for removing scars, warts and birthmarks.

Healing takes two to three weeks, and the wound has to be cleaned with saline or diluted vinegar and treated with ointments to prevent scarring. In most cases, the procedure is done only once, Dr. Fisher said, and lasts many years.

There are now some less invasive laser procedures, the authors write, but their effectiveness is doubtful.

The third effective treatment is injecting a form of hyaluronic acid, similar to a substance the skin normally produces, into the dermis that underlies the wrinkles. This was originally designed as a space filler, with no intended physiological effect. But as the injection stretches the dermis, the fibroblasts respond by producing more collagen and less MMP. The authors cite studies that have demonstrated that increased collagen production is visible within a month after the injection. The benefit lasts about six months, Dr. Fisher said.

This type of hyaluronic acid, he said, should not be confused with hyaluronic acid in some topical cosmetic products. Rubbing such products on the skin will not stimulate collagen production.

Do the benefits of these treatments outweigh the risks?

“It’s a matter of the kind of problem a person perceives and how he wants to deal with it,” Dr. Fisher said. “For these treatments, which have sound research behind them, and for people who want to improve their appearance, the benefits far outweigh any problems.”

The authors have no ties to companies that make skin care products, but the University of Michigan, where they teach, has patents on the use of matrix metalloproteinase inhibitors in the treatment and prevention of aging skin.

This article has been revised to reflect the following correction:

Correction: August 21, 2008
Because of an editing error, an article on Tuesday about three treatments proved to be effective against wrinkles described incorrectly part of the process of one of those treatments, carbon dioxide laser resurfacing. After the laser removes thin layers of skin, the healing wound produces more collagen, not less.

Medical Benefits of a Tummy Tuck


An interesting post on the ASPS website by Dr Jeremy White from Florida.

Abdominoplasty – or a tummy tuck, as it is more commonly known – is a cosmetic surgery procedure that tightens the muscles and removes loose skin and fat from the abdomen so that it appears flat and toned.

Mostly associated with “mommy makeovers,” a procedure that allows women to restore their figures after pregnancy, abdominoplasty is also used to help patients that have undergone extreme weight loss in a short period of time.

Between 2000 and 2014 the number of tummy tuck procedures rose an impressive 87 percent, according to the American Society of Plastic Surgeons. Many procedures were, no doubt, for cosmetic reasons, but there are several medical benefits to be gained after the procedure.

Reduction of Stress Urinary Incontinence

After a vaginal birth, some women can develop Stress Urinary Incontinence (SUI), a bladder control problem associated with uncontrollable leakage brought on by coughing, sneezing, exercising or even laughing.

In most cases, SUI is treated without surgery. For patients who require more care, several studies have indicated that a tummy tuck can aid in recovery especially in patients that have not had a caesarian section. During the procedure, a slight bladder obstruction is created using soft tissue near the pelvic area, thereby reducing incontinence.

Improved Abdominal Tone and Better Posture

After extreme weight loss or multiple pregnancies, stomach muscles can become distended, and diet and exercise alone cannot help. A tummy tuck surgically tightens weak muscles, while removing excess skin and fat, to flatten the abdomen.

Weak abdominal muscles are often associated with lordosis, or sway back. After an abdominoplasty, patients may notice that their posture has improved significantly, thanks to the tightened muscles supporting their spine. The improved support and better posture can have the added benefit of relieving certain types of back pain.

Ventral Hernia Correction

A ventral hernia occurs when the intestine or abdominal tissue breaks through the abdominal wall and forms a pocket or sack. There are several potential causes, including abdominal weakness caused by massive weight loss or surgeries like C-sections or appendectomies.

The underlying symptoms that require a ventral hernia correction are remarkably similar to those for abdominoplasty. Both surgeries correct weakened adnominal muscles and pressure on the skin. No matter the cause, whether pregnancy or weight, a weak abdominal wall will allow a hernia to form.

Once you develop a ventral hernia, it is very easy for it to happen again. Often, your surgeon will weigh the benefits of adding an abdominoplasty procedure to the hernia repair to strengthen the abdominal wall and prevent future occurrences. Combining the procedures is not only safe, but very practical, as it can reduce medical expenses and recovery time.

Risks and Rewards

Due to its growing popularity, many people believe that a tummy tuck is an easy procedure. It’s important for patients to realize that it is still a major operation, requiring one to five hours in the operating room, under general anesthesia.

A typical abdominoplasty removes up to 10 pounds of stomach fat by disconnecting the skin from the underlying tissue, suturing abdominal tissue, and cutting away any extra skin. A full recovery can take several weeks, and just like any other surgery, there are risks of infection and other complications.

That said, the various medical and cosmetic benefits of a tummy tuck make the procedure appealing for many people. Interested patients should discuss the procedure in detail with their surgeon and consider all the advice before deciding whether to undergo surgery.


Another Study Confirms Excess Sun Exposure & Smoking Makes You Look Older!

Based on a Study from the British Journal of Dermatology

Background Lifestyle has been proven to have a dramatic effect on the risk of age-related diseases. The association of lifestyle and facial ageing has been less well studied.

Objectives To identify lifestyle factors that associate with perceived facial age in white north European men and women.

Methods Lifestyle, facial wrinkling and perceived facial age were studied in two cross-sectional studies consisting of 318 Dutch men and 329 women aged 45–75 years who were part of the Leiden Longevity Study, and 162 English women aged 45–75 years who were nonsmokers.

Results In Dutch men, smoking, having skin that went red in the sun, being outside in the sun most of the summer, sunbed use, wearing false teeth and not flossing teeth were all significantly associated (P < 0·05) with a total 9·3-year higher perceived facial age in a multivariate model adjusting for chronological age. In Dutch women, smoking, sunbathing, sunbed use, few remaining teeth and a low body mass index (BMI) were associated with a total 10·9-year higher perceived facial age. In English women, cleaning teeth only once a day, wearing false teeth, irregular skin moisturization and having skin that went red in the sun were associated with a total 9·1-year higher perceived facial age. Smoking and sunbed use were associated more strongly with wrinkling in women than in men. BMI, sun exposure and skincare were associated predominantly with perceived facial age via wrinkling, whereas oral care was associated via other facial features.

Conclusions Although associative in nature, these results support the notion that lifestyle factors can have long-term beneficial effects on youthful looks.