History of the Patients:
- Premature ageing syndromes (progeria, acrogeria etc.) should be ruled out in early onset cases.
- Occupational sun exposure (with or without the use of sunblocks) provides information on UVR exposure.
- Personal history (stress, smoking habits etc.)
- History of prior treatment for wrinkles (with results) helps in selection of the modality of treatment.
1. GLYPHIC WRINKLES:
These are accentuated normal skin creases. They are common in young individuals with increased sun exposure for instance the farmers.
2. LINEAR FURROWS:
These are long grooves, straight or curved, seen horizontally on the forehead, radiating as crow’s feet from lateral canthus of the eye, or extending as creases from the nose to the corner of the mouth. They are seen routinely in elderly patients.
These are very fine criss-cross wrinkles. They occur even in sun protected areas and are a universal phenomenon among old age people.
Wrinkles may also be classified as:
1) Static wrinkles: Follow normal facial expressions.
2) Dynamic wrinkles: Follow ageing and physical tension.
Principles of the Treatment:
1. Protection against UV Radiation
2. Patient education regarding the use of sunscreens (SPE>15), umbrella, hats and other protective clothing is important.
3. Mid-day sun exposure and reflected UVR (eg. from water, sand and snow) should be avoided as they are more photo-damaging.
4. Avoid sunbathing.
5. Use soap sparingly or switch to milder and glycerin based or neutral soaps to prevent dryness, which accentuates wrinkle formation.
6. Emollients should be a regular part of your daily skin care regime.
7. The choice of the treatment depends on the severity and type of wrinkles along with the aesthetic needs of the patients.
8. Cosmetic camouflage is an effective temporary mean of concealing ageing skin problem like wrinkles, mottled pigmentation and xerosis.
9. Associated medical disorders and treatment being taken (anticoagulants) should be inquired before contemplating therapeutic measures.
Skin Rejuvenation Schedule:
Everyone desires to maintain a youthful appearance and intends to delay the signs of ageing. It is becoming a common demand placed before the dermatologist.
1. The occlusive moisturizers coat the stratum corneum giving emollient effect and preventing water loss.
2. The humectants draw water into stratum corneum from the atmosphere, deeper epidermis and the dermis, causing mild swelling of stratum corneum giving an impression of a smoother skin with fewer wrinkles.
1. Retinoids prevent collagen breakdown and stimulate collagen synthesis.
2. Hydroxyacids reduce corneocyte cohesion thereby hastening desquamation of pigmented cell and keratinocytes turnover rate.
3. Vitamin C stimulates collagen synthesis and by inhibiting melanogensis helps in producing depigmenting antioxidant property.
1. These are free radical/reactive oxygen species (ROS)
2. They are produced by UV radiation, normal metabolic process, pollution, stress, smoking, inflammation, drugs or heavy metal.
3. These free radicals take electron from vital components leaving them damaged and inducing change in gene expression path, which causes degradation of collagen and elastic leading to ageing of the skin.
4. Antioxidants like vitamins (A, C & E) and trace elements (Zn, Cu, Mn, Se) neutralize these free radicals by providing another electron pair with oxygen, thereby stabilizing it.
5. Biological modulators such as tea extracts, oils, soy, aloe vera, ginseng etc.
D. Chemical Peels
1. Superficial and medium depth peels improve the texture of the skin, mottled pigmentation, fine wrinkles, surface roughness, freckles and lentigenes.
2. Superficial and medium depth peel are dynamic tools for treating photo ageing. They should be combined with UVR protection, retinoid and home care products for maximum efficacy.
E. PROCEDURAL MEASURES:
1. Antiwrinkle injections
2. Dermal fillers
3. Skin boosters
6. Radiofrequency face lift
8. Laser skin resurfacing
9. Surgical face lift