Wrinkles, a natural part of aging, are most prominent on sun-exposed skin, such as the face, neck, hands and forearms.

Although genetics mainly determine skin structure and texture, sun exposure is a major cause of wrinkles, especially for fair-skinned people. Other factors, such as pollutants and smoking, also contribute to wrinkling.

If your wrinkles bother you, you have more options than ever to help smooth them or make them less visible. Medications, skin-resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments.

Wrinkles are the lines and creases that form in your skin. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.

When to see a doctor

If you're concerned about the appearance of your skin, see a dermatologist. He or she can assess your skin and help you create a personalized skin care plan. A dermatologist can also recommend medical wrinkle treatments.

Wrinkles are caused by a combination of factors — some you can control, others you can't:

  • Age. As you get older, your skin naturally becomes less elastic and more fragile. Decreased production of natural oils dries your skin and makes it appear more wrinkled. Fat in the deeper layers of your skin diminishes. This causes loose, saggy skin and more-pronounced lines and crevices.
  • Exposure to ultraviolet (UV) light. Ultraviolet radiation, which speeds the natural aging process, is the primary cause of early wrinkling. Exposure to UV light breaks down your skin's connective tissue — collagen and elastin fibers, which lie in the deeper layer of skin (dermis). Without the supportive connective tissue, your skin loses strength and flexibility. Skin then begins to sag and wrinkle prematurely.
  • Smoking. Smoking can accelerate the normal aging process of your skin, contributing to wrinkles. This may be due to changes in the blood supply to your skin.
  • Repeated facial expressions. Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. Each time you use a facial muscle, a groove forms beneath the surface of the skin. As skin ages, it loses its flexibility and is no longer able to spring back in place. These grooves then become permanent features on your face.

When you make an appointment with a dermatologist, it's a good idea to prepare for your appointment by making a list of questions you want your doctor to answer. For wrinkles, some basic questions to ask your doctor include:

  • What is the best course of action?
  • What are my treatment options and the pros and cons of each?
  • What will the treatments cost? Does medical insurance usually cover these treatments?
  • What results can I expect?
  • How often will I need to repeat the treatment?
  • What kind of follow-up, if any will I have?

Don't hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What products, such as cleansers and moisturizers, do you use on your skin?
  • Do you use sunscreen?
  • Did you expose your skin to sun when you were younger?
  • Do you smoke or have you ever smoked?

If your wrinkles bother you, you have many options to help smooth them or reduce their appearance. Wrinkle treatments include:

Medications

  • Topical retinoids. Derived from vitamin A, retinoids — such as tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) — that you apply to your skin may reduce fine wrinkles, splotches and skin roughness.

    Because retinoids can make your skin burn more easily, you must use a broad-spectrum sunscreen and wear protective clothing daily. Retinoids may cause redness, dryness, itching, and a burning or tingling sensation.

  • Nonprescription wrinkle creams. The effectiveness of anti-wrinkle creams depends in part on the active ingredients. Retinol, alpha hydroxy acid, antioxidants and some peptides may result in slight to modest improvements in wrinkles.

    Nonprescription wrinkle creams, however, contain less of the active ingredients than do prescription creams. Therefore results, if any, are limited and usually short-lived.

Surgical procedures and other techniques

A variety of skin-resurfacing techniques, injectables, fillers and surgical procedures are available to smooth out wrinkles. Each has its own set of potential results and side effects. Some studies indicate that a combination of treatments may yield the most satisfying results.

  • Laser, light source and radiofrequency treatments. In ablative (wounding) laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis), stimulating the growth of new collagen fibers. As the wound heals, smoother, tighter skin forms.

    It can take up to several months to fully heal from ablative laser resurfacing. Risks include scarring and lightening or darkening of skin color.

    Newer developments in laser technology, such as nonablative fractional laser resurfacing, have decreased healing time and reduced risks. Nonablative lasers are better suited to people with moderate wrinkles because results are subtle. Nonablative laser treatment typically needs to be repeated more often than does ablative treatment.

    There's also a device that uses radiofrequency instead of light for nonablative treatment that achieves mildly to moderately tighter skin.

  • Chemical peel. Your doctor applies an acid to the affected areas, which burns the outer layer of your skin to remove age spots and freckles, as well as wrinkles.

    Depending on the depth of the peel, you may need several before you see a difference. Redness lasts up to several weeks.

  • Dermabrasion. This procedure involves sanding (planing) the surface layer of skin with a rotating brush. The planing removes the skin surface, and a new layer of skin grows in its place.

    Redness, scabbing and swelling generally last a couple of weeks. It may take several months for pinkness to fade and for you to see results.

  • Microdermabrasion. Similar to dermabrasion, this technique removes only a fine layer of skin. This technique usually requires a series of treatments to produce results, possibly as many as 16.

    You may notice a slight redness or stinging sensation on the treated areas. Microdermabrasion produces modest, temporary results.

  • Botulinum toxin type A (Botox). When injected in small doses into specific muscles, Botox keeps the muscles from contracting. When the muscles can't tighten, the skin appears smoother and less wrinkled.

    Botox works well on frown lines between the eyebrows and across the forehead and on crow's-feet at the eye corners. Results typically last about three to four months. Repeat injections are needed to maintain results.

  • Soft tissue fillers. Soft tissue fillers, which include fat, collagen and hyaluronic acid gel (Restylane, Juvederm, others), can be injected into deeper wrinkles on your face. They plump and smooth wrinkles and furrows. You may experience temporary swelling, redness and bruising in the treated area. The procedure may need to be repeated every few months, as the effect of most fillers is temporary.
  • Skin tightening. Several devices use heat to tighten the skin. This noninvasive treatment produces mild to modest results, which usually develop gradually over four to six months. There's no recovery time for this procedure.
  • Face-lift. The face-lift procedure involves removing excess skin and fat in your lower face and neck and tightening the underlying muscle and connective tissue. The results typically last five to 10 years. Healing times can be lengthy after a face-lift. Bruising and swelling are usually evident for several weeks after surgery.

Keep in mind that results vary depending on the location and depth of your wrinkles. However, nothing stops the aging process of skin, so you'll likely need repeated treatments to maintain benefits.

These procedures aren't usually covered by insurance. Also, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you're considering.

Many over-the-counter wrinkle creams and lotions promise to reduce wrinkles and prevent or reverse damage caused by the sun. But these products are not likely to make a noticeable difference in your skin.

The Food and Drug Administration (FDA) classifies these creams and lotions as cosmetics, which are defined as having no medical value. So the FDA regulates them less strictly than it does drugs. This means that products don't need to undergo rigorous testing for safety and effectiveness before approval to go on the market.

Because the FDA doesn't evaluate cosmetic products for effectiveness, there's no guarantee that any over-the-counter product will reduce your wrinkles.

Here are ways to make the most of your skin's appearance:

  • Protect your skin from the sun. Protect your skin — and prevent future wrinkles — by limiting the time you spend in the sun and always wearing protective clothing, such as wide-brimmed hats, long-sleeved shirts and sunglasses. Also, use sunscreen when outdoors, even during winter.

    The American Academy of Dermatology recommends using a broad-spectrum sunscreen with an SPF of 30 or more. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring.

  • Use products with built-in sunscreen. When selecting skin care products, choose those with a built-in broad-spectrum sunscreen — meaning it blocks both UVA and UVB rays.
  • Use moisturizers. Dry skin shrivels plump skin cells, which can lead to premature fine lines and wrinkles. Though moisturizers can't prevent wrinkles, they may temporarily mask tiny lines and creases.
  • Don't smoke. Even if you've smoked for years or smoked heavily, you can still improve your skin tone and texture and prevent future wrinkles by quitting smoking.
  • Eat a healthy diet. There is some evidence that certain vitamins in your diet help protect your skin. More study is needed on the role of nutrition, but it's good to eat plenty of fruits and vegetables.
Oct. 21, 2014