Wrinkle Treatment and Advice
By Cynthia Bailey MD.
Wrinkle treatment has always been a very popular topic in my dermatology practice! Most people start seeing wrinkles in their late 20's as 'crow's feet' around the sides of our eyes. In this article I explain what causes wrinkles, what you can do to prevent them and how you can even reverse them. Find out what skin care products work and what are over-promising. I'm going to give you an overview of this popular topic and some ideas on how to use your skin care routine to help prevent and get rid of wrinkles.
What causes skin to wrinkle as we age?
Wrinkles are due to a loss of collagen and elastin (similar to collagen and for the purposes of simplification I will refer to them both as 'collagen') in the skin. Skin collagen is primarily lost due to from sun damage (extrinsic skin aging), but aging also causes some skin collagen loss (intrinsic skin aging). As skin wrinkles it becomes thin and fragile too. To truly reverse wrinkles on your skin you need to re-thicken the skin by building more collagen.
Unfortunately, collagen can't be added to the skin from the outside. It has to be made by your body's own cells inside the skin. Buying expensive collagen containing creams does nothing to replenish lost skin collagen. You can only build skin collagen by using products with ingredients that stimulate your skin's fibroblast cells to produce collagen inside your skin. - Dermatologist and Skin Wellness Expert Dr. Cynthia Bailey
Wrinkle treatment using skin care ingredients that stimulate cellular collagen renewal inside our skin.
There are only 3 types of skin care product ingredients that, in my professional opinion, have the power to 'turn on' your skin's collagen renewal. These 3 ingredients are:
- Retinoids - Such as prescription tretinoin cream (Retin-A) and professional retinol products with retinol concentrations of 0.25% or greater such as Retinol Anti-Wrinkle Night Cream.
- Glycolic acid (also called an AHA or alpha hydroxy acid) - A glycolic acid product must have a free glycolic acid concentration of over 10% and be formulated to an acid pH to stimulate skin collagen renewal. These are professional products such as my Glycolic Acid Anti-Wrinkle Face Creams.
- Vitamin C - There must be at least 10% concentration in the product (in the L-ascorbate form), formulated to an acid pH under 3.5 and the product needs to be in a container that does not allow oxygen to enter. My Vitamin C Anti-Wrinkle Professional Serum is made to these specifications. In addition to treating wrinkles, Vitamin C also helps to protect the skin from damaging free radicals that can lead to wrinkles including from sun exposure and other harsh environmental stressors.
All of the other ingredients claiming to treat wrinkles don't have good scientific evidence in vivo in humans. The term 'in vivo' means in the living organism - like you in your bathroom. You may see skin care ingredients and products that claim to stimulate collagen renewal. The claims sound scientific but look deeper - the studies are typically vitro studies, meaning in the lab on cell or tissue or even just chemistry reactions swirling in liquid. That's not good enough. Your skin is an excellent barrier to ingredients penetrating from the outside to the inside of your skin where your cells and chemistry need stimulation to produce collagen. Believe me, I keep up on this topic - I, and my 60+ year old face, will use any and all ingredients that stimulate my fibroblasts to churn out collagen. We use the 3 listed above.
How do you pick the right wrinkle fighting cream for your skin?
All of the three best collagen building skin care ingredients can be irritating and tricky to use so you can't just rush in and apply all three to your skin and wait for results. You need to understand how to use them in your skin care routine. They each have pros and cons that you need to understand. You also don't want to combine Vitamin C with the other 2 ingredients at the same time. Let me help!
Build your Dr. Bailey Complete Skin Care Routine™ to support your skin as it adjusts to these powerful wrinkle fighting products.
Complete Skin Care involves the 4 essential skin care steps:
The 'rocket science' in skin care treatment of wrinkles comes in the CORRECT and PROTECT steps. Support your skin in CLEANSE and CORRECT. By that I mean:
- Don't irritate your skin with harsh cleansers.
- Do hydrate your skin with moisturizers that support critical skin lipids in your skin's stratum corneum barrier to keep your skin from getting irritated.
When you build a Complete Skin Care Routine to treat your wrinkles with these considerations, you will have the most success. It's true!
Wrinkle Treatment with Dermatologist Dr. Bailey's Complete Skin Care Routine™
I often add the collagen stimulating ingredients one at a time because they can be irritating. I usually start first with a retinoid because most complexions can tolerate retinoids since they do not have the acid pH. Even sensitive complexions can often eventually use a retinoid if the sensitivity and skin barrier is healthy. This includes many people with rosacea - like me.
Choices include the prescription retinoid called tretinoin (Retin A) or my non-prescription Retinol Anti-Wrinkle Night Cream. My Retinol Night Cream contains the right concentration of the proven active retinol.
Retinoids are really only effective on the face, neck, chest and back of the hands. The rest of the skin on your body is too thick for them to meaningful penetrate. You need to know that retinoid creams make your skin more sun sensitive and more sensitive to irritating things like harsh soaps or climates. This happens because retinoids exfoliate the top stratum corneum layer of dead cells to brighten skin. This also allow sun and harsh things to penetrate more readily.
Once a complexion has adjusted to retinoid treatment for wrinkles, I add glycolic acid. Lastly, I add vitamin C. Vitamin C has a half-life in skin of 4 days. This means that only half the amount is gone after 4 days. I let my patients apply this ever 2 or 3 days after using it daily for a week. This is also how I personally use vitamin C.
To support skin as it responds and adjusts to these powerful products, I select cleansers, antioxidant anti-inflammatory products, hydrating products and non-irritating mineral zinc oxide sunscreens based on a person's skin type. If facial redness is a problem, we address that first because it leads to stratum corneum barrier weakness and that leads to irritation with all the 3 powerful collagen stimulating ingredients.
Supportive products and tips that I use to help my patients tolerate a powerful wrinkle treatment skin care routine:
- Wash with gentle cleansers only. If rosacea or seborrhea are present then they need to be treated. I recommend washing the treated skin with a pH balanced and sulfate free gentle cleanser such as Extremely Gentle Foaming Facial Cleanser. Follow this with a gentle toner to get skin really clean such as Naturally Hydrating Pore Minimizing Toner . If rosacea or seborrhea are a problem, use Calming Zinc ® Bar Soap at least once a day. It can be alternated with the Extremely Gentle Cleanser.
- Soothe and quiet any skin irritation. My Green Tea Antioxidant Cream is often the critical product that makes the difference. I have my patients apply it right after washing or right after using my Instantly Luminous Multi-Action Serum, which also soothes dry, limp and irritated skin.
- Sun protection is critical every day to fight wrinkles. Especially if you use a retinoid. All of my sunscreens work beautifully with tretinoin and retinoid therapy. UV exposure starts the degradation of collagen in your skin by the matrix metalloproteinase enzymes. That breakdown runs non-stop even once you are out of the sun unless you turn it off with retinoids. Yep, it's true!
- Use a deeply hydrating facial moisturizer to balance skin hydration. This helps maintain a healthy skin barrier and to protect the skin from harsh weather. Apply the facial moisturizer under your sunscreen during the day. Pick a product that is free of irritating ingredients or allergens. Ideal options include Daily Moisturizing Face Cream for Oily to Normal Skin if you have normal to oily skin. If you have dryer skin, use a richer oil-containing moisturizer such as Daily Moisturizing Face Cream for Dry to Normal Skin. You can add a few drops of a good Booster Oil to your moisturizer when your skin feels dry. This helps to further enrich the lipid content of your skin.
Powerful Complete Skin Care Routine™ for Wrinkle Treatment
CLEANSE skin with Extremely Gentle Foaming Facial Cleanser and rinse well with warm (not hot) water. Follow this by applying my Naturally Hydrating Pore Minimizing Toner with a cotton pad. Get both in my Skin Cleanse Zen Kit.
HYDRATE your skin to help it fight irritation and dryness by supporting your precious skin lipids. Use one of my high-tech squalane rich formulations selected for your skin type: Daily Face Cream for Dry to Normal (what I use) or Oily to Normal complexions.
PROTECT your skin from all UV rays to prevent collagen breakdown. All of my sunscreen products give you the best invisible mineral zinc oxide technology available.Pick your product based on your skin type. My top choices are my Sheer Strength Pure Physical Matte Tinted Cream SPF 50+ Sunscreen and my Sheer Strength Pure Physical Spray SPF 50+ Sunscreen. I wear the Tinted SPF on my face and the Spray on my neck, ears, chest and hands every single day.
CLEANSE skin as above. If you have a Clarisonic Brush this is a great time to use it to deeply clean your skin. If you suffer from facial redness use my Calming Zinc Soap to fight rosacea and seborrhea.
HYDRATE skin to fight dryness and irritation that can occur with this powerful routine. The cream base in Glycolic Acid Anti-Wrinkle Face Cream or tretinoin cream are moisturizing enough for most complexions. If you are using the Retinol Night Cream without Glycolic Acid Cream then top your Retinol with the Daily Face Cream. I personally boost my Daily Face Cream with a few drops of my Omega Facial Booster Oil.
Get my Anti-Aging Antioxidant Skin Care Kit to fight the signs of skin aging!
I've done the work for you by putting all of the best products into a bundled kit. My Anti-Aging Antioxidant Skin Care Kit products reverse the signs of wrinkles and skin aging. These are the products that I and my patients use to fight skin aging. The kit includes powerful antioxidant products including Green Tea and Vitamin C. You can also add Retinol and Glycolic Acid and it gives you a choice of one of my most popular sunscreens and facial moisturizers.
The good news is that today we have a great understanding of why our skin wrinkles as we get older. We also have great skin care products to prevent and reverse wrinkles at any age.
Improvement of photoaged facial skin in middle-aged Japanese females by topical retinol (vitamin A alcohol): a vehicle-controlled, double-blind study. Kikuchi K, Suetake T, Kumasaka N, Tagami H, J Dermatolog Treat. 2009;20(5):276-81
Choosing Topical Retinoids for Aging Skin, Sachs, DL, Dermatology Focus, Summer 2013 Vol 32 No 2 page 4
Application of Retinol to Human Skin In Vivo Induces Epidermal Hyperplasia and Cellular Retinoid Binding Proteins Characteristic of Retinoic Acid but Without Measurable Retinoic Acid Levels or Irritation, Sewon Kang, Elizabeth A. Duell, et. al., J Invest Dermatol 105:549-556, 1995
Vitamin A Antagonizes Decreased Cell Growth and Elevated Collagen-Degrading Matrix Metalloproteinases and Stimulates Collagen Accumulation in Naturally Aged Human Skin, James Varani, Roscoe L Warner, Mehrnaz Gharaee-Kermani, et. al., J Invest Dermatol (2000) 114, 480–486;
Topical Tretinoin for Photoaged Skin: a Double-blind Vehicle-controlled Study, Weiss JS, Ellis CN, et. al., JAMA. 1988, 259: 527-532
Tazarotene Cream for the Treatment of Facial Photo Damage: a Multicenter, Investigator-Masked, Randomized, Vehicle-Controlled, Parallel Comparison of Tazarotene 0.01%, 0.025%, 0.05%, and 0.1% Creams and Tretinoin 0.05% Emollient Cream Applied Once-Daily for 24 Weeks. Kang S, Leyden JJ, Lowe NJ, et al., Arch Dermatol. 2001;137:1597-1604.
Mechanisms of Photoaging and Chronological Skin Aging, Gary J. Fisher, PhD; Sewon Kang, MD; et. al., Arch Dermatol. 2002;138(11):1462-1470
Bernstein, EF, et. al. (including Van Scott, E), Glycolic Acid Treatment Increases Type 1 Collagen mRNA and Hyaluronic Acid Content of Human Skin, Dermatologic Surgery 2001;27:429-433
Ditre CM et. al. (including Van Scott, E), Effects of alpha-hydroxy acids on photoaged skin; A pilot clinical, histologic, and ultrastructural study, Journal of the American Academy of Dermatology, 1996;34:187-195
Firas Al-Niaimi, MRCP(UK)(Derm) and Nicole Yi Zhen Chiang, MRCP(UK)(Derm), Topical Vitamin C and the Skin: Mechanisms of Action and Clinical Applications, J Clin Aesthet Dermatol. 2017 Jul; 10(7): 14–17.
Pittayapruek P, Meephansan J, Prapapan O, Komine M, Ohtsuki M. Role of Matrix Metalloproteinases in Photoaging and Photocarcinogenesis. Int J Mol Sci. 2016;17(6):868. Published 2016 Jun 2. doi:10.3390/ijms17060868