Topical treatments for fine lines and wrinkles

I practice integrative and functional medicine so my patients will feel better, reverse and prevent disease.

I also provide aesthetic medicine services at the same office.

Why? Because facial fine lines and wrinkles are the top three skin concerns among my patients ages 30 to 50.

If it helps them feel their best by looking their best, well, then, I’m happy that I can help.

Especially when the results can undo years of damage, like for a 53-year-old patient I recently treated with Xeomin (botulinum toxin A) …

You see, using Botox drastically evened out her left face wrinkles to match her right residual facial paralysis caused by Ramsey-Hunt Syndrome years ago. She is thrilled with the results and her genuine happiness reminds me why I love aesthetic medicine.

Another reason I love it is because at my practice, San Diego Integrative Medicine and Spa, I get to work across the hall from my sweet wife, Julia. Her clients rave about their results. She is an expert at eyelash extension and semi-permanent make-up.

Together we feel contributing this kind of positive energy gives our patients momentum to live a healthy lifestyle.

Because ultimately, it’s those lifestyle habits, the way you eat and how you treat your body — including your skin — that are the biggest factors to looking and feeling your best… even when it comes to fine lines and wrinkles. But there is a little help to be had in the form of topical treatments…

Causes of facial fine lines

Fine facial lines are among the first signs of aged-related skin damage. Those fine lines result from a few obvious causes: too much artificial tanning or sun damage (ultraviolet light), smoking, genetic predisposition and advancing age.

But, there are these other contributing causes to fine lines that often get overlooked:

• A nutrient-poor diet. A little further down you’ll see that some of the most effective compounds used topically to improve your skin come from nutrients found in fruits and vegetables. That’s why not only is a well-rounded diet important, but so is one based on organic, clean foods.
• Stress that is frequent or prolonged causes cortisol over-production by your adrenal gland. One of the symptoms of cortisol excess is accelerated skin aging.
• Exposure to harsh chemical ingredients (in creams and lotions) or even chronic use of prescription medications.
• Constipation, because it promotes systemic (total body) inflammation. When stool sits inside your colon too long (two bowel movements daily is considered healthy), some of the chemicals in it are absorbed back into your bloodstream through the intestinal wall called the entero-hepatic circulation process. This means that toxic water insoluble wastes in the bile, intended for elimination, can be re-absorbed back into your bloodstream — and that can wreak havoc with your complexion and skin health.

Some of these things you can do something about — in fact most of them. But many people just don’t even realize that taking care of their skin is important — until it is too late.

Topical treatments for fine lines

The first place to start is with the contributing causes…

Decide to stop what’s harming your skin. The best way to do this I know of is to go on a liquid cleanse (Lemonade Cleanse or fresh juicing), followed by consistent consumption of mostly raw, whole food nutrition. Also, greatly reduce or eliminate processed foods high in sugar or refined oil or trans fats from your diet.

[youtube https://www.youtube.com/watch?v=0H9u4GEKk2I]

Then you’re ready to start on the outside…

Treatment of fine lines ranges from topical cosmeceutical creams to office procedures such as chemical peels, microdermabrasion, hyaluronic acid dermal filler injections, radiofrequency, IPL (intense pulsed light) and laser — all these are at your local medical spa.

Let’s start with topical creams…

Cosmeceuticals contain powerful anti-aging and healing ingredients to make your skin smoother, softer and younger-looking. They are classified based on their ability to improve skin appearance (but not skin structure and function as drugs are).

Antioxidants

Antioxidants protect skin cells from the damage caused by free radical molecules. And if you have read about antioxidant food sources, you know of the best way to benefit from them — eating a whole foods diet full of fruits and vegetables.

Nutrients from whole foods, like antioxidants are the key to health inside and outside. Antioxidants are popular in cutting-edge topical serums and creams, and include:

• Vitamin C (L-Ascorbic acid) is a vital nutrient for skin growth and repair, and one of the strongest antioxidants for skin. It is proven to prevent and reduce skin aging and wrinkles. It is expensive ($75-200 for 2 to 3-month supply). The most effective formulation is 20% at a pH of 2 (very acid).
• Vitamin E (Alpha tocopherol) claims to protect skin softness, prevent sun damage and delay skin aging. Dermatologists instead often recommend Aquaphor® to protect and smooth skin which contains petrolatum, panthenol (derived from B-vitamin), glycerin and bisabolol (from chamomile).
• Polyphenols: resveratrol, green tea, soy and coffeeberry contain polyphenols shown to reduce skin cancer, sun damage and skin aging. Resveratrol (from grapes, berries, nuts, etc.) is the most potent one when formulated correctly.
• CoEnzyme Q-10 reduced wrinkles in 27% of users over 6 weeks in one study.
• Alpha lipoic acid 5% cream applied daily reduced sun damage (photoaging) in a study of 33 women average age 54 years in a 12-week placebo-controlled study.

Hydroxy acids

Popular hydroxy acids, such as glycolic acid and salicylic acid cause removal of dead surface skin cells. Hydroxy acids are naturally found in fruits like lemon, grapefruit and other citruses.

They compare in effectiveness to Retin-A. Be aware of their risk of persistent redness, scarring or cold sore flare-ups.

• Beauty spas and non-prescription creams contain 4 to 10% concentration for daily use, but be careful if you have very sensitive skin.
• Physicians can use 50-70% concentrations in their office for deeper chemical peels, typically as trichloroacetic acid (TCA) for fine wrinkle reduction. Repeat treatment every 2 to 4 weeks for optimal results.

Peptides

Peptides or amino acids increase cells in the skin to produce more collagen, the support structure of youthful skin. Originally these were marketed for healing stretch marks. The three main peptides are:

• Signal peptides increase collagen formation (e.g. Palmitoyl-pentapeptide, Peptamide-6)
• Carrier peptides activate enzymes to increase collagen and carry trace elements such as copper for wound healing (e.g. glycyl-l-histidyl-l-lysine)
• Enzyme-inhibiting peptides block collagen destruction and also relax muscles like Botox by blocking acetylcholine release (e.g. Argireline)

Growth factors

Growth factors and cytokines are vital molecules for skin repair and aging reversal. These naturally become depleted with age and current studies prove they increase dermal collagen.

Stem cells

Stem cells from plants, animal, human fat cells and placental tissue/amniotic fluid have been proven to increase collagen, decrease wrinkles and promote wound healing. They are found in many serums and creams on the market already.

Vitamin A retinoids

• Natural retinoids are derived from Vitamin A and you don’t need a prescription to buy these. They are clinically proven to help visibly reduce both fine lines and deep wrinkles. They must be converted into pre-formed vitamin A. From weaker to stronger, these ingredients are: retinyl palmitate, retinol and then retinal aldehyde (a.k.a. “retinal”).
• Retinoic acid is the strongest natural retinoid. The prescription cream Tretinoin is retinoic acid in pharmaceutical form (Retin-A®, Renova®) and is dosed from 0.02% up to 0.1%. These treat more than just acne — now being prescribed for fine lines, to strengthen skin, and to stimulate new skin growth. Retin-A also treats keratosis follicularis (small red rough bumps on the back of your upper arms), psoriasis and flat warts.
• Synthetic retinoids(a.k.a. retinoid analogues) are made in a laboratory and act like natural pre-formed vitamin A in your skin. These are by prescription only and (from weaker to stronger) are: Adapalene (Differin®) Gel 0.1% to 0.3%, and Tazarotene (Tazorac®) cream 0.05% and 0.1%.

Wrinkles

The most obvious wrinkles of the face are formed by underlying muscle contractions of facial expression.

Most of us don’t even realize we do it, but consistently raising the eyebrows (frontalis — forehead muscles), squinting the eyes (orbicularis oculi — around lateral eye muscles) or scowling (corrugator — glabella muscles that make the “11 lines” between the eyebrows), is repetitive action that contributes to wrinkles.

These are the wrinkles that are easily overcome by injection of botulinum toxin, which lasts 3 to 5 months per treatment.

In my next article I’ll share causes and treatments for sagging skin, the major aesthetic concern for my patients over age 50.

To long feeling good and looking good,

Michael Cutler, M.D.