By Dr. Doris Day
How do you feel about your wrinkles? Do you embrace them and think they are the sign of a life well lived? Do they horrify you and make you think you look like your wonderful mom who you love dearly but, let’s face it, she’s been old since the day you were born?
In this age of aesthetics chasing and erasing lines and wrinkles is very popular, but the question I always ask is: “is it a good idea?” The answer is not easy or obvious. It is also not an all or none response. Not all wrinkles are created equal and you may be surprised to know that erasing all the wrinkles doesn’t make you look younger and can even make you look older!
My nearly 20 years of practicing and teaching aesthetic dermatology has been a very enlightening journey, partly because it didn’t really exist before 20 years ago so I’ve been living and participating in the history and building the art of the science of it, and partly because there’s been an exponential growth of treatment options and our understanding of the aging process. But mostly it’s because I’m right there in the age group of women seeking the treatments... so it’s really about me. In the past the main option would be to age to a point and then have surgery to pull things back up into place. The result was fewer wrinkles but that often wouldn’t translate into looking younger.
One of the biggest and most important lessons I’ve learned is to never chase lines and wrinkles, instead I investigate and understand them and I treat the source. Sometimes the story is a simple one of too much sun exposure, usually over decades. In fact, over 90% of wrinkles come from exposure to ultraviolet radiation. This is important not just for wrinkles of course, but the story there is that I also need to be on the lookout for skin cancer and do regular screenings to make sure I catch them early to offer the best cure rate and the least amount of scarring.
Sometimes the story is more subtle and complicated but when I understand the story and share it with you, you will see why some wrinkles are to be cherished, or at least accepted and others are better being addressed for reasons of health, and of course rejuvenation. Here’s a prime example: One of the biggest wrinkle concerns I hear every day is a concern about forehead lines. For some reason people hate their forehead lines. It may seem like a simple thing to fix with a neuromodulator like Botox Cosmetic or Dysport but I submit to you that this is one of the trickiest and more advanced areas for treatment and I almost never recommend it for this area. Here’s why. One of the most important jobs of the forehead muscle is to lift the brows and keep your eyelids out of your eyes. That makes the muscle an elevator, it lifts. Lifting is a positive movement and I would not want to eliminate it.
Chances are if you start to notice more lines in your forehead it’s because your brows are slowly starting to drop and your lids are getting a little heavy. You probably feel it before anyone else sees it. But it often leads you to engage the forehead muscle to contract to pull up the brow and since many of the muscles of the face are attached to the skin, the skin moves along with it and makes forehead lines. Taking away it’s ability to do that will actually drop your brows making them lower and heavier and will make your eyelids sag, never an ideal situation. In this case erasing forehead lines may make you look smoother, but it won’t make you look better, or younger. The real solution is to try a tightening or lifting treatment to lift the brows and now with the advances in treatments this can be done without surgery.
My favorite treatment for tightening and lifting without surgery, and even better without down time uses radiofrequency and ultrasound energy. These are not lasers, they are devices that use specific types of energy to create heat at specific depths deep in the skin and to stimulate collagen contraction and new collagen formation to lift the brows or other parts of the face and eliminate the need to use the muscle for that action. It’s a longer lasting and often more natural looking approach. You’ll look just like you and feel great. And any lines left can be treated with a little neuromodulator and filler to further soften them for a natural and very attractive appearance.
Another example of what I see on a very regular basis is a concern over nasolabial fold lines - those lines from the corners of your nose to the corners of your mouth. Women and plenty of men too, notice those lines deepening as they age and want them treated. It’s easy to do, but usually not the best place to start since those line are often a reaction to deflation of the midface. By gently and discreetly placing the filler where it’s needed, often far away from those folds, we can create a soft lift and improve those lines without ever touching them. It’s magical in the effect and the best part of the magic is that it looks beautiful and natural, and no one will be able to tell anything was done.
The moral to this story is that every wrinkle tells an important one that’s unique and personal to you, and it’s worth paying attention because you have great control over it and have the power to make it a positive one with a happy ending. This involves proper sun protection every day all year round, using great products on your skin like retinol and antioxidants, eating a healthy diet and staying hydrated, also having the right treatments for you as needed and learning to love the way you look even more with every decade, wrinkles or no wrinkles. I always love a happy ending.
Dr. Day, a dermatologist, is affiliated with NYU Langone Hospital.