Stop smoking. One study found that wrinkles are five times more likely in smokers than non-smokers. The skin on the face of a smoker aged 40 resembles that of non-smokers in their 60s. Researchers in Japan have discovered that cigarette smoke reduces the ability of the skin to renew itself, so that less new collagen is produced by skin cells and the breakdown of existing collagen is encouraged (New Scientist 15 April 2000).
Avoid sun exposure. Staying out of the sun as much as possible, wearing a hat that shades the face and using sunscreens will prevent further damage and may also help the skin improve – there is evidence that the skin can repair itself to some extent, if given half a chance.
Check that your sunscreen filters out both UVA and UVB light – look for ‘broad spectrum’ on the label. UVB light is the most important in causing skin cancer. Both UVB and UVA cause the skin to age, but experts are still arguing about which is more important. The SPF (sun protection factor) number on the bottle indicates the amount of UVB protection a product provides, but it is difficult to know how much UVA protection there will be. Most manufacturers use a star system for UVA, with four stars meaning maximum UVA protection.
Ideally, apply a sunscreen every day, not just on holiday or on sunny days, because even quite low but repeated doses of UVA and UVB can wreak havoc on collagen and elastin. In spring and autumn in the UK, use a sunscreen of SPF 15 or higher, and a 3- to 4-star UVA protection (Dermatology in Practice 2007;15:6–7). In the summer, use higher protection. Unfortunately, there is no such thing as a safe tan – a tan is a sign that the skin has already been exposed to too much light and is desperately trying to protect itself against further damage. Use fake tans and sunscreen instead.
Improving your diet may help to prevent wrinkles. According to New Scientist (14 July 2001), researchers in Australia studied 450 elderly people to see if there was a link between what they ate and how wrinkly they were. The least wrinkly people had been eating lots of vegetables, beans, fish, low-fat milk and tea. The most wrinkly had been eating lots of soft drinks, cakes, pastries, red meat and full-fat dairy produce.
Moisturizers cannot prevent or really get rid of wrinkles. They coat the skin with a very thin layer of oil or silicone, which prevents it drying out. If skin is dry, wrinkles are more noticeable, so by keeping the skin moist and plump, moisturizers help to blank out smaller wrinkles. It is best to apply a moisturizer after washing in the morning, while your skin is slightly damp. Look for a moisturizer that contains sunscreen, to help minimize further damage.
Do anti-ageing creams work? Anita Roddick, founder of The Body Shop, once said that anti-ageing skincare products (except moisturizers) are “complete pap”. She said “there is nothing on God’s planet that will take away 30 years of arguing with your husband and 40 years of environmental abuse. Anything which says it can magically take away your wrinkles is a scandalous lie” (The Times 19 October 2000).
Cosmetic companies are now doing a lot of research, so some of the recent products may help but it is hard to know if they are truly effective. Ben Goldacre, who writes the excellent ‘Bad Science’ column in the UK Guardian newspaper explains why. Part of the problem is the cost of doing the research properly. The other reason is that ‘those tests could bite any company right back: because if they were to show no effect, then your business is trash; but if they do show an effect, then busybodies wade in to regulate your pharmaceutically active product. If it was my cosmetics company, I’d stick with the sciencey diagrams and hope for the best.
In 1998, the Consumers’ Association magazine Which? selected 12 ordinary moisturizers and 12 anti-ageing creams. Four women tested each product, according to the manufacturers’ instructions, for 4 weeks without knowing which product they were using. Most of the women did not notice any difference in the look or feel of their skin. Ten of the 48 women using anti-ageing creams reported an improvement, but even more of those who had used moisturizers – 18 out of 48 – noticed the same thing. Three-quarters of all the women thought that they had been using a simple moisturizer. Which? concluded that “some of the claims made for the ingredients of anti-ageing creams can be substantiated but, in the low concentrations used in the creams, they are unlikely to do more than moisturize your skin”.
Oestrogen is a hormone that seems to make the skin thicker, increasing its collagen and water content. Doctors in Germany guessed the ages of women around the menopause and then measured their oestrogen levels. The higher their oestrogen level, the younger they appeared. The women with the highest levels looked 8 years younger than they really were, whereas those with the lowest levels were guessed to be 8 years older than their true age.
So you might think that hormone replacement therapy (HRT) containing oestrogen would probably help to reduce wrinkles. However, a study of 485 post-menopausal women found no such effect (Journal of the American Academy of Dermatology 2008;59:397–404). Also, the risks of HRT (such as breast cancer and stroke) mean that it should not be taken for cosmetic reasons.
Similarly, an American study of oestrogen cream found no beneficial effect on sun-damaged skin (although it did promote the production of collagen in skin that had not already been sun-damaged) (Archives of Dermatology 2008;114;1129–1140). It is not yet clear whether oestrogen-containing creams have any harmful effects.
Retinoids, such as tretinoin, isotretinoin and tazarotene, are chemicals that are related to vitamin A. They make the skin produce new cells more quickly, so it becomes thicker and more compact. The skin also produces more collagen but less pigment (melanin). After a month or two of using retinoids, the skin becomes smoother, fine wrinkles are repaired, age spots fade and the skin colour becomes more even, but it does not produce totally wrinkle-free skin. If you carry on using the cream, the skin continues to improve for a few more months, but after 6 months of use there is no further change. If you stop using it, the skin gradually goes back to how it was before. Retinoids do not have any effect on very noticeable wrinkles, such as the deep lines that appear between the nose and mouth, or on thread veins.
Some anti-ageing creams contain weak retinoids (such as ‘pro-retinol’), usually 4–12%. There is no evidence that these concentrations have any impact on the repair of collagen in the skin (Dermatology in Practice 2007;15:6–7). To obtain the most effective concentrations, you need a doctor’s prescription. However, doctors cannot prescribe tretinoin for sun-damaged skin under the National Health Service in the UK, so you will have to ask your doctor for a private prescription, which means you will have to pay for it. For the first 2 weeks, you apply it every other night, for the next few weeks you apply it every night and, after a few weeks, two or three nights a week is enough. If there is no improvement after 6 months, there is no point in continuing.
Retinoids irritate the skin, so that there may be dryness and flakiness, sometimes with itching, soreness, redness and a tight feeling. You have to avoid the sun and use a sunscreen. Some specialists worry that retinoids could increase the risk of skin cancer.
How effective is tretinoin cream?
A study of 251 people, aged 29–50 years, with sun-damaged skin showed that tretinoin cream used once a day for 6 months (Archives of Dermatology 1991;127:659–665):
- produced some type of improvement in 79%; however, 48% of people who used only sunscreen and moisturizers also showed improvement
- made the skin 29.3% less rough
- faded age spots by 37%
- improved wrinkles by 27.1% (measured by taking silicone impressions of the skin).
Verdict: in spite of the hype, tretinoin will not change your skin radically, but it may produce some improvement.
Alpha hydroxy acids (AHAs) are chemicals found in fruit juices (thus their name ‘fruit acids’), wine, sugar cane and milk. They may be the ‘magic ingredient’ of ancient recipes for skin, containing milk, lemons or wine. AHAs loosen the substances that hold cells on the skin surface together, allowing the dead cells to peel off. The underlying skin looks fresher. AHAs have very little effect on wrinkles, though some researchers claim that they make the skin thicker, help it to hold moisture and improve the elastin.
Many face creams now include AHAs. When buying such a cream, check the concentration of AHAs. Any cream containing less than 5% is not very effective, but the safest to use. A cream containing 5–10% AHAs is probably more effective but scientists worry that, in the long term, this concentration might damage your skin, and you might end up with more wrinkles rather than less. For the first few weeks of use, AHAs may make the skin slightly flaky. If the cream is very acid, it may cause more irritation, so look for a pH of 3.5 or higher (the higher the pH, the lower the acidity).
So are AHAs safe? The US Food and Drug Administration (FDA) is concerned about them and is doing more research and the European Commission (EC) is looking into the matter. So at the moment, we simply do not know. The main worries are that:
- they damage the skin by penetrating its defensive barrier; if you find that products containing AHAs cause irritation, stinging, burning, redness or swelling round the eyes, stop using them immediately
- because they make the skin sensitive to sunlight, they could increase the risk of further skin damage and of skin cancer; so they might actually speed up skin ageing and increase the risk of skin cancer. At present, there is no evidence that this occurs.
If you use an AHA product, use a SPF 15 sunscreen as well, every day, even if the weather is overcast, and choose a cream with a low AHA concentration.
Beta hydoxy acids (BHAs) are similar to AHAs but may be less likely to irritate the skin. The most common is salicylic acid.
Labelling of skin care products
Check for these words on skin cream labels – they mean alpha or beta hydroxy acids:
- mixed fruit acids
- triple fruit acids
- tri-alpha hydroxy fruit acids
- L -alpha hydroxy acids
- malic acid
- citric acid
- glycolic acid
- lactic acid
- hydroxycaprylic acid or alpha-hydroxycaprylic acid
- glycolic acid + ammonium glycolate
- alpha-hydroxyoctanoic acid
- sugar cane extract
- salicylic acid.
Vitamin C is essential for the production of collagen. It also encourages the renewal of skin cells and is an antioxidant, which means that it mops up free radicals. Free radicals are molecules produced by the body’s metabolism, particularly when it has to deal with pollution in the environment. Free radicals can be harmful and may contribute to skin ageing. Vitamin C is a very unstable vitamin that is broken down by light and does not penetrate the skin readily, so cosmetic companies have had great difficulty making a skin preparation containing it (MIMS Dermatology 2007;3:54–55). However, they seem to have cracked the problem, and skin preparations containing vitamin C are now available. Whether they really do reduce ageing changes in the skin remains to be seen.
‘Growth peptide’ chemicals are now included in some ‘anti-ageing’ creams. They could be made from various sources, such as skin cells or fibroblast cells that have been grown in the laboratory, cells from placentas, or plants. All of our body cells contain some of these chemicals, where they act as messengers to turn a variety of processes on and off. Whether they have any anti-aging effects when applied as creams remains to be seen.
Botulinum toxin (Botox) injections have become a well-known anti-wrinkle treatment. Botulinum toxin is actually a powerful poison that blocks the action of nerve fibres. This causes a mini-paralysis of the muscles used for facial expression that crease the skin. By pinpointing a specific area, such as ‘crow’s feet’ and frown lines, the specialist can smooth out the skin – you do not have frown lines because you cannot frown. The effect is not immediate (it may take a week or two to show) and is mainly gone in 4 months.
Like any other procedure, it has some risks. If it is not done properly you could end up looking rather expressionless, or one side of your face could look different from the other. As with any cosmetic procedure, it is important to find a good doctor (look at the section on choosing a cosmetic surgeon for general advice).
Fillers are increasingly popular. Hyaluronic acid gel is the commonest type. This substance is naturally present in the skin, and is a component of collagen. It retains water very well, helping to plump the skin. I can be injected into the skin to fill in hollows and smooth out lines, including deep wrinkles such as nose-to-mouth grooves and frown lines. About 12% of people develop problems such as bruising, swelling, redness or hard blotches after the injections. Hyaluronic acid is absorbed by the body, so the effects last for only 4–6 months, and you might need 3–4 treatments a year to maintain the effect. The various sources of hyaluronic acid gel include certain bacteria, rooster comb, human umbilical cord, and jelly from cows’ eyes (Patient Preference and Adherence 2009;3:225–230).
Chemical peeling with AHAs (glycolic peel) is another treatment provided by some private clinics. It went out of fashion for a while (when laser resurfacing seemed more promising), but is now regaining popularity. Chemical peeling works by producing a chemical burn on the surface of the skin. As the skin heals, some of the smaller wrinkles and irregularities are smoothed out and there is some improvement in the appearance.
Laser resurfacing of the skin removes part of the outer layer of the skin (the epidermis). This regrows in 3–6 weeks from the remnants left in the hair follicles and sweat glands. During this time, you will look as if you have severe sunburn, as your skin will be red and there may be some weeping. The repair process alters the skin collagen, ‘lifting’ mini-wrinkles from the skin during the subsequent 4 months. Afterwards, you must always use sunscreen to protect your skin.
There may be side effects, such as lightening or darkening of the skin. In people whose skin tends to form keloid scars, laser treatment is risky. There is also a risk of reactivating herpes (cold sores).
Because these skin techniques are so new, discoveries are still being made about the best methods, and what they can and cannot do, and their long-term effects. As with all cosmetic operations and procedures, try to choose a reputable clinic and a well-known doctor; your family doctor may be able to advise you. Ask to see ‘before and after’ photos, and check that the procedures were carried out by the person you are talking to and are not simply promotional material supplied by the laser manufacturer.
Plastic surgery was the only option before retinoids became available. It can produce a big improvement in lines at the sides of the eyes and in sagging skin (which retinoids will not help) but will not improve the overall texture of the skin. As with all plastic surgery, make sure you choose a reputable clinic. Ask to see ‘before and after’ photos, and check that the doctor you are talking to actually did the work shown.
First published on: embarrassingproblems.com
Reviewed and edited by: TBA
Last updated: October 2020