Dark Circles Under Eyes: 5 deep tear trough treatments

We’ve talked before about dark circles under eyes. One of the most common causes is a deep tear trough.  The tear trough is that depression extending from the inner corner of your eye diagonally toward your cheek.  This depression occurs where the facial fat has thinned out and dropped down into the cheeks. The bone of the eye socket is now right below the skin and the two are fairly well attached to each other.  As the skin above and below age and change, this area becomes even more apparent. It can become dark and develop a noticeable shadow, which makes one appear tired and more aged.  There are many options to treat this, and the methods are changing as we better understand facial aging.

dark circles under eyes - Facial filler Juverderm

Juvederm treatment under eyes and around mouth.

1. Make-up:

Many women (and even some men) utilize concealer in this area to lighten the skin and diminish the shadow.  When the problem is subtle, make-up is a great, non-invasive and inexpensive treatment.  As the problem worsens, however, make-up cannot fully hide the changes and may begin to accentuate it.

2. Skin lightening creams:

In certain people and ethnic groups, the skin in this area darkens. This can be due to actual pigment changes in the skin or from very shallow blood vessels just below the thin skin. When it is pigment related, skin lightening creams, such as hydroquinone, can be effective.  When starting this type of treatment, it is helpful to consult a skin specialist or aesthetician highly experienced in its use. Start with a weaker concentration (no higher than 4%) and use it for a short time until you are sure you aren’t especially sensitive.  Slowly increase the use and concentration until the desired effect is achieved. Rarely will these types of creams completely fix the problem, but they can make a noticeable improvement.

dark circles under eyes - Hydroquinone skin cream

Hydroquinone skin cream

3. Phototherapy:

Intense pulsed light, and even some laser treatments, are used to lighten skin pigmentation and tighten skin in the under eye area. Often this is proceeded by use of a topical lightening cream and possibly a short course of Retin-A to maximize effect.  Again, this should be done by someone with a lot of experience in administering the whole treatment.  Different skin types react differently, so be sure your practitioner explains how they are tailoring your treatment to you personally.

4. Facial Filler:

Hyaluronic acid fillers such as Juvederm, Belotero, and Restylane are well suited to treating the tear trough area when the problem is loss of facial fat volume.  Filling this area back up with a substance that is similar to the building blocks of normal collagen can give a new youthful appearance to the mid-face. It is relatively inexpensive, costing around $500 for a treatment. In many cases it lasts 12-18 months.  Filler is injected with a small needle into the space directly above the bone and then massage around until it appears smooth.  In a few weeks, it softens up be hardly be felt.  It is a safe procedure with some occasional bruising taking place. When injected deep, the chances of it getting into a blood vessel and causing problems in uncommon, although this is the greatest risk. See Dr. Harris explain more about facial filler in a short video here.

dark circles under eyes - Belotero facial filler

Belotero facial filler

5. Lower eyelid fat repositioning and blepharoplasty:

When fat in the lower eye socket begins to come forward, it creates a bag in the lower eyelid. A crease forms at the bottom of the bag over the bone of the eye socket. Lower eyelid surgery (blepharoplasty) is performed to move fat from this bag into the upper cheek and tear trough, which fills in the depression and returns the fat to a normal location, where it was before it descended into the cheek.  In some people, a portion of the fat is also removed. In others we also remove a small amount of skin below the eyelashes. All of these techniques serve to smooth out the transition from the eyelid to the cheek, which is a hallmark of a youthful, rested appearance. See our gallery for eyelid before and after photos.

If under eye shadow or bags are a problem for you, give us a call for a free consultation at (801)264-4420, or email Dr. Harris directly at [email protected].

TCA Chemical Peels

TCA chemical facial peels have been used for years to rejuvenate the skin.  They are excellent for skin tightening, softening fine lines, and smoothing out skin color and texture. The TCA (trichloroacetic acid) peel is a medium-depth peel, and is very popular for skin of all colors and imperfections. TCA chemical peels can vary in strength from 10%-50% depending on the skin tone, imperfections, wrinkles, etc. that are in need of improving. TCA chemical peels at higher concentrations produce deeper peeling, as does the number of applications (layers) of TCA applied to a given area.

Properly preparing your skin beforehand along with proper aftercare are all important to getting the most out of the treatment. Here are the 5 most important things to know and do before and after a peel.

Chemical peel

1. Prepare your skin:

Patients undergoing TCA chemical peeling should pre-treat the skin with an alpha hydroxy acid (AHA) product for 3-4 weeks prior to the peel. Products containing AHA encourage exfoliation and faster skin cell turnover. This will result in a more even peel and reduce the risk of hyperpigmentation after the peel. Patients that have any potential for hyperpigmentation (i.e. darker skin tone, history of dark scars) are asked to use a product containing 2% hydroquinone, a “fading cream”, in addition to the AHA product for 3-4 weeks. This will further reduce the risk of hyperpigmentation after the peel. You can get AHA online or at certain pharmacies.  We really like the product from Acne.org. Palmers Skin Success Fade Cream (2% hydroquinone) can be purchased online or at most Walmart, CVS, Rite Aid, Walgreens stores.

Alpha hydroxy acid cream

Alpha hydroxy acid cream

Palmer's Skin Success Fade Cream

Palmer’s Skin Success Fade Cream

2. Prevent complications:

TCA chemical peels may cause an individual to develop a cold sore if they are prone to getting them. Prescription anti-viral medication will be prescribed for a couple days before and after the peel to prevent a cold sore outbreak for all patients with a history of cold sores. Please tell your physician if you have a history of cold sores.

3. Let the skin heal:

In the days immediately following the TCA chemical peel, your skin may take on a dry, brown appearance after the initial redness has faded (usually around days 3-5). This is normal. This is the stage right before the skin begins to shed. Do not force the peeling process by attempting to peel any skin that has lifted.  It is very important that the skin stays intact until it’s ready to slough off on its own, as it is acting as protection to the fresh new skin underneath. Twenty-four hours after your peel, use a very mild cleanser (such as Cetaphil) to wash your face gently with your fingertips. Gently pat your face dry and reapply the antibiotic ointment put on right after the peel. You can also use Aquaphor, Eucerin, or similar thick moisturizer. Do not use abrasive scrubs, cleansers, or cloths on your skin for at least 14 days.

 4. Protect your skin:

After the peel, it is absolutely essential to protect yourself from the sun. The TCA chemical peel makes you very vulnerable to sunburn, which can also cause discoloration of the skin. You must commit to wearing a zinc-based sunblock of 30 SPF or higher everyday in the weeks prior to the peel, and for at least two months after the peel is done. This step is absolutely crucial in terms of your outcome after the peel. Failure to wear sunblock after the peel will result in scarring and hyperpigmentation (dark patches).Make sure the sunblock you purchase contains zinc as one of the active ingredients, as zinc provides a “barrier” protection against sun damage, and is also nourishing to the skin. A few brands that contain zinc: Blue Lizard, Clinique “City Block SPF 40”, ECO Logical Skin Care “Green Screen”.

5. Repeat the treatment:

TCA chemical peels can show good results with only one treatment, but often a few treatments spaced 6-12 weeks apart are necessary to stimulate long-lasting change in the skin.  Many offices, including ours, offer deals when several peels are purchased together.  Once the skin texture has improved and you are happy withe the result, doing a peel once or twice a year may be all you need to maintain the appearance.

If you have questions about TCA chemical peels, call our office for a free consultation at (801)264-4420.  Thanks to Katrina Poulsen, RN for contributing to this article and helping to establish our office protocols for TCA chemical peels.

 

 

It has often been debated what if any effect our diet has on our skin.  Does chocolate lead to acne?  We’ve all heard these sorts of questions.  Well several studies have recently shown that a diet rich in certain nutrients can give your skin a healthier glow.  Other foods, when avoided, may prevent break outs or poor skin appearance. Here’s a short list (put together by the authors of Eat This, Not That) of skin friendly nutrients and the best foods in which to find them.

Vitamin E: Almonds are packed with vitamin E, which is a powerful anti-oxidant which scavenges free radicals which can cause skin breakdown.  In one study where participants consumed 14mg of vitamin E (about 20 almonds), they had less evidence of UV skin damage after sun exposure.

Omega 3 fatty acids: The omega 3’s are essential fatty acids, meaning you don’t make them on your own and have to get them through the diet.  They are linked to lower triglycerides and have several beneficial effects for the heart.  Flax seeds are packed with omega 3’s. In one skin study, participants that consumed a half teaspoon of flax seed for 6 weeks had more plump and hydrated skin with less redness and irritation.  Salmon is also a great source of omega 3’s.

Almonds for better skin

Lycopene: This free-radical found most commonly in tomatoes can also give extra protection from UV radiation.  Cooking tomatoes will concentrate this nutrient.  Lycopene is also found in watermelon.

Vitamin C: This is a key ingredient in collagen and is found in lots of foods, including citrus fruits and carrots.  Sweet potatoes are an excellent source.  One study showed that consuming 4mg daily over time can reduce the formation of wrinkles by as much as 11%.

Folic acid: Leafy green vegetables are a great source of this nutrient, which is integral to DNA repair.  Studies have shown that those who eat a diet rich in green vegetables including folic acid have half as many skin tumors as those who have diets sparse on these vegetables.

Omega 6 fatty acids: Described as the ultimate moisturizer, omega 6 fatty acids have been shown to reduce scaly, itchy skin and may be of great benefit to people with eczema.  Safflower oil is an excellent source.

Vitamin A: This fat soluble vitamin helps reduce the overproduction of surface skin cells, reducing skin oils and clogged pores.  Carrots are a great source.

Catechin: This anti-oxidant is prominent in hot green tea. It has been shown to have anti-inflammatory and anti-cancer properties.  It has been shown to reduce the effects of sun damage in people drinking 2-6 cups daily.

green tea for good skin

Flavanols: Dark chocolate is rich in this anti-oxidant shown to reduce the roughness of skin and prevent skin cancer.

A good rule of thumb is to eat a diet high in vegetables, incorporating as many colors as possible.  Avoiding foods with a high glycemic index has also recently been associated with clearer skin.  In addition, dairy has been recently linked to acne and anecdotal evidence has spurred a number of new studies.  Bottom-line, a healthy diet will be evident in a brighter, healthier countenance.

 

 

This past week I took a basal cell skin cancer off the eyelid of a man younger than I, and I’m in my mid-thirties.  Remember when skin cancer was something your grandma and grandpa dealt with?  Well those days are past and we are ushering in a generation of young people who will be dealing with skin excisions, biopsies, deforming surgeries and possibly early death due to their love of the sun, tan skin, and refusal to believe they are causing themselves harm.  On a recent trip to a sunny locale, I was applying sunscreen before going out on a  morning of boating.  A friend repeatedly scoffed at my use of sunscreen, insisting I needed more color and couldn’t understand what I was worried about.  Everyone in this person’s circle of friends was tan, young and feeling great, but what will the next few years hold for them.  Here are a few tanning myths that you need to get by right away to avoid being a shriveled up raisin of skin cancer in your golden years.

Myth #1: “I have to get a base tan so I won’t burn on my vacation. Many believe they need to achieve a “base tan” early in the spring, usually at a tanning booth, so they won’t get sunburned later.  Some even think this is protective against sunburns and thus skin damage.  Don’t buy into this farce. Any sun or tanning bed exposure that causes a tan is damaging your skin, end of story.  UV rays are still blasting away at your DNA and collagen no matter the color of your skin. Spray tans are no help either. Some believe that these will somehow protect you from a burn or damage.  Not true.

Myth #2: “I only need sunscreen if I’m going to the beach.”  Most people don’t think to put on sunscreen, unless they are expecting to be outside for an extended period of time.  A recent New England Journal of Medicine article showed a man who drove a delivery truck for 28 years. He developed dramatic changes to the left side of his face, which was bombarded by UVA rays, while the right side of his face was protected from the shade.  Check out the difference between the sides in the picture below.

Facial aging from sun exposure

Myth #3: “I’ve got dark skin so I don’t get sunburned.”  Many people born with naturally darker toned skin think they don’t need to protect their skin as they don’t burn as easily.  Whether or not you get a sunburn, the UVA and UVB rays are still bombarding you, causing mutations in your DNA and ruining your skin’s elasticity.  Olive skinned people don’t look any better in their old age than fair skinned people. Very dark skinned people are also at risk for sun damage.  Acral lentiginous melanoma accounts for 50% of melanomas in dark skinned individuals and is often missed as it develops on the palms and soles of the feet. Bob Marley died of this form of melanoma.

Myth #4: “It’s cloudy, so I’ll skip the sunscreen. ”  UV rays are still present on cloudy days. If you are going to be outside, apply sunscreen.

Myth #5:  “I wear sunscreen, so I’ll never have skin problems.”  I wish sunscreen was that good. The mistake most of us make is not reapplying it often enough and not realizing that it doesn’t block all UV radiation.  When possible, wearing hats, sunglasses and longer clothing will block out more UV radiation and further reduce your potential skin damage. Sunglasses are especially important to reduce early cataracts and surface damage to the eyes, including unsightly yellow spots on the eyes called pinguecula (see photo).

pinguecula

Pinguecula

 

 

 

 

 

 

 

 

 

 

 

 

 

Myth #6: “Tanning beds are a safer way to tan.”  And O.J. Simpson is innocent.  The tanning bed industry is constantly working to convince people that tanning beds are safe or even healthful.  Some claim their bulbs emit lower UVB and other say tanning is a great way to get your vitamin D. Both of these claims are misleading.  All tanning beds cause accelerated skin damage.  Multiple studies have shown that people who use tanning beds have a higher rate of melanoma.  And regarding vitamin D, you need about 2-10  minutes a day of sun exposure a day to produce plenty. If you drink milk regularly or take vitamin D supplements you don’t need any extra sun exposure.

Facial aging takes a toll on our lower face as skin thins, fat atrophies and descends, and wrinkles form. Three common problems people come in for are deep nasolabial folds (the crease from your nose to the edge of your mouth), vertical lip lines (sometimes called smoker’s lines, but not exclusive to smokers), and small or fading lips. All of these changes are tell-tale signs of aging, but there are products available that do a great job of reducing their appearance. Let’s look at each one.

Nasolabial folds:

nasolabial folds

Nasolabial folds (arrow)

These folds are present in everyone who ever smiled, but as your facial skin becomes less elastic and facial fat shrinks away, the cheeks descend and form permanent nasolabial folds. These can be accentuated by significant weight loss, sleeping on your side, and skin damage due to tanning. Preventing them is ideal, but aside from using sunscreen, which won’t guarantee they’ll stay away, you can’t do much to avoid them. There are three main ways they are treated. 1) facial fillers such as Juvederm, Restylane and Radiesse are used to fill in the lines, restoring some of the lost volume. These can be injected both directly beneath the crease, but also into the cheeks above creating some minor lifting. In both instances, dramatic reduction of the lines can result. With most of these products, some improvement from baseline can be seen for about a year (more or less varying by individual). There are some risks, such as rare severe reactions to the fillers as well as over-placement of product. Restylane and Juvederm can be dissolved in place with a second injection, but Radiesse has to be expressed or surgically removed. All will fade with time if left in place.

Radiesse to the nasolabial folds

Nasolabial folds and mental crease (chin line) treated with Radiesse.

Vertical lip lines:

vertical lip lines

Vertical lip lines

Loss of fat around the mouth along with facial movements can lead to formation of vertical lip lines. Many people find these objectionable because they are associated with smoking and they make the person appear tired or unhappy.  Other than using sunscreen and not using your lips, you can’t do much to avoid them.  Four different treatments are commonly utilized.  Botox can be injected in small amount in several places along the lips to relax the muscles causing the lines.  This can, however, cause your mouth to move differently and look irregular when you smile.  Fillers, most commonly the hyaluronic acid varieties such as Juvederm and Restylane, can be injected in various patterns to soften the lines’ appearance.  Some people also inject collagen, but this tends to last for a much shorter time. Laser skin resurfacing has also been shown to improve the appearance of these lines.  Finally, dermabrasion, which is essentially sanding down the skin to remove the wrinkle, can be done.  I prefer the injectable fillers as they are not permanent, can be reversed if too heavy handed, are very unlikely to cause inadvertent scarring, and won’t generally affect your mouth movements.

 

Fading (flat) lips:

Progressive addition of Juvederm to the lips

Thin lips with progressive addition of Juvederm for volume

Lip fullness can be something you lose with time, or something you just never had. The ideal proportion of the female lips are about 40/60, or if you look straight at the total height of the upper and lower lips closed, the upper lip should be 40% and the lower lip 60% of the height. Most commonly, the upper lip is more flat or rolls in and under as we age, making it appear thin. To regain that ideal shape, you must replace volume. Similar to above, dermal fillers work very well for this. They are injected along the vermillion border (junction of normal skin and pink lip skin) near the central portion of the lip, as well as within the body of the pink tissue of the lip. The outer edges near the corners of the mouth are avoided to prevent that fish mouth appearance. Maintaining the proper proportions and being conservative with volume changes will make the lips appear full and youthful, not inflated.

Call our office at (801)264-4420 for a consultation to discuss dermal fillers and your options.
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Myth #10: Vitamin E reduces scarring – Vitamin E is an antioxidant, which are agents that neutralize the oxidant effect of free radicals (molecules that damage collagen and cause skin dryness, fine lines and wrinkles). Free radicals are not the cause of scarring and any effect you may see from a vitamin E cream on scarring is either something else in the cream, an effect of the massage you did while you put the cream on, or would have happened anyway. Many creams claim to reduce scarring, such as Mederma, but few have any hard evidence that they work.

Myth #9: Skin pores open and close – When looking in the mirror you may notice lots of black pores, especially on the tip of your nose. Scores of cosmetics and treatments have been devised to reduce the appearance of these pores, many claiming they close the pores. Others claim that steam or hot water opens the pores. The pores are always open, which is necessary to allow us to sweat. The skin oil, or sebum, also comes out of the pores. The pores appear closed or full when the oils get backed up, clogging the opening. Warm water or steam helps melt these oils, cleaning out the pores. The pores, however, have no muscles and do not open or close.

Myth #8: Acne is caused by fatty foods and chocolate – Acne is caused mainly by hormonal changes, which can be affected by stress, genetics and other unknown factors. Diet may affect this to some degree, but their isn’t clear evidence how. A few studies done in the late 1960’s seemed to disprove the relationship between chocolate and acne. Pimples are formed when clogged pores become inflamed and collect both oil and pus. What exactly causes this inflammation to occur is not known.

Myth #7: Anything organic is better for the skin than synthetic products – Natural products rarely exist in a form that is perfectly balanced for you skin’s use. Either they are too potent and can cause irritation or too weak and don’t have much affect at all. Luckily, there are lots of chemists who can balance the beneficial properties of these materials to give you the best effect possible. Organic products only have to contain a small amount of naturally occurring chemicals (as little as 2%) to wear the organic label. (The price will likely be more than 2% greater than the non-organic variety).

Myth #6: Getting a base tan prevents burns later – Tanning in any form, whether at the beach or in a tanning bed is causing permanent damage to your skin. A base tan does nothing to prevent this damage. Face it, if you insist on tanning now, you will pay with extra wrinkles later (but not much later) as well as dramatically increase your chances of skin cancer.

Myth #5: Sunburns are only bad when you are young – Many people believe that any sun damage that will lead to skin cancer or wrinkling occurred when they were a teenager, and is out of their control now. They then proceed to continue tanning thinking skin protection is no longer important. UV damage can lead to skin cancer in only a few years time. I’ve seen several patients with facial skin cancers in their thirties. Sunscreen is always a good idea no matter your age.

Myth #4: Skin creams with collagen can replace collagen – Collagen is a large molecule and isn’t going to pass through your skin and somehow incorporate itself exactly where it was lost. Your body has to synthesize new collagen on its own from basic proteins. Certain vitamins, such as A and C, can help this along.

Myth #3: Vitamin A (retinol) will thin out the skin – Vitamin A enhances the skin’s barrier function, aids in collagen production, regulates oil production, reduces skin dryness, and increases skin oxygenation. Topical steroids will thin the skin when used for prolonged periods.

Myth #2: Dry skin creates wrinkles – Moisturizers may temporarily reduce the appearance of very fine lines by plumping up the skin, but no moisturizer will permanently reduce wrinkles, no matter the cost.

Myth #1: Shaving body or facial hair makes it grow back thicker – The part of the hair you can see above the skin is essentially dead and has no way of signalling back to the body to change its growth pattern when cut. Shaven hair will feel more rough as the cut ends are blunt, but the volume of hair has not and will not change.

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We now have 2 good products on the market for smoothing out dynamic wrinkles: Botox and Dysport. Both are forms of botulinum toxin, a potent chemical that blocks signals at the junction between nerves and muscles. Botox (onabotulinum A), has been around for about 30 years and was initially developed to treat disorders of muscle spasm, such as frequent uncontrolled blinking (blepharospasm). Doctors noted that their patients who received Botox around the eyes had decreased wrinkles, an unexpected benefit of the treatment. An enterprising pharmaceutical company, Allergan, sought a cosmetic indication from the FDA. Botox Cosmetic was introduced to the market, approved for treatment of glabellar wrinkles (those vertical lines between your eyebrows). As is often the case, doctors experimented with injecting Botox in many areas of the face and today it is administered all around the eyes, face and lips.

In 2009, a second product came on the market called Dysport (abobotulinum A), which is very similar chemically to Botox. Many doctors have now gained experience with both medications, but which one is better? Patients who have tried both often prefer one over the other stating that one has a faster onset or lasts longer. A double blind randomized trial (the gold standard for research) was conducted in which patients were injected at the crow’s feet on one side of their face with Botox and the other side with Dysport. They were photographed at the time of injection and at 30 days after. They were also asked to rate which side they liked better. Among the 90 patients studied, they rated Dysport better 2/3 of the time and the researchers also rated Dysport as better for smoothing crow’s feet than Botox. The difference was mainly noted when patients were smiling very vigorously. At rest no difference was noted. In other studies, the risks and side effect profiles were equivalent.

In my experience, Botox and Dysport both work well.  Patients who have used both comment that Dysport seems to have a quicker onset (1-3 days vs. 3-7 days), but that hasn’t been universal.  Dysport can be slightly cheaper as the company that distributes it in the US often offers rebates to the patients. If you have been using Botox and it is working well for you, I’d continue with it.  Occasionally people develop a tolerance to one drug and then you could switch over to the other and likely still get good results again. If you have never tried either, the choice is yours. They both work well and are safe.

If you are interested in trying Botox or Dysport, call our office for a consultation at 801-264-4420.

 

We regularly get questions about which skin cream will reduce wrinkles or what is the best thing to reverse aging.  There are many things you can do and avoid, no matter your age, to maintain your skin looking its best.  Here are the 10 that we recommend everyone put into their daily skin care regimen (in no particular order).

10. Control the sun: We all need the sun.  Besides keeping our planet alive, it is necessary to synthesize vitamin D, which is good for bone health, the immune system and may reduce the risk of certain cancers and other diseases.  Excessive sun exposure, however, is the number one reason skin goes from tight and youthful looking, to loose and more aged in appearance.  Sunlight destroys elastic tissue causing lines and wrinkles. It also leads to telangiectasias (fine blood vessels visible under the skin), sallowness (a yellowing of the skin), as well as freckles and potential skin cancers. The myth that the majority of skin damage occurs in our youth and we can’t change it now has led many to not bother with sunscreen in older age.  This has been debunked and all ages should use sunscreen.

Finding a sunscreen that you’ll use everyday is the best way to avoid harmful UV exposure. Olay Regenerist UV Defense is one particular cream that has SPF 15 protection, doubles as a nice face cream, rather than an oily sunscreen, and won’t break the bank.  There are many similar products that may be more or less expensive. Click here for an alternate list of sunscreens. Don’t forget your neck and upper chest, as these areas are prone to premature aging as well.

9. Stop smoking: Just in case you hadn’t heard, smoking is really bad for you.  Not only does it harm your lungs, it also prematurely ages your skin.  Smoking leads to premature development of deep wrinkles and an unhealthy yellowing of the skin.  Facial aging can be seen under a microscope in smokers as young as 20.  Many of these changes or partially or totally reversible by stopping smoking.

8. Rebuke the tanning bed: Look at it this way, do you want to look good (in your opinion) for a few years, or good (in most other people’s opinion) for all of your years.  Tanning is a one-way street to major wrinkling and loss of skin tone. Also, a recent study showed that those who use tanning beds 10 times per year are 8 times more likely to get malignant melanoma, which is very often deadly.  The skin effects of indoor tanning are similar to smoking, and the potential addiction is also very real (read the NY Times article on the subject)

7.  Understand facial expressions: You know those deep lines between the eyebrows you see in older people, well those were carefully developed with decades of smirks, scowls and squinting.  Humans are expressive people and much of what we say is projected nonverbally by our face.  Unfortunately, this constant flexing of facial muscles folds the skin, leading to the formation of static wrinkles.  While I don’t recommend becoming an expressionless zombie, there are a few ways to lessen the effects of our expressions.  1) Be aware of your expressions – if you are developing deep forehead lines or crows feet prematurely, look in the mirror and make the expressions that deepen these wrinkles.  Being aware of these expressions will allow you to avoid making them (we’ve all seen people who scrunch up their face while listening to a compelling story). 2) Wear sunglasses – not only do they protect your eyes and eyelids from UV exposure, they also reduce your desire to squint, which causing wrinkles. 3) Be happy – the wrinkles that come from smiling are arguably better looking that those caused by frowning.

Injectable neurotoxins, better known as Botox and Dysport, have become popular due to their ability to prevent certain expressions that lead to wrinkles. When properly administered, they can block certain facial contractions, but still allow for an expressive face.  A little can go a long way when placed in the right sites on the face.  Once static wrinkles have formed due to repeated facial contortions, these medicines cannot totally eliminate lines.  Injectable fillers (Juvederm, Restylane, Perlane, Radiesse, Sculptra) then must be used to lessen or eliminate the lines.

6. Hands off your skin: You are already battling gravity, loss of skin elasticity, and the elements.  Why further age your skin by pulling and rubbing it?  As an eye doctor I frequently see patients who have rubbed their eyelids so much that they are stretched out and need surgery to correct.

5. Sleep on your back: If you can, train yourself to sleep on your back.  Sleeping on your side or face down leads to premature creases forming, especially between the nose and mouth (nasolabial fold).  I often will ask my filler patients which side they sleep on and I am right most of the time.  The side they sleep on has a deeper fold and sometimes the eyelids are noticeably more lax.

4. Get your beauty sleep: While you should sleep on your back, it is just as important to actually get that sleep.  Inadequate sleep will quickly cause changes in your skin.  The peak hours of sleep are when collagen production is accelerated and cortisol and insulin production increase.  This leads to better repair of damaged skin.  To improve your sleep, get into a healthy schedule of getting up and retiring at the same times each day.  Make your bedroom a place for sleep (banish the TV).  Don’t eat or exercise just before going to bed.  And make sure you have a comfortable pillow and mattress.

3. Keep hydrated: Drink ample water to maintain hydration, which will keep the skin more perky.  Moisture inside and out is important.  Dry skin is not a cause of wrinkles, but moisturizers have been shown to reduce the appearance of lines, temporarily, by plumping them up. Applying them to skin moistened with water is the most effective way to lock in that moisture.  Just don’t get sucked in to spending a fortune on these creams, as the very expensive creams rarely are much more effective than the more affordable alternatives.

2. Consider a retinoid: Dermatologists, nearly across the board, recommend prescription retinoids (Retin-A, Tazorac) as the only anti-aging creams that really work.  They have been shown to reduce fine lines and many say they give an nice glow to the skin.  They do not reduce your pore size, as is claimed by some.  They also will make you more susceptible to sunburn and will cause some redness in the beginning.

1. Develop daily skin habits: Just pampering your skin some of the time won’t cut it.  Wash your face well nightly to remove the dirt and pollution floating around in the air.  Start each morning with an application of a sunscreen product. Find time to exercise daily, which will improve circulation and tone.

Share your skin related comments with us below.