(November 18, 2008 - Insidermedicine)  At the recent Annual Conference of the Canadian Dermatology Association in Montreal, we caught up with Dr. Jeffery S. Dover, MD, FRCPC, who is a Dermatologist and Associate Clinical Professor at Yale University School of Medicine, as well as the Co-Director of SkinCare Physicians located in Chestnut Hill, MA.

If I had wrinkles..

If I had wrinkles the first thing I would do is see a good dermatologist, learn about sun avoidance, use of good sunscreens, I would start an anti-aging regimen which included cleansing my face morning and night, using an eye sunscreen and using some sort of treatment cream specifically with retin-A in it, and then if I had either broken blood vessels or brown spots or sagging or wrinkling I would find a treatment specific to that and embark on that.

What causes wrinkles?

Wrinkles are for the most part caused by sun exposure over years and years. Some people will never get wrinkles no matter how much sun they get, and others never have had that much sun and yet they wrinkle a lot, but for the most part people who tend to avoid the sun for their lives for the most part tend to age more gracefully and tend not to wrinkle as much.

How can you prevent wrinkles from getting worse?

Like smoking, when people stop smoking their lungs actually improve dramatically, the same thing happens with wrinkles on the skin. People who love the sun, if they cut back the amount of sun they get, wear broad-brimmed hats, wear good spf-30+ sunscreens, their skin will actually improve on its own without any other treatment. The first thing we always recommend is sun protection, sun avoidance, and we can change people’s behavior a bit, not totally, but a bit.

The most important thing I tell patients no matter what they come in for, we always talk about sun protection and sun avoidance in some detail and recommend specific sunscreens to make sure at least they know about it, and slowly over time as they become more regular patients of mine it’s remarkable how they tend to get less sun, use at least some sunscreen and wear hats and try to protect their skin from the sun. That will prevent more wrinkling from coming, and will give the patients a chance for their wrinkles to improve on their own.

What non-surgical options exist for treatment of wrinkles?

Because surgery is considered invasive, and most of my patients don’t actually want surgery, the second thing that we talk about after sunscreens and sun avoidance is home remedies, home creams, what we call cosmeceuticals or anti-aging creams, of which there are many – our favorites are prescription items, something with retin-A in them, which are only available by prescription in Canada and the United States, and you need that prescription from your doctor or a dermatologist. We use that in conjunction with sunscreen and that’s the basis of our skin care regimen. There are lots of other skin care products available, literally thousands, some which work, some which don’t, some are very expensive, some are not, but it turns out the cost or price has no bearing on how effective they are. So it is really important to find a cream you like, a cream that your dermatologist or at least someone you trust thinks works, and it’s important to have a regimen that you can use every day. My favorite regiment is called cleanse, treat, and prevent: Cleanse every morning and every night with a nice soap or cleanser, treat the wrinkles with an anti-aging cream with retin-A in it as a minimum, but you can use one of these other cosmeceuticals you can buy at a drug store or a department store, and then finally prevent with sunscreen. So everybody needs to cleanse, treat and prevent, it’s a matter of literally two or three products, at a minimum, and it takes a total of a couple of minutes a day which almost anybody can find.

How is a given course of treatment decided upon?

As people age, some get wrinkles, some get brown sun-induced spots, some get broken facial blood vessels or redness, and some get some sagging, and some get all four. What I like to do when I see patients for the first time is to show them a mirror or have them hold a hand-held mirror and I get them to show me what bothers them the most, and then it is important and prudent to treat the things that bother them. If we improve things that I see but that they don’t notice, they won’t notice a difference and they’ll be unhappy. So what we do is we ask them specifically what bothers them, some don’t want to show me, they say “I hate looking in the mirror, and I hate the way I look.” But we insist in a very gentle way, and they show us “oh, I have redness here and broken blood vessels on the side of my nose cheeks or chin”, or “I’ve got these brown spots on the backs of my hand or on my cheeks”, or “I don’t like the wrinkles around my eyes, or the crease in my forehead”, or “I don’t like the sagging on my cheeks or my jowls”, and then what we do is we prescribe a treatment plan for each of these.  

What is a facelift?

A facelift is a surgical procedure which is pretty involved where excess skin, sagging skin, is removed, literally cut off an tossed out, and the skin is then tacked or stitched back with the stitch lines behind the ears and the hairline so that they are usually not visible. This is only effective for sagging skin. It doesn’t make old skin feel younger, it doesn’t rejuvenate skin, it doesn’t make red go away, it doesn’t make brown spots go away, and it doesn’t make the skin’s texture any better, it just tightens bad skin, and for that it is very effective.

Are there risks with cosmetic surgical procedures?

There are risks with any form of surgical procedure. For the simpler procedures, the risks are very little, and for the more involved surgical procedures like facelift, they are much more involved, like bruising, swelling, and potentially infection or scarring, and incumbent upon the physician and the patient to discuss these in great detail before embarking so that there are no surprises.

Are there any other therapeutic options?

One of the nice new additions to our therapeutic choices is botox, which helps treat frown line, lines of “negative facial expression” such as frown lines on the forehead, or smile lines beside the eyes. We also have fillers which help to fill [gestures], and help to fill the folds at the corner of the mouth, and we also can use fillers to plump up lips as they get smaller with age.

Botox and fillers are relatively easy to perform, they have very short downtime, if no down time at all, and they have very low risks, so they are very successful and popular amongst physicians and patients alike.

For broken blood vessels, or red cheeks, red noses, red chins, there are laser and light procedures which work beautifully. These usually consist of a series of three treatments, with almost no down time, a bit of redness, a bit of swelling, very impressive improvement, up to 90% improvement, with a series of about 3 treatments. For brown age spots, which really make people look older, we can improve those with lasers or light sources, usually with three treatments. These patients look ten years younger with no improvement of their wrinkles, and no improvement of skin texture, just by evening out skin color.  These are easy, relatively inexpensive, and very high yield, so patients really like those as well.