Facial Aesthetics

Whether its laughter lines, frown lines or crow’s feet - wrinkles (the folds or creases in your skin), are a normal and natural sign of ageing. Wrinkles aren’t harmful but many people don’t like the way they look and want to reduce or prevent them.

There are lots of different ways to treat wrinkles. In this topic we’ve covered the most common ones and highlighted things to think about if you’re considering having any treatment.

Research suggests that long-term stress can make people look older.

Stress can cause psychological and physical symptoms such as poor sleep, irritability and feeling anxious. It's also thought that stress can cause people to look older. Extreme or prolonged stress can harm your health. For some advice around what you can do to treat stress have a look at the treatment section on our stress topic.

Facial exercises may help tone the muscles in your face so it's possible they may delay the appearance of fine lines and wrinkles. However, there isn't any strong evidence to prove this.

Your face is made up of a complex network of muscles in your forehead, cheeks, around your eyes, in your chin and around your lips. These muscles enable you to create facial expressions. Like other muscles in your body, they slacken with age and your face can start to sag.

Toning your facial muscles by tensing specific areas may make your skin feel tighter and may help delay the appearance of fine lines and wrinkles. However, there’s no scientific evidence that’s of a good quality to prove that facial exercises can reduce wrinkles.

Wrinkles are part of the natural ageing process. There are some things though that can make them appear sooner. Environmental factors, such as ultraviolet (UV) radiation from the sun and smoking, can dry your skin and make wrinkles appear sooner. If you eat an unhealthy diet and drink too much alcohol, it may cause wrinkles to appear at a younger age.

Wrinkles usually appear in areas that are most exposed to the sun, such as your face, neck or the back of your hands. This is because UV radiation from the sun damages the DNA in your skin cells, which causes your skin to age and become less elastic. Some sunlight is important because your skin uses it to produce vitamin D, which helps to build and maintain strong bones. However, too much sun is harmful. If you spend a lot of time in the sun, particularly without protecting your skin, you may develop fine lines and wrinkles younger than usual.

There is a range of treatments to try and help reduce the appearance of wrinkles, and make your skin look smoother and more youthful. These treatments are available privately. If you are thinking about having treatment, make sure you see a reputable practitioner or surgeon and check their qualifications.

How well many of these treatments work is difficult to say. There often isn’t enough scientific proof to say whether they work or not. Yet on the other side of the scale, lots of people report that they are happy with the results so it’s often a subjective thing. That’s why it’s really important that you gather all the information and weigh up the risks and complications with the benefits before you make a decision.

Some of the most common wrinkle treatments are outlined below.

There are many creams that claim to reduce the appearance of fine lines but they can’t remove wrinkles. Creams and gels that contain retinoids (a form of vitamin A) may improve fine lines and some milder signs of ageing skin. They do this by tightening your skin so fine lines are less visible.

Some retinoid creams are available to buy over-the-counter but you will need a prescription from your doctor for others.

However, they do have side-effects. The creams can irritate your skin and make it more prone to burning in the sun, for example. Always read the patient information leaflet that comes with your cream or gel. If you have any questions, ask your pharmacist or private consultant for advice.

Other creams that may help to reduce the appearance of fine lines include antioxidant creams that contain vitamins C, B and E. These work by preventing free radicals produced by the sun, stress, and pollution from harming your skin.

Chemical peels aim to improve and smooth the texture of the skin on your face. They use various chemicals to remove the damaged outer layers of your skin, and may help reduce lines and fine wrinkles. Chemical peels that range from mild chemical peels that you can buy over-the-counter, to deeper chemical peels. You will need an experienced clinician or doctor to do a deeper chemical peel for you in a clinic or hospital. As with all treatments, the stronger the preparation used, the more effect it has and the greater the risks. Over-the-counter peels can be used to improve your skin’s appearance if you have fine lines.

Laser facial resurfacing aims to reduce mild scars, or lines and fine wrinkles caused by sun damage and general ageing.

A laser (a beam of high-energy light) is used to remove the outer layers of the skin on your face. It also stimulates the growth of new collagen fibres. As the area heals, new skin forms that is softer and less wrinkled or scarred. The more intense the laser treatment then the greater the effect but also the time for healing and risks involved.

Botulinum toxin injections may reduce some types of wrinkles. They are often used to treat forehead and frown lines that come from making facial expressions. They can also reduce lines at the corners of your eyes (crow's feet). Botulinum toxin can only reduce what are called active wrinkles which are caused by muscle activity. It won’t work for wrinkles, creases or lines that don’t change with your facial expressions.

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. If you have botulinum toxin treatment, your clinician or doctor will inject the protein into specific muscles in your face. It will relax or paralyse these muscles to reduce their effect on lines and wrinkles. Untreated areas of your face should continue to move as normal and you will be able to laugh, smile and frown, but with less wrinkling of your skin in the treated areas.

It may take one to five days for the treatment to take effect and the best results will be after around a week or two. The treatment should last for three to six months. You will need to have botulinum toxin injections repeated if you want to keep the effects.

Botulinum toxin injections aren’t suitable if you’re pregnant or breastfeeding or have a neurological disorder, such as myasthenia gravis. The injections can't treat wrinkles caused by sun damage.

Dermal fillers aim to plump up your skin and make it appear fuller and smoother. Dermal fillers are often used to reduce lines around your chin and your lips, and to enhance the shape of your lips. There is a range of dermal fillers available that work in different ways, and they can be temporary or permanent.

If you have a permanent filler, it won't adapt to further changes to your face as you age. Therefore these aren't used as much as temporary fillers. Your clinician will usually recommend using a non-permanent dermal filler. These are either synthetic, or made from a material that closely resembles a naturally occurring acid in your body. Your clinician will inject the dermal filler into the required area with a tiny needle.

The effects from dermal filler treatment usually last from three months to 18 months, depending on the type of filler and the area you have treated. You will need to have repeat treatments if you want the effects to last longer.

Cosmetic surgery can be done to help reduce deep wrinkles and sagging skin. In facelift surgery, your surgeon will lift up the skin and tissues of your face and/or the underlying muscle. This will make your face tighter and smoother. The operation can be done on your whole face (a full facelift) or on your brow area (brow lift), lower face and neck.

Your face will continue to age after you have a facelift. The best results are achieved in people who have skin with good levels of elasticity and have a strong bone structure. A facelift can make you look younger but how long the results last for can vary depending on your skin type and lifestyle, but may last for up to 15 years.

It's important to gather all the facts you need to make a decision. Don’t rush into making one until you do. It’s really important that you see a specialist practitioner who is qualified. If you’re unsure about how to find this out, your GP can advise you.

Bear in mind that while lots of people are satisfied with the result of their procedure, there is always a risk that it might not meet your expectations and treatments do have health risks and complications. Talk these through with a qualified practitioner.

Before you decide to have treatment, think carefully about what you're hoping to gain from the treatment and the result you can realistically expect. It's important to understand that some of these treatments are designed for specific things only.

• Botulinum toxin injections will only improve wrinkles caused by muscle activity.
• Dermal fillers can be used for fine lines and deeper wrinkles but can't correct sagging skin.
• Laser facial resurfacing can cause changes in your skin pigment (colour), so the treatment may not be suitable if you have darker skin.
• Cosmetic surgery isn’t recommended for mild lines. It’s only a suitable option if you want to remove sagging skin, extra fat and deep wrinkles.

Many different places, from clinics to beauty therapists, offer wrinkle treatments and some treatments aren’t regulated. Find out as much as you can about any treatment you're thinking of having and what kind of training and experience the person who will give the treatment has. If you are considering surgery and are unsure about the qualifications then your GP may be able to advise you. It's important to remember the following.

• Botulinum toxin injections are prescription-only.
• Clinics that offer laser facial resurfacing must be registered with the Care Quality Commission. Always ask for proof of registration before you have any treatment.