Wrinkles on my Face and Lips
As we age, our skin progressively loses its elasticity and its firm attachment to the tissues underneath. This causes facial skin to droop and the skin of the neck to hang in folds. It also causes the lines of facial expression to deepen and for new lines to appear particularly around the mouth. A face lift will tighten up the loose skin of the face and neck but it will have little effect on the wrinkling of skin around the eyes and none at all on the vertical lines around the mouth. This fact sheet deals with the treatment of these lines and wrinkles. For information on the treatment of other effects of the ageing process, you should read the fact sheets entitled AGEING FACE and BAGGY EYELIDS.
What can be done?
There are four methods for treating lines on the face which are generally regarded as being worthwhile: CHEMICAL PEELING, DERMABRASION, BOTOX INJECTION AND INJECTION OF FILLER GEL.
In CHEMICAL PEELING, a solution of phenolic acid is painted onto the area of the skin to be treated to produce a controlled, superficial burn. The burnt layers congeal to form a scab which separates after about a week to reveal a new layer of surface skin. This process causes the treated skin to tighten up and its wrinkled surface to flatten out.
In DERMABRASION, the surface layers of the skin are rubbed away mechanically with an abrasive wheel or special rough paper until the skin has been leveled down to the depths of the lines to be treated. The raw surface heals like a graze with a new layer of skin forming under a dry scab.
Hyaluronic acid in gel form is injected in the deeper layers of the skin underneath the length of each wrinkle so that its bulk brings the depth of the wrinkle to the surface. This effect may last for upto a maximum of two years.
BOTOX INJECTION, which is injected into the muscles of the face under the skin, those muscles causing pull on the skin to create wrinkles as part of facial expression. This injection will freeze the muscle hence the wrinkle disappears and at the same time normal movements of the face and expressions are not effected. This effect will last for a maximum of one year and then needs to be repeated. Botox is suitable for certain areas of the face only.
More often then not, a combination of these methodswill have to be used. They can also be used in combination with other facial surgery.
What are the consequences?
After both chemical peeling and dermabrasion, the freshly healed skin will look reddish for a few days and, during this time it is likely to be uncomfortably irritable. During the next few weeks, the redness turns to pink so that, by 4 to 6 weeks after treatment, the skin has usually recovered its near-normal color. There will, however, be a permanent difference in the pigmentation of the treated skin which would be most noticeable after sun tanning. Most often, the treated skin is whiter than normal but, it may be browner, particularly in patients who are taking a contraceptive pill and in those who have a dark skinned complexion.
None of these methods of treatment completely eliminates the appearance of lines and wrinkles on the face and lips though they should be made to look much less obvious. Whichever method of treatment is used there will be a tendency for the lines to return as part of the continuing ageing process. Chemical peeling and dermabrasion can also be repeated if necessary.
What are the limitations?
The main limitation of each method is its inability to eliminate the presence of lines and wrinkles only appearing with facial expressions: smile lines at the corners of the mouth, laughter lines at the corners of the eyes. If you are particularly concerned by the latter, a better treatment may be a ‘brow lift’ which is described in the fact sheet entitled WRINKLES OF THE FOREHEAD.
What are the risks?
All these methods of treatment are relatively safe and office procedures. Dermabrasion is the only treatment which may require a general anaesthetic which would carry a small risk of chest infection particularly if you are a smoker.
There is a small risk that both dermabrasion and chemical peeling could produce noticeable SCARS were the treatment to be carried too deeply.
There is a small risk that any of these treatments could be complicated by INFECTION. Were this to happen, it should settle quickly with a course of antibiotics.
What you should do before the treatment
If you are having treatment by either chemical peeling or dermabrasion and are taking a contraceptive pill, you should stop doing so for at least a month beforehand and a month afterwards in order to reduce the risk of pigmentation in the treated areas.
For dermabrasion in brown skin our practice is to do a test patch behind the ears and even after that complete guarantee cannot be given against darker or lighter pigmentation after the procedure.
What you can expect at the time of your treatment
Normally before the injections a cream is applied to numb the skin or certain areas may be numbed by fine injections of local anaesthetic.
Unless only a very small area is treated, dermabrasion is usually done as a day care procedure. Skin may be numbed by applying cream or injections. You will be given some tablets to settle you down and ease the discomfort of soreness whilst the chemical is being applied and which lasts for the next few hours. After application, the treated areas will be covered with adhesive tape which will have to be removed after 24 hours. This will reveal a moist surface to which you will be instructed to apply an antibiotic powder until a dry scab forms during the next day to two. Once formed, you will need to keep the scabs soft by applying an antibiotic cream or Vaseline until the scabs separate about a week after treatment. During this time you should keep the treated parts of your face as still as possible to prevent the scabs from cracking and it is usually best to take in a fluid diet through a straw.
If you are having treatment by dermabrasion, you will may on ocassions need a general anaesthetic and an overnight stay in hospital. The treated area may be covered with a light dressing which will stick to the underlying scab as it forms. You should avoid pulling this dressing until the scabs are ready to separate at which stage you can trim the dressing as it loosens about a week later. As with chemical peeling, you should keep the treated areas of your face as still as possible whilst they are healing. Until healing is complete you should avoid exposure to sun.
What you should do after your treatment
If you have had Botox or Fillers, you should avoid putting make-up on the treated areas and exposing them to the sun for 2 hours.
If you have had a chemical peel or dermabrasion, you can wash your face with a mild soap and water whilst the scabs are there. Once the scabs have separated, you should use a good quality bland face cream at night and apply it liberally. You should not use make-up for at least three weeks until the brightly pink skin begins to fade.
You should also avoid direct sunlight until the treated skin has completely recovered which usually takes 3-6 months. If you do so earlier, there is a risk of abnormal pigmentation.
Your surgeon must be properly qualified to do the operation and he will advise you what can and what cannot be achieved in your case. Do take that advice.
Dr. Mirza Shehab Afzal Beg is a British trained plastic surgeon possessing the highest qualification of Plastic surgery in UK i.e. FRCS (Plast) which no other surgeon currently practicing in Pakistan has. He has also worked as a Consultant in Plastic Surgery in UK. On his return from UK he is based at Liaquat National Hospital and is also a honorary consultant at Aga Khan Hospital. He has his cosmetic surgery and hair transplant set up at Clifton, Karachi.