Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

no obvious wrinkles at rest or on animation

1st line – topical retinoids

Back
ONGOING
|
no obvious wrinkles at rest or on animation
1st line – 

topical retinoids

Vitamin A derivatives lead to improvement in the appearance of fine wrinkling and actinic keratoses, as well as reduced roughness and hyperpigmentation.

Work by stimulating exfoliation of epidermal cells; repairing DNA damage, dermal collagen, and small blood vessels; shrinking sebaceous glands leading to reduced pore size and skin tightening; and providing new collagen and a new, thicker epidermis.[44][45]

Tretinoin is the most effective retinoid for photodamage and is better applied continuously over long periods and at night.[46][47][48]

Isotretinoin is effective in improving the appearance of coarse and fine wrinkles, with less reported irritancy.[49]

Retinaldehyde has also been found to be effective in improving the appearance of skin wrinkling.[50]

Tazarotene leads to improvement in the appearance of fine and coarse wrinkling, hyperpigmentation, surface roughness, and global severity of photoageing.[51] It is believed to be as efficacious in alleviating wrinkles as tretinoin.

Adapalene, a retinoid-like drug, is also effective for photoageing.[52]

Primary options

tretinoin topical: (0.02% or 0.05%) apply sparingly to the affected area(s) once daily at night

Secondary options

isotretinoin: consult specialist for guidance on dose

OR

retinaldehyde topical: see product literature for guidance on dose

Tertiary options

tazarotene topical: (0.1%) apply sparingly to the affected area(s) once daily at night

OR

adapalene topical: (0.1%) apply sparingly to the affected area(s) once daily at night

Plus – antioxidants

Back
ONGOING
|
no obvious wrinkles at rest or on animation
Plus – 

antioxidants

Treatment recommended for ALL patients in selected patient group

These agents include green tea, vitamins C and E, and coenzyme Q10, and come in a cream, lotion, or oral formulation.

Work by neutralising free radicals produced by the sun, stress, and pollution.

Plus – superficial chemical peel

Back
ONGOING
|
no obvious wrinkles at rest or on animation
Plus – 

superficial chemical peel

Treatment recommended for ALL patients in selected patient group

A small number of over-the-counter superficial chemical peels, such as low pH soaps, can be used to give the skin a more rejuvenated appearance.

Chemical peels improve the appearance of the skin and various peeling agents exist. Alpha-hydroxy acids derived from fruits and vegetables increase epidermal and collagen thickness, as well as epidermal and dermal hyaluronic acid levels.[53] Complications include dryness and mild irritation. Salicylic acid (30%) in a hydroethanolic vehicle is also used for superficial peels.[54]

Repeated in a series of three to five chemical peels at monthly intervals, with the maximum treatment effect lasting between 6 and 12 months.

Plus – lifestyle modification

Back
ONGOING
|
no obvious wrinkles at rest or on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

superficial wrinkles on animation only

1st line – topical retinoids

Back
ONGOING
|
superficial wrinkles on animation only
1st line – 

topical retinoids

Vitamin A derivatives lead to improvement in the appearance of fine wrinkling and actinic keratoses, as well as reduced roughness and hyperpigmentation.

Work by stimulating exfoliation of epidermal cells; repairing DNA damage, dermal collagen, and small blood vessels; shrinking sebaceous glands leading to reduced pore size and skin tightening; and providing new collagen and a new, thicker epidermis.[44][45]

Tretinoin is the most effective retinoid for photodamage and is better applied continuously over long periods and at night.[46][47][48] Adverse effects include stinging sensation, erythema, and exfoliation.

Isotretinoin is effective in improving the appearance of coarse and fine wrinkles, with less reported irritancy.[49]

Retinaldehyde has also been found to be effective in improving the appearance of skin wrinkling.[50]

Tazarotene leads to improvement in the appearance of fine and coarse wrinkling, hyperpigmentation, surface roughness, and global severity of photoageing.[51] It is believed to be as efficacious in alleviating wrinkles as tretinoin.

Adapalene, a retinoid-like drug, is also effective for photoageing.[52]

Primary options

tretinoin topical: (0.02% or 0.05%) apply sparingly to the affected area(s) once daily at night

Secondary options

isotretinoin: consult specialist for guidance on dose

OR

retinaldehyde topical: see product literature for guidance on dose

Tertiary options

tazarotene topical: (0.1%) apply sparingly to the affected area(s) once daily at night

OR

adapalene topical: (0.1%) apply sparingly to the affected area(s) once daily at night

Plus – antioxidants

Back
ONGOING
|
superficial wrinkles on animation only
Plus – 

antioxidants

Treatment recommended for ALL patients in selected patient group

These agents include green tea, vitamins C and E, and coenzyme Q10, and come in a cream, lotion, or oral formulation.

Work by neutralising free radicals produced by the sun, stress, and pollution.

Plus – superficial chemical peel

Back
ONGOING
|
superficial wrinkles on animation only
Plus – 

superficial chemical peel

Treatment recommended for ALL patients in selected patient group

A small number of over-the-counter superficial chemical peels, such as low pH soaps, can be used to give the skin a more rejuvenated appearance.

Chemical peels improve the appearance of the skin, and various peeling agents exist. Alpha-hydroxy acids derived from fruits and vegetables increase epidermal and collagen thickness, as well as epidermal and dermal hyaluronic acid levels.[53] Complications include dryness and mild irritation. Salicylic acid (30%) in a hydroethanolic vehicle is also used for superficial peels.[54]

Repeated in a series of three to five chemical peels at monthly intervals, with the maximum treatment effect lasting between 6 and 12 months.

Plus – botulinum toxin

Back
ONGOING
|
superficial wrinkles on animation only
Plus – 

botulinum toxin

Treatment recommended for ALL patients in selected patient group

Injection of this neurotoxin temporarily inhibits muscular contraction, thus rejuvenating the wrinkled face by reducing the hyperkinetic lines of facial expression. Botulinum toxin (BTX) type A is the most commonly used serotype and represents the first-choice treatment given that several randomised trials have shown its efficacy, optimal dosing, and safety. Although BTX type B has been used in the treatment of hyperkinetic facial lines, there are fewer data regarding its efficacy and optimum dosing.

Type A is used to reduce lines and furrows, particularly 'crow's feet', glabellar lines, bunny lines, perioral wrinkles, platysmal bands, and horizontal forehead lines caused by dynamic muscular activity.[55][57][58][59] Advanced techniques for use by experienced physicians include injection into muscles of the lower face and neck.[60][61]

Treatment effects can persist for 3 to 6 months, after which treatment has to be repeated.

Adverse effects include injection-site pain, bruising, headache, short-term hypoaesthesia, and blepharoptosis.[62][63]

Primary options

botulinum toxin type A: consult specialist for guidance on dose

Secondary options

botulinum toxin type B: consult specialist for guidance on dose

Plus – lifestyle modification

Back
ONGOING
|
superficial wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

deep wrinkles on animation only

1st line – botulinum toxin

Back
ONGOING
|
deep wrinkles on animation only
1st line – 

botulinum toxin

Injection of this neurotoxin temporarily inhibits muscular contraction, thus rejuvenating the wrinkled face by reducing the hyperkinetic lines of facial expression. Botulinum toxin (BTX) type A is the most commonly used serotype and represents the first-choice treatment given that several randomised trials have shown its efficacy, optimal dosing, and safety. Although BTX type B has been used in the treatment of hyperkinetic facial lines, there are fewer data regarding its efficacy and optimum dosing.

Type A is used to reduce lines and furrows, particularly 'crow's feet', glabellar lines, and horizontal forehead lines caused by dynamic muscular activity.[55][57][58][59] Advanced techniques include injection into muscles of the lower face and neck.[60][61]

Treatment effects can persist for 3 to 6 months, after which treatment has to be repeated. Adverse effects include injection-site pain, bruising, headache, short-term hypoaesthesia, and blepharoptosis.[62]

Primary options

botulinum toxin type A: consult specialist for guidance on dose

Secondary options

botulinum toxin type B: consult specialist for guidance on dose

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

2nd line – medium-depth chemical peel

Back
ONGOING
|
deep wrinkles on animation only
2nd line – 

medium-depth chemical peel

Ameliorate superficial wrinkles and pigmentary changes. Deep-thickness peels are used for the treatment of deep wrinkles.[64][65]

Trichloroacetic acid (TCA) (acid concentration 30% to 40%) alone or in combination with other substances (Jessner solution: resorcinol 14 g, salicylic acid 14 g, lactic acid 14 mL in ethanol to make 100 mL) is the first-choice chemical peel and results in a medium-depth peel.[66] Adverse effects include milia formation, herpes labialis, post-inflammatory hyper- or hypopigmentation, and scarring.

Pyruvic acid is converted to lactic acid, resulting in a medium-depth peel. It improves skin texture, and the appearance of fine wrinkling and hyperpigmentation.[67]

A phenol peel results in a deep-thickness peel. It is associated with post-peel oedema and necrosis, and has longer recovery times.[68] Appropriate analgesia, cardiac monitoring, and resuscitation equipment are necessary because of the risk of cardiac arrhythmias and laryngeal oedema. This agent is therefore used as a last-line therapy.[69]

Medium-depth and deep-thickness peels are usually not repeated as a series.

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

3rd line – fillers

Back
ONGOING
|
deep wrinkles on animation only
3rd line – 

fillers

Restore facial fullness and contribute to soft-tissue augmentation to improve the appearance of contour defects associated with ageing. Replacement agents, which occupy space in the deep dermis or subcutaneous fat, or stimulatory fillers, which stimulate fibroblast activity, collagen synthesis, and soft-tissue growth. Fine wrinkles are treated with intradermal fillers and deep folds with agents injected into the deep dermis or subcutaneous tissue. Categorised as temporary or biodegradable (collagen, hyaluronic acid, autologous fat), semipermanent (calcium hydroxylapatite, poly-L-lactic acid), and permanent (polymethylmethacrylate [PMMA], silicone).

Hyaluronic acid products are the most commonly used because their unique viscoelastic properties and high water-retention capacity fill grooves effectively. Depending on the chemical nature of the material of the hyaluronic acid, they can be injected with different techniques.[70] Carry a small risk of allergic reactions. Results last for 6 to 12 months.[71][72][73] Poly-L-lactic acid can cause granuloma formation. Collagen may be bovine, human, or porcine. Human-derived products do not require skin testing to rule out allergy.[78] Results last 3 to 18 months. PMMA can be suspended with bovine collagen or hyaluronic acid. It is used to treat deep wrinkles and has a long-lasting effect, but is associated with permanent granuloma formation.[79] Autologous fat lacks immunoreactivity and can be used in large volumes, but requires fat extraction.[80] Calcium hydroxylapatite leads to erythema, oedema, transient lumpiness, and granuloma formation.[81][82][83][84] Results may last beyond 1 year.

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

4th line – dermabrasion

Back
ONGOING
|
deep wrinkles on animation only
4th line – 

dermabrasion

Particularly useful for lines of the perioral region.[85] An inexpensive and simple procedure performed under local anaesthesia or a regional nerve block. Using a hand-held dermabrader, the epidermis and upper layers of the dermis are mechanically removed, resulting in lowering and smoothening of the abraded creases. Ablation is usually extended down to the level of the mid-dermis at the papillary-reticular junction.[86] Re-epithelialisation of this partial-thickness injury is usually completed within 7 to 10 days. Incomplete dermal regeneration and neocollagen formation have been demonstrated following dermabrasion.

Although associated with less erythema and hypopigmentation than other techniques, complications include scarring, hyperpigmentation, and reactivation of a herpes virus infection. The effectiveness and risks of complications are related to the depth of injury, with deeper treatments associated with higher complication rates. For persistent or deeper wrinkles, dermabrasion may be repeated 6 to 12 months after the initial operative session.

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

5th line – laser ablation

Back
ONGOING
|
deep wrinkles on animation only
5th line – 

laser ablation

Ablation refers to the removal of the epidermis and upper dermal layers. The ultrapulse or scanned CO₂ laser and the Er:YAG (erbium:yttrium aluminium garnet) laser are used for facial rejuvenation. Changes in skin texture and improvement in the appearance of wrinkles result from superficial skin ablation and tissue shrinkage secondary to heat-induced remodelling and collagen contraction.[92]

CO₂ lasers penetrate deeper, leading to a greater inflammatory reaction, prolonged erythema, and longer-lasting results, but also an increased risk of hypopigmentation and scarring.[93] Er:YAG lasers result in less thermal damage and tissue contraction, but more intraoperative bleeding occurs; however, there is decreased post-operative morbidity with a shorter recovery period and fewer complications. Post-operative morbidity depends on the depth of the thermal injury.

Particularly effective in the perioral and periorbital regions. Fine static wrinkles respond better than hyperdynamic facial creases to laser treatment.

Moderate to severe photodamage shows best results with the CO₂ laser. Excellent results can be achieved using an Er:YAG laser to treat more superficial wrinkles and less photodamaged skin.[95] Combination CO₂ and Er:YAG lasers allow sufficient tissue ablation while being associated with safer thermal stimulation and coagulation.

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles on animation only
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

superficial wrinkles at rest, deep wrinkles on animation

1st line – dermabrasion

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
1st line – 

dermabrasion

Particularly useful for lines of the perioral region.[85] An inexpensive and simple procedure performed under local anaesthesia or a regional nerve block. Using a hand-held dermabrader, the epidermis and upper layers of the dermis are mechanically removed, resulting in lowering and smoothening of the abraded creases. Ablation is usually extended down to the level of the mid-dermis at the papillary-reticular junction.[86] Re-epithelialisation of this partial-thickness injury is usually completed within 7 to 10 days. Incomplete dermal regeneration and neocollagen formation have been demonstrated following dermabrasion.

Although associated with less erythema and hypopigmentation than other techniques, complications include scarring, hyperpigmentation, and reactivation of a herpes virus infection. The effectiveness and risks of complications are related to the depth of injury, with deeper treatments associated with higher complication rates. For persistent or deeper wrinkles, dermabrasion may be repeated 6 to 12 months after the initial operative session.

Plus – lifestyle modification

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

1st line – microdermabrasion

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
1st line – 

microdermabrasion

Superficial wrinkles and photoaged skin may be treated by microdermabrasion, where crystals or other abrasive substances are blown onto the face.[87] The mechanism of action of this technique is not clear. Although actual skin abrasion has not been demonstrated, histological changes in the reticular dermis (namely, vascular changes) have been reported.[88]

Beneficial effects of microdermabrasion include a reduction in skin stiffness, and an increase in cutaneous compliance, as well as a mild improvement in the appearance of photodamaged skin.

Plus – lifestyle modification

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

2nd line – fractional photothermolysis

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
2nd line – 

fractional photothermolysis

This new technology for the treatment of photoageing yields impressive and safe results.[89][90][91]

Plus – lifestyle modification

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

2nd line – laser ablation

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
2nd line – 

laser ablation

Ablation refers to the removal of the epidermis and upper dermal layers. The ultrapulse or scanned CO₂ laser and the Er:YAG laser are used for facial rejuvenation. Changes in skin texture and improvement in the appearance of wrinkles result from superficial skin ablation and tissue shrinkage secondary to heat-induced remodelling and collagen contraction.[92]

CO₂ lasers penetrate deeper, leading to a greater inflammatory reaction, prolonged erythema, and longer-lasting results, but also an increased risk of hypopigmentation and scarring.[93] Er:YAG lasers result in less thermal damage and tissue contraction, but more intraoperative bleeding occurs; however, there is decreased post-operative morbidity with a shorter recovery period and fewer complications. Post-operative morbidity depends on the depth of the thermal injury.

Particularly effective in the perioral and periorbital regions. Fine static wrinkles respond better to laser treatment than hyperdynamic facial creases.

Moderate to severe photodamage shows best results with the CO₂ laser. Excellent results can be achieved using an Er:YAG laser to treat more superficial wrinkles and less photodamaged skin.[95] Combination CO₂ and Er:YAG lasers allow sufficient tissue ablation while being associated with safer thermal stimulation and coagulation.

Plus – lifestyle modification

Back
ONGOING
|
superficial wrinkles at rest, deep wrinkles on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

deep wrinkles and sagging skin at rest and deeper wrinkles on animation

1st line – autologous fat grafting or rhytidectomy

Back
ONGOING
|
deep wrinkles and sagging skin at rest and deeper wrinkles on animation
1st line – 

autologous fat grafting or rhytidectomy

These patients are best served with the combination of a surgical procedure (autologous fat grafting or rhytidectomy) and a local treatment (microdermabrasion, dermabrasion, or laser ablation) to improve the appearance of visible folds.

Facial lipofilling is used for volume replacement and facial rejuvenation.[97] Particularly effective for the malar region, as well as for nasolabial folds attributable to soft-tissue atrophy where treatment should include release of the dermal attachments creating the folds. Also beneficial in rejuvenation of the dorsum of the hand.[98] Fat is harvested from the abdomen and medial thighs by liposuction. Minimal overcorrection of <10% should be performed. Complications include irregularities and contour defects, due to inappropriate fat harvesting and/or the lipofilling injection techniques.[101] Results are more favourable in younger (<40 years) than in older (>60 years) patients.[100]

For sagging skin and deep folds attributable to gravitational descent, a facelift or rhytidectomy procedure is indicated. Deep plane and composite rhytidectomies achieve some improvement in the appearance of nasolabial folds.[103] Forehead plasties elevate ptotic eyebrows and smoothen the transverse forehead and/or glabellar lines.[104] Skin tightening and subcutaneous structure suspension provided by a facialplasty offer some improvement to the appearance of overhanging folds and gravitational lines. It should be made clear to patients that facelifts address only ptosis and have no effect on wrinkles and skin texture. Complications include scarring, haematoma formation, alopecia, nerve damage, facial asymmetries, and facial nerve palsy. Results can last for up to 15 years.

Plus – microdermabrasion, dermabrasion, or laser ablation

Back
ONGOING
|
deep wrinkles and sagging skin at rest and deeper wrinkles on animation
Plus – 

microdermabrasion, dermabrasion, or laser ablation

Treatment recommended for ALL patients in selected patient group

These patients are best served with the combination of a surgical procedure (autologous fat grafting or rhytidectomy) and a local treatment (microdermabrasion, dermabrasion, or laser ablation) to improve the appearance of visible folds.

In microdermabrasion, crystals or other abrasive substances are blown onto the face.[87] Beneficial effects of microdermabrasion include a reduction in skin stiffness, and an increase in cutaneous compliance, as well as a mild improvement in the appearance of photodamaged skin.

Dermabrasion is performed under local anaesthesia or a regional nerve block using a hand-held dermabrader to mechanically remove the epidermis and upper layers of the dermis resulting in lowering and smoothening of the abraded creases. Particularly useful for lines of the perioral region.[85]

Ablation refers to the removal of the epidermis and upper dermal layers. The ultrapulse or scanned CO₂ laser and the Er:YAG laser are used for facial rejuvenation. Changes in skin texture and improvement in the appearance of wrinkles result from superficial skin ablation and tissue shrinkage secondary to heat-induced remodelling and collagen contraction.[92]

Plus – lifestyle modification

Back
ONGOING
|
deep wrinkles and sagging skin at rest and deeper wrinkles on animation
Plus – 

lifestyle modification

Treatment recommended for ALL patients in selected patient group

Sun exposure, sunlamps, and tanning beds should be avoided, and sunscreens with broad-spectrum ultraviolet (UV)-A and UV-B protection should be used on all areas of unprotected skin, especially the face and hands. Broad-rimmed hats and other protective clothing should also be worn when out in the sun. Abstinence from smoking prevents acceleration of the ageing process and its associated wrinkling. Sunglasses may prevent squinting from the sun, and thus, accentuation of facial expression lines such as 'crow's feet'.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer