The wrinkles around your eyes are the giveaway of your age in your late thirties, the etches in your face in your forties, and the just plain old deep folds and creases after. The secret to taking care of these lines is maintenance, maintenance, maintenance.

When we talk about fine lines, we are talking about skin quality and elasticity. When you smile, do your eyes get eight stacks of thin skin? This type of fine line cannot be filled. The quality of the skin itself needs to be improved, so that the skin, like a new rubber band, snaps back when tension is released, rather than folds on itself. The best way to improve skin elasticity may surprise you - it is through controlled dermal damage. We like to call it "collagen stimulation", but plain and simply put, we do something to cause injury to the dermis, and it looks better. By stimulating the deep, or dermal, layer of the skin, collagen fibers are built, thickening the skin in a controlled fashion.

The more old-fashioned way of stimulating the dermis is simply to apply an agent to the epidermis, damaging the epidermis, and then the agent goes through to the dermis, which will do the dermal damage. The TCA and Blue Peel both use this technique, which is reliable, but has a downside - your epithelium needs to grow back! The Vi Peel™ also goes through the epidermis, but has greater penetration into the dermis with less epithelial injury, resulting in a shorter down time with a nice deep effect. Newer lasers, such as the Fraxel®, have gone around the epithelium by treating the dermis through microscopic holes placed in a grid like pattern. Imagine an incredibly small column of injury that penetrates the epidermis and dermis, with normal skin around it. This allows the untreated adjacent epithelium to immediately heal the laser site. Now imagine this process spread out over millions of laser points of light, treating only a fraction of skin, but very deeply, at one time. This is why Fraxel® needs more than one treatment to take full effect, as it treats roughly 30% of the skin at each session. The new Lumenis Fractional CO2 works by the same technique, but uses CO2 laser, and with this stronger laser comes a greater effect on the dermis (but with greater recovery time) that you can see after one treatment. Finally, the Alma Accent® XL completely bypasses the epithelium by transferring radiofrequency directly to the deep dermal layer. The Alma is very effective at a slight lift from the deepest layers, with less effect on the superficial layers. It is especially effective when the skin has a slight sag.

Not enough can be said about maintaining your skin to prevent these wrinkles. Sunblock, every single morning, is very effective for delaying the onset of crow's feet. Retin-A, the only product to be clinically proven to reduce wrinkles, should be on your nightly skin regimen. Topical reactions to Retin-A should be expected at first and can be tolerated with a graduated treatment regimen (link to Retin-a - have how to start it). We like Tri-Luma Cream, which has Retin-A with some other effective ingredients, but there are many other formulations that are effective. Retinol, as a note, is not effective for reducing fine lines as it does not penetrate to the dermis. The Leaf & Rusher Tx has tried to get around this by keeping the retinol in a chemical state where it can pass through the epithelium, so this is more effective than other retinol containing products for legitimately sensitive skin.

Finally, don't forget about Botox® and fillers! Botox® works by blocking the action of facial muscles, so it is great for wrinkles created by overactive facial muscles, like between your eyes, on your forehead, and crow's feet. Fillers, like Juvederm™, are always good for the nasolabial folds, which extend from your nose to the corners of the mouth. And fillers in combination with a laser or peel work great for those persistent vertical lip lines.

Remember, maintain. For skin with early wrinkling, consider doing one major treatment per year such as a peel or Fraxel®. For more moderate wrinkling, you may want to knock them out with the CO2 laser and then get down to your maintenance regimen. Use Botox® or fillers only for those wrinkles that are appropriate. And the products do matter - but only if you pick the ones that work!