Holistic Vanity and Aging: The Wrinkle Report

Holistic Vanity is a long form series that covers my personal curiosity and experiences balancing aging, having a sense of personal vanity, and the awareness of a scientifically driven wellness professional who wants to make the healthiest decisions.

In the first post of holistic vanity and aging, I worked through The Grey Hair Issue. The next logical and highly requested topic was wrinkles and skin related aging. I’ll start this journey with a caveat: I have been blessed with some Asian genetics, good cheekbones, and something that possessed me to start using sunscreen in high school (TBH a Marie Claire article asking people in their 30’s what they would tell their younger selves), so I did not have any semblance of wrinkles or fine lines until my early 30’s. And still, in the last half of my thirties, I have no deep wrinkles, although I do have fine lines appearing. That is where we begin.

In retrospect, what probably kicked it off was having a kid. If you’ve ever seen those side by side shots of presidents before and after their terms in office…it feels like that. Rapid aging in 4-8 years. I’d always been interested in skincare because I have a red-tone facial birthmark. Which, depending on how you want to read into that, means I would have either been killed as a witch in the 1600’s, revered as a shaman, or I died a horrific death in a former life that involved some kind of stabbing to the face. But either way, I got amazing at covering my birthmark as a teenager, and was always looking to learn about ways to reduce the redness and keep other parts of my skin healthy.

At the end of the day, the amount of wrinkles or how apparent they are to you is what matters. Until recently, I hadn’t given it a second thought. Like the grey hair, the wrinkle issue feels more relevant when I’m not happy with some other part of my skin. I notice my fine lines less when I have a slight tan, or when I’m well moisturized. But come January or February when I am dry, pale, and have a garnish of light seasonal depression, I see it.

I’m in the phase of aging skin where I wonder if I should be doing more than I am. I wonder if it’s time to step it up a level in terms of more medical grade topicals or an in-office service. I’ve never done any in-office interventions thus far in my life (and only have ever had one facial), so I started to research.

What are wrinkles?

Wrinkles are lines on the skin that form as part of the natural aging progression. As you age, your skin cells don’t function the way they did in your youth so you begin to lose the integrity of the external top layer barrier as well as a decrease in collagen production. There are two types of wrinkles: dynamic and static. Dynamic wrinkles occur during a movement (eg. Scrunching your brow) while static wrinkles are always visible. Dynamic wrinkles will later become static. Wrinkles also occur with use, so the more repetitive motions that occur, the more likely wrinkles are to form in those areas. There are also genetic components to wrinkles, but also environmental, so protect yourself from the sun and don’t smoke.

What’s bad about wrinkle intervention?

In general, there is little downside to wrinkle intervention except time and cost. But, once you move into the realm of using an untrained practitioner to complete a filler or Botox session, the risk increases exponentially. The ‘med spa’ industry is highly unregulated and can be very dangerous if you do not vet your practitioner. There are stories on everything from people with 1 day of training being the primary practitioner to offices that buy their counterfeit Botox off Alibaba. Beyond dangerous offices, there are instances of mild (and rarely major) side effects with everything from topical products to injectables even in reputable locations.

What’s good about wrinkle intervention?

Maintaining a healthy skin barrier will reduce your risk of infections via cuts. Some people feel more confident after addressing skin aging. There’s a huge grouping of mental health benefits that would coincide with improved self image. In terms of Botox, there’s evidence it can help those with migraines or excessive sweating.

Wrinkle Intervention Options:

Note: This piece will not discuss surgical options (eg facelifts). The only thing that sticks with me about this topic is a quote I heard one time that you get “one good facelift” and, being in my thirties, it is absolutely not even close to the time to consider that. I will add the necessary disclaimer that I am not a dermatologist and I am not responsible for any actions you decide to pursue.

Topical:

Retinoids: This is a category of topical skincare agents that come from Vitamin A. This is quite a full spectrum category (Tretonin, retinol, etc) in that there are low level retinoids that are over the counter, but also more intense high concentration retinoids. It is the most used and studied wrinkle intervention. Retinoids penetrate skin layers to activate collagen and elastin to ‘fill in’ the wrinkles. They also stimulate blood flow to the area which can help with skin tone. In general, it can take 3-6 months of regular usage before improvements appear, with the best results taking up to a year. You MUST go slow with this process (don’t jump into a high percentage retinoid out of the gate) and you must use sunscreen because it causes sun sensitivity. This is an intervention I’ve used for years and based on what I’ve heard from dermatologists, should be step one to add to your anti aging routine (not including SPF).

When it comes to topicals of any kind, the recommendation is to carry the product down your neck, onto your chest, and even include the backs of your hands. And for it to work, you’ve got to be consistent.

Bakuchiol: Often times referred to as ‘plant based retinol’. This topical is a good solution for those with sensitive skin and it’s so gentle it can be used in the morning prior to sun exposure. This might be a good option if you find yourself getting confused on ‘rules’ with retinoids.

Argireline: It's known as “Botox in a bottle”. This is a product I started using a year ago, but hear very little about in comparison to retinoids. Argireline is actually a trademark formula owned by a Spanish company, so it’s licensed/purchased by other companies and used in their own products. The mechanism of action is that Argireline interferes with a protein receptor complex that causes muscle movement meaning there are fewer muscle contractions and therefore fewer dynamic wrinkles. It also stimulates collagen production and helps the skin hold moisture. There are no known side effects of this product but with all skin products, you’re going to want to test it on a small area first. The effects topically last a few hours, so to me, it’s a product I’d want to use in the morning. For the longer term effects, consistency matters. A 2002 study found that Argireline can decrease wrinkles up to 30% when used daily for 30 days. And at less than $10 a bottle, there’s really a low monetary risk try for this.

Physical:

Micro-needling: Lots of small needles are poked into the skin to create a wound on the top layers. The would heals and new collagen and elastin are formed. This procedure is preformed at various insertion depths depending on the goal. It is effective and the results are temporary. You can purchase an at-home roller but it’s not recommended because most people cannot meet the sanitation standards that would make this safe (An unclean needle being inserted into the skin is ASKING for an infection. Never mix using the roller between your scalp and skin and always disinfect it after and before use.). Because I’ve done my research and am fastidious about this, I used an at home roller for at least 9 months before it fell out of my routine (I rolled right before going out to work in the garden on a hot day and my skin got irritated, so after I gave it a break I kind of forgot about doing it in my routine). I don’t think I saw wrinkle related benefits from using it, but I do feel it helped with skin texture/tone in my t-zone specifically.

Dermabrasion: This is a treatment that removes skin layers via a physical abrasive (not chemical). As the new skin grows back, the texture is more smooth, therefore reducing the appearance of minor wrinkles and lightly irregular textures. I see this as my ‘next step’ in adding to my anti-aging protocol.

Chemical peels: Same general theory as dermabrasion but using chemical compounds for removal instead of an abrasive material. A chemical solution removes top layers of skin to allow for new skin to regrow. These are generally more effective with longer lasting results than dermabrasion but require more downtime after the process. At home, you can use chemical exfoliants over the counter in the form of glycolic acid, lactic acid, AHA/BHA and other products. These are far, far less intense than in-office. The various acids also may work or may not work for your skin. I find that glycolic acid causes repeated break outs for me, whereas lactic acid does not and that AHA/BHA is very intense but effective.

Laser skin resurfacing: The most intensive treatment of this category, a laser procedure uses direct, short pulsing light beams on the skin. This treatment can be problematic for those with darker skin tones as the risk for hyperpigmentation can go up with certain types of treatment. There are several types of lasers with different pros and cons and timelines for recovery.

Frownies: Think face tape. Frownies are a specific brand of face patch that holds your skin in place, typically overnight (lest you look crazy). By restricting movement, like Botox does, you are retraining muscles to relax. There are no active ingredients on this cast like patch. They are not reusable. It is simply a mechanism for restricting movement. This particular company has been around since the late 1800’s. And as simple and appealing as this sounds, many people find this process unsustainable. Taking the time to place the ‘cast’ on every night, sleep with it on, only to have the effects last a couple hours (unless you can somehow convince your body to continue with the muscle relaxing throughout the day), is typically undesirable. I did a lot of research into this because I did find the simple nature of it so appealing, but ultimately I know I would be irritated with the amount of waste it produced and could not deal with this on my face at night. If the waste bothers you (and it might not!), consider swapping out another aspect of your routine for a reusable version (like cotton makeup rounds for reusable ones) to kind of ‘zero’ the balance of waste production.

Injectables:

Filler: Dermal fillers are substances injected under the skin. While they can be used for wrinkles, they’re also often times used for contouring/facial augmentation. These have been around since the 1980’s but now there are so many of kinds they have been divided into specific groups:

1. hyaluronic acid (HA)

2. polymethyl methacrylate (PMMA)

3. poly-L-lactic acid

4. calcium hydroxylapatite (CaHA).

Each filler differs in ingredients and mechanism of action. Some are best for deeper lines for example or specific areas of the face. HA is the most common and historically safest filler since it is a compound that occurs naturally in the skin. Because fillers have very little down time and now, very little stigma, it’s relatively common for people to utilize fillers and discuss them freely. In general the most typical complication of filler is bruising and swelling which typically resolve in a few days. There’s an allergic risk as well. There’s a risk of infection, but if you’re using a qualified practitioner, this is unlikely. And while rare, vascular occlusion is possible (where filler is accidentally injected into a blood vessel which cuts off blood flow to the surrounding area leading to tissue death). From less of a health standpoint and more of a vanity standpoint, there’s a risk of filler migration leading to asymmetry and..looking weird. I know many, many people who use fillers. If I want to be outwardly judgmental, some of the injections look great for the person, other ones have changed people I know into looking like people I do not know. And that’s something that would be my primary concern if I were to go this route.

Botox: Botox is the original name brand treatment of neuromodulators (others include Disport and Jeuveau for example). It’s an injection that is derived from the botulinum toxin and will temporarily block signals that cause your muscles to contract. In general, Botox has little to no downtime with results appearing about two weeks after the injection. Like filler, Botox has little cultural stigma in America and it’s so common that younger people are even utilizing it as a ‘preventative Botox’ measure to slow the formation/progression of some dynamic wrinkles. For more medical purposes, Botox is also approved for usage to treat chronic migraines since it helps facial muscles/around the scalp relax. So much so that some people report they ‘know it’s time for Botox when they start getting headaches or more facial tension’. The other medical use for Botox is injection into sweat glands as a FDA approved treatment for excessive sweating. Neuromodulators have been studied for decades and are generally considered safe with few negative effects. Short term, if the practitioner is not skilled, there can be issues. Botox is a short term ‘fix’ for wrinkles because it wears off in 3-6 months. Long term, some patients require higher dosing for desired results. Some dermatologists report patients developing a tolerance to Botox where it is no longer effective (the immune system develops antibodies that neutralize the toxin). Aesthetically, there is also a risk of a facial flattening effect on the brows.

Other:

Face Yoga: This is a series of exercises and movements to engage muscles throughout the face with the goal of toning or relaxing specific areas. It’s less like ‘going to the gym’ and more of a retraining of the brain to use different parts of the face. For example, one set of exercises can be training the eye muscles to do what they need to do without moving the forehead. In a way, it’s the same theory as Botox but with active participation: teach muscles to relax, or support areas. There’s little evidence (to be fair there probably aren’t many studies), that face yoga has high efficacy, but one study in 2018, showed 30 minutes a day over 20 weeks modestly improved facial appearance in women 40-65 (although the study had problems: small sample size, lots of drop outs, and no control group).

Red Light Therapy: If you’re on social media, you’re seen selfies with people wearing LED face masks. They look crazy but they do have legitimacy…if you use the right one. LED devices are used for anti-aging, acne, and skin calming therapies. Because there is a photoreceptor in skin cells (activated by specific wavelengths of light), ‘photobiomodulation’ occurs and triggers a cascade reaction that ultimately results in ‘nice skin’. Thus far, it has been deemed safe for all skin tones and types. When it comes to actual efficacy, you have to remember the difference between in-office and home devices. In-office devices will always be more effective (stronger, better application), but at home devices are legit too (especially for acne and redness, but less so for anti-aging). Different wavelengths have different benefits. When utilizing LED therapies, you can start to see results within weeks but they will compound over several months. When buying a device, look for FDA cleared devices, review wavelengths, and know that the better fitting the mask, the better the results since the proximity of the light emitting diodes to the skin plays a large role as does the intensity of the quality bulbs (expect to pay several hundred dollars).

Red light: 620–750 nanometers (stimulate collagen production and repair and reduce inflammation)

Blue light: 450–495 nanometers (acne)

Near infrared: 750–1,400 nanometers (for deep-tissue healing)

Far infrared: 3,000 nanometers–1 millimeter (for detoxing and circulation)

I would be remiss without bringing up skin cancer and light therapies because I know it’s something I dug into after having surgery for melanoma. There’s currently no definitive proof that red light therapy causes skin cancer. UV light is a major risk factor for melanoma and red light therapy does not use UV light. When I asked my clinical dermatologist about this (in a discussion related to infrared saunas) she said results are inconclusive and it depends on your risk comfort level.

Collagen Supplements: Collagen supplements became very popular several years ago and while there are some high quality products on the market, there are also ones that are not (just like any supplements). The data on oral intake of collagen for skin health is mostly good. A study in the Journal of Cosmetic Dermatology demonstrated that oral intake of collagen hydrolysates resulted in a meaningful reduction in wrinkle depth, particularly in women aged 35 to 55, after 12 weeks of supplementation. Other published studies in journals found that there were improvements in skin elasticity (randomized, double blind, placebo controlled). With that said, a review of studies indicates that results vary significantly across different study designs and populations. We also have some gaps in understanding the exact mechanism by which oral collagen translates to skin benefits. What we do know is oral collagen supplements typically contain hydrolyzed collagen (collagen peptides). These are broken down into smaller amino acids which are easier for the body to use. These may stimulate cells that are responsible for collagen synthesis in the skin. This is one of those recommendations where the science is pretty good, so if you’re motivated to do it, it’s not going to hurt (as long as you use a reputable source).

General Moisturizing: Look, when it comes down to it, hydrated skin looks less wrinkly. It’s not a secret and it’s not a magic bullet either. This is the most base item you can address and should address, even to just make sure the integrity of your outer layer of skin stays intact to ward off cuts/infections. You can consider face masks, thicker moisturizing creams, drinking more water, using a humidifier. Go get your salamander on.

What I’m going to do and how I decided:

Despite my current awareness level of fine lines appearing, I don’t think an intervention to the level of filler or botox or even an in-office clinical dermabrasion is warranted. And I think it’s the right decision, although I kind of wish I had a great resounding story of ‘why’ like I did with my Grey Hair Issue. More than anything, I think researching options made me realize the ROI on a more intensive intervention would be bad. The downtime and the expense of some of these would have very limited impact on the level of fine lines I currently have. But so often, it’s hard for people to separate their personal self view and vanity from the reality of their appearance. Find someone you truly trust and ask them.

I tend to be intervention conservative and mentally I feel like I’m ‘saving’ a more intensive procedure for maybe in 5-10 years when it will make a substantial difference. I’m going to continue my current “30’s” routine of skin care: heavy SPF and physical sun protection (hats), retinoids, Argireline and other peptides, and moisturizer. I plan to mindfully re-integrate a few products or tools I already have but fell out of using for one reason or another, so I’ll add back in an at-home chemical exfoliant in lieu of dermabrasion or chemical peels in-office. I’ll probably start using my at-home dermaroller. I should add in an eye area specific topical which I need to research, but will probably end up using something from The Ordinary like most of my favorites.

Here’s my current and planned protocol, which works for me, may not work for you, but I know you’re curious. Many of these products are from The Ordinary because they provide simple, clinically oriented products without filler ingredients/unnecessary luxe packaging. Because of this, they charge insanely low prices for these products. I will say, this is probably not the brand for you if you are overwhelmed by the scientific nature of the names/ range of intensities of the formulations without guidance. The website does make it so you can build a routine with the help of their online tool, so I would start there. This is not a sponsored post for them, I just like the nature of their products, I like being able to order all in one place, and I like being able to go get it at Target if I didn’t realize I was out.

1. SPF: Supergoop’s Unseen Sunscreen, The Ordinary SPF 45 Serum

2. Retinol 1% in squalene by The Ordinary

3. Argireline 10% by The Ordinary

4. Matrixyl 10% + HA by The Ordinary (like Argireline it’s another peptide for anti-aging that stimulates collagen and elastin production)

5. Natural Moisturizing Factors + HA by The Ordinary

6. *re-adding in: AHA/ 30% BHA 2% exfoliating mask by The Ordinary

7. *adding in new: Multi-Peptide Eye Serum by The Ordinary

8. Derma roller plus bottle of alcohol sanitizer

9. *considering LED therapy device but need to deep dive into brands

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Holistic Vanity always has a flexibility. Coming to terms with my emotions about each of these topics and knowing I can change my opinions feels low stress. Because if I learned anything from the Grey Hair thing, it’s I don’t need more stress.