Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are several medical (topical medicines and creams) and many invasive
techniques available for ameliorating wrinkles. They are all effective to the
degree that 1) they change the nature of aging collagen, 2) they stretch the skin, 3) fill in the depressions in the skin, or 4) they paralyze muscles that cause the skin to crease. They include both medical and surgical methods:
Vitamin A Acid (tretinoin
[Retin A, Renova]):
This ingredient, available by prescription, has the longest track record of
success in treating aging skin and fine lines. Creams containing tretinoin
must be used on an ongoing basis. They may produce redness and peeling at
first, but discomfort can usually be minimized by lowering the cream's
concentration or applying it less often until the skin gets used to it.
Alpha-hydroxy acids: These so-called "fruit acids" include
glycolic and lactic acid. Preparations containing these fruit acids are
quite safe and cause no more than mild and temporary irritation. They
produce only subtle improvement though.
Antioxidants: These include preparations that contain the
vitamins A, C, and E, as well as beta-carotene. Such creams may provide a
certain amount of sun protection as well as mild improvement of fine
Ordinary moisturizers: Creams that don't contain any of the above
substances can only make wrinkles look temporarily less prominent ("reduce
the appearance of fine lines").
Glycolic acid peels: These superficial peels can make a very slight
difference in the intensity of fine wrinkles.
Deeper peels: These peels use ingredients like salicylic acid and
trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper
peels do a better job of smoothing fine lines. The deeper the peel, however,
the greater the risk of side effects, such as long-lasting pigment changes
(changes in the color of the skin) and scarring. Such peels do not require
anesthesia. Mild sedation helps ease short-term but fairly intense
Microdermabrasion: This refers to "sanding the skin" with a
machine containing silica or aluminum crystals; many estheticians offer this
service, usually in "packages" of six or seven sessions. Microdermabrasion
does not change skin anatomy, though it may make the face feel smoother.
Cosmetic products marketed as "home microdermabrasion" are just mild
exfoliants, harmless but not likely to produce any meaningful change in
Dermabrasion: This is a true surgical procedure, often performed
under general anesthesia. The treating physician uses a rotating instrument
to sand the skin down. Depending a great deal on the skill and experience of
the operator, dermabrasion can result in excellent improvement but can also
produce significant side effects, including scarring and permanent changes
in skin color.
Laser resurfacing: Using instruments such as the carbon dioxide and
erbium lasers, physicians can achieve results similar to those of
dermabrasion with greater reliability and precision. The laser is passed
several times over the area to be treated until the peel reaches the middle
of the dermis, the skin's second layer. This helps stimulate the body's
natural collagen synthesis (production), which plumps up sagging skin and
wrinkles. Some doctors perform laser resurfacing under "conscious sedation,"
in which the patient remains awake and receives intravenous medications to
calm and ease pain. This sedation is combined with the application of
topical anesthetic creams such as EMLA, as well as injections of local
anesthetics like lidocaine. Procedures may need to be repeated to maximize
improvement. Skin takes a long time to heal (weeks to months) after
resurfacing. In addition, this procedure, like dermabrasion, can cause
permanent pigment changes and scarring.
Fractional resurfacing: Newer lasers work through a
modification of traditional laser resurfacing. Treatments affect not the
whole skin but instead only evenly spaced spots surrounded by undamaged
skin. Healing is much faster than traditional resurfacing, with less
"downtime" afterward. Several treatments are needed to achieve full benefit.
Non-ablative laser resurfacing: Newer lasers attempt to stimulate
collagen synthesis under the skin without peeling or damaging the epidermis.
Studies and clinical experience suggest that such procedures can improve
fine wrinkles, though not as much as laser resurfacing. Several treatments
may be necessary. These procedures are almost painless and there is little
or no redness, peeling, or downtime afterward.
Heat and radiofrequency: Another variation of noninvasive
facial rejuvenation is to heat tissue using radiofrequency devises and
infrared light sources. Techniques are still being developed but results to
date suggest that such treatments are safe and can produce visible and
lasting improvement, though not as much as surgical techniques like
Plastic surgical procedures: Surgical facelifts, brow lifts, and similar
operations can be very helpful for selected patients.
Botox: Injection of botulinum toxin, the muscle poison, can
paralyze muscles that produce the "frown lines" on the forehead, fine lines
around the eyes, and other wrinkles. Improvement lasts several months and
must be repeated to sustain improvement. Injected properly, Botox is quite
safe; the muscle poison does not spread through the body to do damage
Fillers: Fillers are injected into the skin to increase
volume and flatten wrinkles and folds. For a long time, the most popular
filler was collagen, whose effect only lasts a few months. More recently,
new filler substances such as hyaluronic acid (Restylane, Juvederm) and
calcium hydroxylapatite (Radiesse) have become popular because their
effect can last six to nine months or even longer.
Anyone considering any of the cosmetic procedures should be sure to consult
doctors who have experience in one or several of these techniques. Patients
should fully inform themselves about the risks and potential benefits of the
procedure they are considering before going forward.
Farage, M.A., Miller, K.W., Elsner, P. and Maibach, H.I. "Intrinsic and extrinsic factors in skin ageing: a
review." International Journal of Cosmetic Science 30 (2008): 87–95. doi: 10.1111/j.1468-2494.2007.00415.x
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 2/17/2012