Deep wrinkles

All she saw of his piglike face was the thin pouting lower lip, propped up by an apex of deep wrinkles. He nodded curtly to her. It was, he said, a gross insult for a man of his standing to be questioned by any woman. 

Botulinum toxin is used in dermatology to reverse deep wrinkles. Its pharmacological mechanism of action in this use is... 

Patients with skin phototype above IV are therefore ruled out from this treatment, as are patients with a light skin phototype but a lot of freckles, and patients whose skin is severely photoaged. Phototype IV patients should make a choice between deep wrinkles and a possible depigmentation. 

The absence of frosting is compatible with a superficial peel - but not with an improvement in the appearance of deep wrinkles, which can only be treated with a deep peel. Then again, a downtime of 6-8 days is not compatible with a superficial peel, as it is the same as the downtime following a medium TCA peel to the papillary dermis. 

Deep wrinkles and folds are not a good indication for TCA peels ... 

With regard to acne, in 80% of cases, the first application of ETCA to active papulopustular facial lesions improves their number and severity by 50%, and the lesions seem to heal without scarring. ETCA is applied on the basis of one peel per week for 4 weeks that clear the lesions almost completely without having to resort to antibiotics. Deep wrinkles and acne scars do not disappear they lie deep under the skin and even phenol or carbon dioxide laser resurfacing cannot always treat them. A combination of several different techniques is clearly needed in these indications. 

Urkov used a simple alcohol solution of phenol, and treated deep wrinkles with electrocoagulation after the peel. He then applied an occlusive dressing for up to 3 days. His post-peel treatment was based on the dry technique . 

A phenol peel is mainly indicated to treat facial skin for severe photoaging. It is the only type of peel that can get rid of deep wrinkles and regenerate elasticity and firmness in... 

The lower lip is treated in the same way as the upper lip (see above). The skin on the chin is often resistant to treatment, and several coats may be required. Acne scars and deep wrinkles are particularly resistant in this area, and sometimes require chemabrasion during the peel itself or after 24 hours of occlusion. 

Using peels to different depths on the same patient is indicated when disorders of different depths coexist. Consider a patient who presents with early elastosis, a few lentigines and deep wrinkles on the upper lip only phenol can get rid of the wrinkles on the upper lip, but it would be unnecessarily deep to treat the early elastosis on the rest of the face. The phenol would of course get rid of the few senile lentigines, but a deep and very localized treatment with Only Touch can also get rid of them and with less risk. This patient would therefore benefit from the following combination (Figure 38.2) ... 

The use of these peel combinations will enhance a monotherapy procedure. An example would be the patient with moderately severe photoaging changes around the periorbital and perioral areas, such as deep wrinkles and crepey eyelid skin and rhagades around the mouth, combined with only moderate photoaging changes around the rest of the face. This would be characterized by epidermal... 

Baker s solution is particularly useful for perioral rhytides and for crosshatched corrugated lateral facial rhytides which occur with severe photoaging. It can also be applied to minimize wrinkling in the vermilhon part of the hp. For very deep wrinkles a broken wood appHcator stick can be used to scrub the peeHng agents into deep perioral rhytides. 

HA injections can restore the natural and youthful appearance of the skin. This minimally invasive procedure restores tissue volume, reduces wrinkles, and fills the depressed areas by local absorption. The use of HA as a skin filler became popular in the mid-1980s and, according to the AS APS, it is considered to be the fastest growing, non-invasive, procedure in the United States [17]. Filler HA is a viscous, transparent gel, which can be injected through a small gauge (G) needle, typically of 23-27 G. It provides increased volume and skin hydration due to its hydrophilic nature. Deep wrinkles require a high concentration of HA (approximately 25 mg/ml), while shallow wrinkles are typically treated with a lower concentration (5 mg/ml). HA filler lasts approximately... 

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