The vast majority of antiwrinkle products and procedures don’t work. But some do. A review published in Archives of Dermatology identified three approaches—prescription-strength topical retinoids…injections of hyaluronic acid…and carbon dioxide laser resurfacing—that have been proven to reduce facial wrinkles. All three treatments are available from a dermatologist. Ask him/her which is best for you.

HOW SKIN AGES

Collagen is a connective tissue that makes young, healthy skin firm and elastic. It provides the structural support for blood vessels and maintains the skin’s shape. In youthful skin, the collagen surrounding skin cells is firm and abundant. As people age, collagen-producing cells known as fibroblasts become less active. The body produces less collagen, and the skin loses some of its tautness and elasticity. At the same time, collagen fibers that already are present in the skin gradually break down. Both processes are a natural consequence of aging, although they’re accelerated by lifestyle factors, such as smoking or excessive sun exposure.

Once collagen starts to break down, or fragment, fewer fibroblasts are able to attach to the remaining collagen fibers. Without these attachments, fibroblasts don’t receive the mechanical “stretch” signals that trigger collagen production and reduce the body’s output of collagen-degrading enzymes. This is why older adults tend to develop more (and deeper) wrinkles. They have a higher amount of collagen fragmentation…fewer stretch signals between fibroblasts and collagen fibers…a lower rate of collagen replacement…and a greater rate of collagen destruction.

Effective wrinkle treatments influence each stage of this process. They promote new collagen formation, promote the attachment of fibroblasts to collagen fibers and allow the mechanical stretching that both increases collagen and reduces collagen breakdown.

TOPICAL RETINOL

Retinoid-based creams and ointments are derived from vitamin A. A double-blind, placebo-controlled study published in Archives of Dermatology looked at two groups of elderly patients. Those in one group were treated with a cream containing 0.4% vitamin A (retinol). Those in a second group were given a placebo cream. Study personnel applied the creams to people in both groups three times a week for 24 weeks.

Results: People treated with retinol had an increase in glycosaminoglycans, molecular chains that absorb water and increase collagen — and an approximately 23% reduction in fine wrinkles.

It’s unlikely that most over-the-counter retinoid products contain enough retinoids to have noticeable effects. There’s no way to be sure, because few of these products list retinoid concentrations on the label.

The prescription creams are applied once or twice a day. People may see results in as little as eight weeks. Because retinol increases collagen, it probably increases the stretch between fibroblasts and collagen fibers. This potentially could give long-lasting results even when the products are discontinued — but this hasn’t been proven.

Side effects: People who use the stronger preparations sometimes develop a minor rash (retinoid dermatitis). The rash clears up once the treatment is discontinued. You’re less likely to experience skin irritation if you start with a low-dose product and gradually increase the concentration.

Important: Treatment with a topical retinoid increases the skin’s sensitivity to sunlight. People who use it should always apply sunscreen before going outdoors, even when the weather is cool.

Cost: About $150 for 40 grams (g) of 0.02% concentration, which lasts four months or longer.

HYALURONIC ACID INJECTIONS

Dermatologists once thought that injections of hyaluronic acid derivatives, called cross-linked hyaluronic acide, which are substances with collagen-like properties, mainly worked by plumping the skin and “filling out” wrinkles. Hyaluronic acid does make the skin plumper, but now we know that it also promotes the tissue stretching that increases collagen production and inhibits its breakdown.

Patients usually are given a local anesthetic, and the dermatologist injects a hyaluronic acid derivative (such as a product called Restylane) into the wrinkle. Most people will notice a reduction in wrinkles almost immediately. In studies, an increase in skin collagen occurs after about one month.

Patients can repeat the treatments as often as desired. The improvement from a single injection usually lasts between nine and 12 months.

Side effects: Temporary swelling, redness and bruising in the treated area.

Cost: $550 to $650 per syringe. The average patient requires one to two syringes per treatment.

CARBON DIOXIDE LASER RESURFACING

One type of carbon dioxide laser resurfacing is called fractionated resurfacing.The patient is given a local anesthetic. Then a laser is used to generate heat that removes the upper skin layer, called the epidermis. New collagen is produced by the body as the skin heals.

It takes two to three weeks for the skin to heal, and skin redness may last for six to 12 weeks. Patients need to keep the raw areas clean. They also should apply wound-care ointments, such as Catrix 10 or Aquaphor, to keep the skin moist and prevent scarring.

The results typically last for several years. Most people get only a single treatment.

Other types of skin resurfacing, such as the use of alpha or beta-hydroxy acids, or the use of less intense lasers, allow patients to heal more quickly after the procedures. However, these approaches haven’t been proven to be as effective as carbon dioxide laser resurfacing.

Side effects: Temporary discomfort, swelling and redness. Uncommon complications include infection, changes in skin color and scarring. Patients with darker skin tones have a greater risk of healing with darker pigmentation.

Cost: $3,500 to $4,000.