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wrinkle; rhytide; rhytidosis facialis

A furrow, fold or crease in the skin. Etiology: 1) photoaging 2) perioral wrinkles associated with cigarette smoking Pathology: 1) degeneration of dermal elastic tissue 2) pathology of photoaging Management: 1) tazarotene, 0.1% (Avage) [2] 2) Botulinum toxin A for deep frown lines a) Botox Cosmetic [3,4] b) onabotulinumtoxinA (Botox, Allergan) c) incobotulinumtoxinA (Bocouture, Xeomin) [7] 3) alpha-hydroxy acids exfoliate skin 5) all-trans retinoic acid 4) vitamin A, vitamin C & vitamin E are promoted for wrinkles a) no benefit of oral administration b) minimal benefit of topical administration [2] 5) autologous fibroblasts as filler material [5] - filling process occurs over several months since it takes time to produce endogenous collagen 6) fractional laser resurfacing may be effective [8] 7) focused ultrasound skin tightening is investigational [6] 8) cryotherapy may be effective [9] - consists of insertion of a probe tipped with 27-gauge needles cooled by a gas cylinder containing nitrous oxide - temperature of proble is < -88 C - cryotherapy induces temporary second-degree injury to the temporal branch of the facial nerve via partial disruption of the axon and myelin sheath [9] 9) fractional radiofrequency microneedling - requires multiple treatments for optimal results [11] - alternative to lasers, especially for darker skin types [11] 10) Ellacor, a dermal microcoring device available in the United States Oct 2022, is reportedly effective for treatment of facial wrinkles [10] 11) prophylaxis: sunscreen

Specific

lateral canthal line (crow's feet)

General

skin disease (dermatologic disorder, dermatopathy, dermatosis)

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Prescriber's Letter 10(1):5 2003
  3. Beer KR. Comparative evaluation of the safety and efficacy of botulinum toxin type A and topical creams for treating moderate-to-severe glabellar rhytids. Dermatol Surg. 2006 Feb;32(2):184-92. PMID: 16442037
  4. Lowe P et al, Comparison of two formulations of botulinum toxin type A for the treatment of glabellar lines: A double blind, randomized trial. J Am Acad Dermatol 2006, 55:975 PMID: 17097394
  5. Weiss RA et al, Autologous cultured fibroblast injection for facial countour deformities: A prospective, placebo-controlled, Phase III clinical trial. Dermatol Surg 2007, 33:263 PMID: 17338681
  6. Alam M et al Ultrasound tightening of facial and neck skin: A rater-blinded prospective cohort study. J Am Acad Dermatol 2010 Feb; 62:262. PMID: 20115948
  7. Sattler G et al. Noninferiority of incobotulinumtoxinA, free from complexing proteins, compared with another botulinum toxin type A in the treatment of glabellar frown lines. Dermatol Surg 2010 Dec; 36:2146. PMID: 21134045 - Prager W et al. Comparison of two botulinum toxin type A preparations for treating crow's feet: A split-face, double-blind, proof-of- concept study. Dermatol Surg 2010 Dec; 36:2155. PMID: 21134046
  8. Tierney EP et al. Treatment of lower eyelid rhytids and laxity with ablative fractionated carbon-dioxide laser resurfacing: Case series and review of the literature. J Am Acad Dermatol 2011 Apr; 64:730. PMID: 21414497
  9. Palmer FR III et al. Safety and effectiveness of focused cold therapy for the treatment of hyperdynamic forehead wrinkles. Dermatol Surg 2015 Feb; 41:232 PMID: 25654195
  10. Brunk D First-in-Class Device for Facial Wrinkles Hits the Market. Medscape. Oct 28, 2022 https://www.medscape.com/viewarticle/983173
  11. Brunk D For Optimal Results, Fractional RF Microneedling Requires Multiple Treatments Medscape. December 21, 2022 https://www.medscape.com/viewarticle/985968