Last month I discussed wrinkle formation and prevention—sunscreen, sunscreen, sunscreen. And Botox for those of you who don’t want expression lines either. Have I mentioned how bad smoking is for your skin?

This month, let’s explore the options for “treating” wrinkles, starting with the least invasive procedure—moisturizing creams.

Every moisturizer works to some extent by temporarily plumping up the top layer of your skin with humectants (chemicals designed to attract water). But, since we know from last month that wrinkles are formed deeper in the skin, this will only reduce the appearance of the fine lines that you have. And that is exactly what every manufacturer tells you in their advertising!

Notice that they do not say that their product will eliminate or reduce the wrinkles; they carefully state that their product will reduce “the appearance” of fine lines and wrinkles.

This is the important part. Back in November’s column, I explained that the epidermis (outer layer of our skin) is designed to protect us from our external environment. It literally keeps out all the bad stuff. But skin can’t differentiate between the molecules of “bad” stuff and the molecules of “good” stuff you’re putting on it. It doesn’t know that you’ve just applied a $150 "miracle" potion, a $10 cream that was on sale at the drug store, or some cleaning solution that spilled while you were mopping the floor.

Last year, Consumer Reports did a study on wrinkle creams. Using a double-blind study method for 12 weeks, testers tried products from Avon, Lancôme, Strivectin, La Prairie and others. At the end of the test, Olay Regenerist Perfecting Cream performed the best. But that said, it only reduced wrinkles by about 10 percent – barely visible to the naked eye.

Retin-A (Retinol) is well-known for its healing effect on acne-prone skin, but it will also work on fine lines. A derivative of Vitamin A, Retin-A works to promote turnover of skin cells and stimulates natural production of collagen. This is only available by prescription, and works best if you continue use for a year or more. Be aware that it can cause dryness and redness and will definitely make you more sensitive to sunlight.

Peels, either chemical (glycolic acid or alpha-hydroxy acid) or mechanical (micro-dermabrasion, dermabrasion, laser re-surfacing), are also effective at treating wrinkles. Depending on the concentration of solution used in a chemical peel or the style of abrasion used in a mechanical peel, results can be subtle or dramatic. Please see my June 2005 column for detailed information on peels of all types.

Deeper wrinkles are usually a result of facial movement over time. Crow’s feet around the eyes, for example, come from squinting in the sunlight. And forehead creases are the accumulation of a lifetime of wrinkling your brow or frowning. Botox works on these deeper wrinkles by paralyzing the muscle around the area (for several months at a time), allowing the patient to avoid the movement that causes the wrinkles. In combination with injectable fillers, Botox injections can help people avoid more serious surgical interventions for longer periods.

Fillers come in three varieties: your own fat can be “harvested” and injected into you (least likely to cause allergic reaction); collagen (animal or human protein aka Zyplast, Cosmoplast); and polymer-based (Restylane, Juvederm, Sculptra).

Fat-grafting is the most expensive and most invasive method of filler, requiring more recovery time. Collagen and polymer-based fillers can be injected in the doctor’s office and should only be done by a plastic surgeon or dermatologist with experience in using them. Fillers can last up to four years, depending on the type used and the area of the face treated.

Thermage is a relatively new treatment for aging skin involving the use of radio-frequency waves. During a Thermage treatment, the radio waves heat the collagen deep within your skin in order to tighten it. This also stimulates new growth of your natural collagen. While some patients have reported immediate results, it generally takes a few months to see the effect (which can last up to two years). The only reported side effect is mild redness akin to sunburn.

Face lifts are no longer reserved for actors, the very old and the very wealthy. There now are variations on full-face lifts that treat specific areas, for example, eyelid surgery.

During a full-face lift, the underlying tissue and muscles of the face are lifted, repositioned and stitched into their new place. Excess skin and fat are also removed and recovery can take several weeks. As with all surgery, there are always risks. If you are considering a face lift, or any variations one one, make sure that your doctor is board-certified by the governing body for plastic surgeons in your country.

A newer version of the face lift, called a “thread lift” or “feather lift,” redrapes the skin of the face rather than working on the underlying muscle. During this procedure, threads that have tiny barbs on them are inserted under the skin and pulled upwards to give a tightening effect. This works best on patients who do not have very loose or seriously sagging skin and the effects can last up to five years.

So, my friends, there you have it – from Retin-A to Zyplast. Whatever you decide for yourself, always interview doctors carefully, check their credentials, and talk to other people who have had the procedure done.

Wrinkles are something that cannot be avoided – we all get them. But this is one instance where the ounce of prevention (sunscreen, dark glasses, big hats) is well worth the price compared to the pound of cure!