Q.  What can I do to manage my facial wrinkles?
 

A.  Nowadays new methods for improving the facial wrinkles other than surgical procedure; non-invasive procedures are introduced. Of course, the effect of surgical treatment lasts longer and has great advantage of showing the immediate effect, but need for the general anesthesia can be psychological burden to the patients. Especially when the patient has mild wrinkles and skin laxity, non-invasive treatment can be tried first. Among these treatment modalities, botulinum toxin (Botox disport) injection has been widely used and show early onset of effect. Botulinum toxin decreases the secretion of the acetylcholine and results in the prohibition of muscle contraction and finally prevents the skin from wrinkled. Because the rhytid is made by the muscle contraction, suppression of the muscle activity can contribute to the weakening of the facial wrinkle. However, overdose injection can cause undesired muscular palsy and eventually the drooping of the muscle and lethargic facial expression. Therefore it is important for the patient to be consulted to the specialist and have an adequate dose of injection. On the contrary to the botulinum toxin, chemical peeling and laser can act directly on the rhytid and its surrounding skin to have a positive effect on the wrinkles. Various chemical materials can be applied with different concentration. Therefore the safety is able to be guaranteed only with the specialists. As peeling too deep into the dermis can cause new scar, accurate and precise management is mandatory for the safe procedure. In addition, temporary erythema and photosensitivity to the ultrviolet light can be accompanied not infrequently, ointment relieving the erythema and sunscreen blocking the UV should be used and precautions should be well acknowledged. Various materials can be applied for the facial wrinkles, but their effect and durability are different from each other. This treatment modality is simple and has immediate impact, but some materials are hostile to the human physiology. Among those materials, paraffin can cause skin necrosis and even alters into the skin cancer. For the affinity to the human nature, autologous fat is available. Hyaluronic acid (Leviderm, Rofillan, and Restylene), Collagen (Artecol), and Allofascia (Fascian) can also be considered. As each material has its own characteristic property, it is highly recommended that material adequate to the patient should be used. Nowadays, cream type (potox) is introduced, which prohibits the production of special complex stimulating the secretion of the acetylcholine, ketacholamine related with the muscle contraction resulting in the gradual decrease of the muscle contraction. It consists of Argireline, Magnesium ascorbyl (collagen builder), Hyaluronate, Shea butter and Argireline (non-toxic-anti-aging peptide) that play major role in reducing the neurotransmitters. This is similar with the effect of botulinum toxin. Cream type is available which is convenient to use and continuous effect can be expected during the application. It has relatively weak effect than the botulinum toxin. Therefore concomitant usage with the botulinum toxin can expect synergistic effect. Recent clinical study shows that it exerts delayed effect after 2 months of application despite of the individual variations. One must consult to the specialist and take adequate treatment modality so that they can get predictable and satisfying result.