The Dermatologist For Wrinkles

The dermatologist:
From simple at-home treatments to high-tech in-office procedures, Dr. Fredric Brandt explains what works best and why.

“Treating wrinkles can be done in and out of the doctor’s office,” says Dr. Fredric Brandt, a dermatologist with offices in Coral Gables, FL and New York City. “Generally, creams and gels work well on fine lines,” he says. “Deep wrinkles require more invasive measures—and a doctor’s expertise.” Often, a combination of treatments will render the best results.

“Eliminating lines is all about rejuvenating the skin. The simplest—but most important— thing to do is to use sunscreen, with both UVA and UVB protection, every day. Sunscreens containing ingredients like parsol 1789, titanium dioxide, or zinc oxide provide such broad spectrum ultraviolet protection. Sunscreen not only helps to prevent future wrinkles, but it actually gives your skin a chance to repair itself.

“Prescription creams and gels containing tretinoin, such as Retin-A and Avita, work well to continue the skin’s recovery process. Avita, available in a cream or gel, is a new form of tretinoin that is time-released, so it’s less irritating than Retin-A to the skin. Both products encourage cell turnover and the growth of new skin.

“Products that contain glycolic acid, vitamin C, or salicylic acid increase collagen production by stimulating the sloughing off of dead skin cells, and of cell turnover, for fresher, younger looking skin. More collagen means fewer wrinkles.


“New antioxidants, like green tea extract, are constantly being discovered. Green tea is very potent and works so well to eliminate fine lines and wrinkles that I’ve included it in my new product, called Lineless. Early tests suggests that green tea is more effective than vitamin C in destroying free radicals and preventing the oxidative changes to skin cells caused by the sun.

“To eliminate deeper wrinkles and more prominent lines, an in-office procedure is necessary. Chemical peels with trichloroacidic acid, glycolic acid, or salicylic acid remove the superficial layers of the skin—just enough to enhance collagen production— but are not so invasive as to require a long recovery period. New techniques, such as the diamond peel or microdermabrasion, are just as gentle and effective. Peels can be taken to the next level—higher strengths of acids to remove deeper layers of skin to eliminate more serious wrinkles—but they can require more recovery time.

Brandt Facial Cleanser
“Laser peeling, or laser resurfacing as it is most commonly called, is the next step in the fight against wrinkles. Laser resurfacing is especially helpful for lines and wrinkles that are static (not muscular) in nature—such as lines on the upper lip—and for removing sun damage on the cheeks and surface changes on the skin, such as brown spots and precancerous keratosis. Two different lasers can be used, alone or in combination, to remove layers of skin to stimulate collagen production. The carbon dioxide laser is the most intense because it removes skin and also heats the underlying skin (to remove severe lines), causing a two week healing process and several months of redness. Erbium lasers remove skin—but don’t go as deep—without significant heating, which means faster healing (approximately one week) and less redness (gone after one month). Your dermatologist will determine which type of laser is most appropriate for your skin.

“New generations of lasers, such as the ND:YAG laser, are emerging that stimulate collagen production without removing any skin; they involve no recuperation time and no more than one day of redness. But these lasers require repeat treatments, and are not yet as effective as the carbon dioxide or erbium lasers.

“Botox is great for eliminating lines and wrinkles caused by the muscular contraction of the face, such as forehead lines, frown lines, and crow’s feet. Botox, the injectable form of the botulinium toxin, is a muscle relaxant that actually paralyzes the dynamic areas of the face where these types of wrinkles accumulate. Botox injections are perfectly safe if done correctly, and the results usually last about four months. I have found that even if repeat treatments are not done, the lines remain much less obvious because the muscle has had a 4-month rest from contracting—and wrinkling.


“Filler materials continue to be a very popular wrinkle treatment. There are several options available, but the most popular is bovine collagen, which has been used for 20 years with a good safety record. A skin test must be performed first to rule out any allergic reaction. Collagen can be used to fill deep lines and wrinkles, circles under the eyes, scars, as well as to enhance the lips. To maintain optimal results, injections should be repeated every four to six months. The latest advance in collagen technology is a new product called Dermologen, a human derived collagen screened for all viral diseases and sterilized at the American Red Cross tissue bank. Theoretically, Dermologen will not cause an allergic reaction and may produce longer lasting results, but further tests are needed.

“Fat injections have been used for several years, and are usually reserved for deeper lines and wrinkles. The fat is harvested from another area of the body, and then reinjected into the face. The duration of these results vary. Consult your physician about his or her technique—and previous track record.

“A new filler material, still awaiting FDA approval, is a hyaluronic acid derivative called Hyaline gel, the same matrix in which collagen is suspended in the skin. Theoretically, this material has no allergic potential and will eliminate the need for skin testing. Hyaline gel has been successfully used for several years in Europe, Canada, and South America, so look for it soon.”