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How Can I Get Rid of Crow's Feet?

042308-crowsfeet.jpgDear Nicki, I'm only 30, but already I'm noticing these little lines around my eyes whenever I smile.  What can be done? -J
Dear J, “Crow’s-feet are usually the earliest wrinkles to appear on a woman’s face,” says dermatologist Debra Price, M.D., clinical assistant professor of dermatology at the University of Miami School of Medicine.  Though sun exposure is the number-one contributor to the formation of crow's feet, many other factors can also play a role, including smoking, squinting, and even smiling. What's more, crow's feet only become accentuated with age because the structure within the skin deteriorates.  As collagen fibers lose their strength and organization, the skin loses its support and wrinkles like crow's feet become more evident, starting out from the sides of the eyes, extending up towards the temples, and sometimes down from the top of the cheek. As always, there are solutions available for every lifestyle and budget:

TOP TIER:  Ablative fractional and CO2 lasers

[caption id="attachment_6863" align="aligncenter" width="259" caption="Skin before and after CO2 laser treatment. Source: Realself.com"]CO2 laser[/caption]
  • Cost:  About $2500 and up
  • Time of procedure:  Less than 1 hour
  • Recovery time:  2 weeks
  • Effects last:  May be permanent (depends on your lifestyle, UV exposure, etc.)
Ablative fractional and CO2 lasers are the gold standard in addressing changes around the eye. The procedure may be thought of similarly to dermabrasion or a chemical peel, except a laser removes skin layers by vaporization instead of sanding or chemicals.  At any rate, each of these treatments work by ablating, or partially abrading, the top layer of skin.  This prompts the skin cells called fibroblasts to make new collagen.  The advantage to the lasers is that they may be "focused" for cutting skin without bleeding, "defocused" for superficially removing your skin, and "ultra pulsed" for facial resurfacing. The result?  Skin grows in plumper, less-lined, and somewhat firmer and tighter. The Difference Between Ablative and Non-Ablative Lasers Both an ablative and nonablative lasers have similar effects, but ablative are a lot more dramatic.  Consider how each works:
  • A wounding (ablative) laser removes thin layers of skin
  • A non-wounding (nonablative) laser stimulates collagen growth and tightens underlying skin
In general, non-ablative devices are great for mild to moderate wrinkling and photoaging.  Non-ablative lasers will also eliminate most acne scarring over a series of 4-6 treatments. Those effects, combined with reduced downtime, makes the non-ablative lasers so appealing.

Mid TIER:  Botox or Dysport 

[caption id="attachment_6864" align="aligncenter" width="534" caption="Dysport treatment for crow's feet. Source: Realself.com"]Dysport[/caption]
  • Cost:  About $400 and up
  • Time of procedure:  Less than 30 minutes
  • Recovery time:  Minimal
  • Effects last: 3-5 months
Muscle relaxers like Botox and Dysport are commonly used to treat crow's feet.  This is because botulism toxin cleaves proteins required for the release of a neurotransmitter, acetylcholine.  This, in turn, causes a chemical denervation of striated muscles around the injected region.  While primarily used as a cosmetic treatment, Botox and Dysport can also be used to treat a slew of medical conditions, including hyperhidrosis (excessive sweating) and migraines. A little-known fact about Botox and Dysport is that they prevent future wrinkles from forming.  This may be the result of mechanically stretching the skin (Journal of Cosmetic Dermatology, 2008).  Whatever the case, since you are under the age of 40, you may find it to be more cost-effective to "spot treat" your crow's feet with Botox or Dysport rather than to treat your entire face with an ablative or non-ablative laser. Keep in mind that Botox and Dysport are not be-all, end-all treatments for crow's feet.  You can also supplement your results with injectable fillers and chemical peels.  Injectable fillers, like Restylane, to fill up the lines. Injections generally last 6-12 months, and are usually redone every 6 months. The cost is generally upwards of $500 per injection, which varies by practitioner. Dermatologist-grade chemical peels and lasers can further stimulate collagen production, keeping the skin firm and crow’s feet production down in the future.

Last Tier:  Take an aggressive approach at home.

To quote Meg Ryan in You’ve Got Mail, “Fight, fight, fight!” Start each day off with a multivitamin that contains vitamin C and linoleic acid, which has been recently reported in a study amongst 4000 women to reduce wrinkles. Next, apply an antioxidant serum and sunscreen or moisturizer with sunscreen, concentrating on the area around your eyes. Be careful that the formulations are tolerated well around the delicate eye area. My well-touted favorites are Skinceuticals CE Ferulic ($107.00, Amazon.com) and NIA 24 Physical Sunscreen SPF 30 ($42.95, Amazon.com), but I also love the new Neutrogena Ultra Sheer Dry Touch Sunscreen SPF 85 ($8.99, Drugstore.com) for ultima supremo sun protection. During the day, Dr. Perricone also recommends that you eat a diet rich in fruits and vegetables (for antioxidant activity), salmon (for omega-3s), healthy fats (think almonds and olive oil), and full of water and green or white tea to keep skin glowing. After all, nutrition and skin care together have better results than skin care alone. 042308-green-cream.jpgAt night, use a retinoid cream, followed by a moisturizer with peptides, niacinamide, and/or antioxidants customized for your skin.  The retinoid treatment is perhaps the easiest to choose: The gold standard is prescription tretinoin, 20 times more potent than over-the-counter retinol.  But if prescription is not an option, there is 0.5% retinol in Skinceuticals Retinol 0.5 ($32.95, Amazon.com), 0.6% retinol in Green Cream Level 6 ($42.95, Amazon.com) 0.9% retinol in Green Cream Level 9 ($49.95, Amazon.com), and 1.0% retinol in Skinceuticals Retinol 1.0 ($52.00, Amazon.com). You may want to start with a lesser concentration of retinol, applied every 2-3 nights, and gradually work up to nightly use. 042308-nv-perricone-advanced-eye-area-therapy.jpgAs for a nightly moisturizer, DMAE has been found and reported in two independent studies in The Textbook of Cosmetic Dermatology and Skin Research and Dermatology to significantly firm skin in the undereye area. A product with a high concentration of DMAE is NV Perricone Vitamin C Ester Amine Face Lift ($95.00, Sephora.com), and another designed for around the eyes with slightly less DMAE is NV Perricone Advanced Eye Area Therapy ($95.00, Sephora.com). If DMAE is too harsh for your skin, niacinamide and antioxidants have also been found to have beneficial effects against wrinkles, in various studies. My favorite moisturizer with niacinamide is Olay Regenerist, while my favorite antioxidant moisturizer is RevaléSkin Night Cream. 042308-md-skincare-alpha-beta.jpgOnce a week, in lieu of your usual nightly routine, use a glycolic acid treatment, provided again that your skin can handle it. (Consult your dermatologist if you are unsure.) Two of my favorite glycolic acid peels are MD Skincare: Dr. Dennis Gross Alpha Beta Daily Face Peel ($75.00 for a thirty-day supply, Sephora.com) and Peter Thomas Roth UnWrinkle Peel Pads ($45.00, Amazon.com).

Bottom Line

No matter what your lifestyle or budget, you do have the ability to get rid of crow's feet!  What are your favorite methods?  Share in Comments!