Fine lines and wrinkles are inevitable for everyone, so it is a good idea to revisit the known contributors. First and foremost, it is estimated that the average adult loses one percent of their collagen density every year of their life, starting in their 20s. This loss of collagen and elastin leads to a more malleable dermis that results in gaps that develop in areas where muscle contraction pushes the softer dermal layers aside. The drop in volume in the dermal matrix can be felt when a finger is run over a wrinkled area. The loss of dermal thickness creates increased gravity pressure on the skin because there is less volume to hold the skin upright and can lead to increased wrinkle depth in areas like the forehead, nasolabial fold, and lines around the mouth. Fine lines are generally the early version of wrinkles, but they also result from texture changes related to dermal-epidermal junction (DEJ) damage.

So, what are companies doing to treat these areas and how effective are these strategies? To put it simply, everyone’s primary goal has been to thicken the epidermis to mask collagen losses in the deeper layers. It may be a surprise to know that while retinol, retinoic acid, and retinyl palmitate have proven that they can thicken the epidermis, there is no evidence that they can add collagen to the source of wrinkles – the dermis. Is a thicker epidermis necessary? It is true that with aging there is some epidermal thickness loss, so the efforts of these products are not all bad. However, people under 50 do not have a significant epidermal thinning problem. In their case, the plumping effect of those retinols provides an acceptable, but temporary, solution to wrinkles. The fact is, the work put into thickening the epidermis is lost when the client stops using the product and the surface layer renews itself over the next 30 days. Peptides have never shown the ability on human skin to do anything more than thicken the epidermis. Even the main effect of alpha hydroxy acids is to plump the epidermis. These ingredients may be a good choice for temporary plumping, but they are only of short-term benefit.

The secret to thickening the dermis comes from an understanding of the bottle necks in the process. The first issue to overcome is that most skin care ingredients have a two to five percent penetration rate past the stratum corneum. How can these actives be expected to increase activity in the dermis, including an acceleration of the collagen manufacturing process, if they never reach their intended goal? This is where delivery technologies matter. A case could be made for the new trend in needling, but that is not a daily strategy and the repeated wounding counteracts the ability for the skin to make up lost ground because it has to put some attention to repairing the needle damage. There have been surprisingly few skin care companies focused on delivery technology considering the hurdle it presents to creating real change in skin wrinkles. Ingredients like phosphatidylcholine can be used to create a lipid carrier to encourage powerful collagen stimulators past the resistant stratum corneum lipid barrier. The research suggests that they create as much as a six fold increase in penetration, which creates a much higher chance of activation of the dermal fibroblasts. The other bottleneck in skin care is lost circulation, which declines at one percent a year, just like collagen does. This should be a clue that these two are closely interconnected. If fibroblasts are not stimulated to increase production, and they do not have the nutrients to do so, then they simply will not respond. It is equivalent to someone lifting weights while not eating protein – no gain can be had. Ingredients like liposomal niacinamide, liposomal chlorella, and liposomal growth factors to increase the skin’s manufacturing capacity by feeding it through vasodilation and stimulating new blood vessel formation. However, it is still important to look at the latest science when it comes to fibroblast stimulators. Retinols are challenging because they have a two percent penetration rate, they cause DNA damage when they oxidize in the epidermis, and they have never shown the ability to thicken anything but the epidermis in clinical studies. This includes retinoic acid, which has actually been shown to cause an 18 percent thinning of the papillary dermis with repeated use. Retinaldehyde, however, is a different story. In studies, it was found to be as effective as retinoic acid at activating fibroblasts collagen, but without the epidermal and dermal toxicity. It was shown to be protective of DNA, rather than being a free radical force against it, like its retinol cousins. The trick to retinaldehyde is that it must be stabilized, and it has to be liposome-delivered in order to be truly active in the dermis.
Fine lines will reap the benefits of these strategies, but another remarkable active ingredient, trioxolane, can play a permanent role in the DEJ aspect of fine line formation. This patented, stabilized oxygen has the unique ability to repair oxidative damage along the DEJ because it matches the potency of oxygen free radicals as a damage-reversing tool for the skin’s immune system. As the DEJ recovers, the textural fine lines disappear, and the epidermis is permanently restored to a more youthful state.

In summary, there is a place for epidermal plumping, as long as it does not involve wounding the skin in the process. The only question is how much of clients’ monthly budget should be devoted to this temporary strategy? It is time to address permanent age reversal. This is something that can be done today, using the right technologies and the right equipment. It is time to take an honest look at some of the industry’s “must-have” ingredients to see if they are effectively doing what they claim. It is time to raise the bar of expectations and demand permanent change in fine lines and wrinkles going forward.

Ben Johnson, MD, is the founder and formulator of Osmosis Skincare. He is a graduate of Creighton University School of Medicine, an entrepreneur, an inventor, and an outside-the-box thinker. Johnson spent most of his career in aesthetic medicine, beginning with a chain of medical spas, but developing innovative skin care that is changing the industry is his passion. His holistic approach incorporates highly effective, revolutionary strategies that treat skin conditions at their source, providing permanent results.