You probably know the causes of wrinkles, right? There are internal factors (age and genetics) as well as external factors (sun exposure). But did you know you can actually tell the difference by how the wrinkles appear on your face?

Wrinkles caused by internal factors will present in the form of thinner skin with less elasticity. You'll experience increased dryness and notice more fine wrinkles as well as slower scar formation.

Photoaging, or wrinkles caused by exposure to the sun and elements, will show up as deeper wrinkles and saggy looking skin. You might also notice irregular pigmentation, or brown spots, and your skin will appear rougher and more leathery.



So what does this mean for you? Well, if you're fighting your wrinkles, knowing what caused them is a good start -- if you notice that most of your problems seem to be related to external factors, you should probably invest in a big hat in sunscreen. Now. But, if you're really serious about diminishing your wrinkles, you have several choices.

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While it may be somewhat apocryphal, the legend has it that Spanish explorer Ponce de Leon traveled to Florida in search of the Fountain of Youth. And though he was more likely there to search for gold and expand the Spanish empire, the story of vitality-restoring water is one that continues to intrigue us to this day.

This is not surprising, considering that even people today are still searching for an elixir of eternal youth. Some turn to plastic surgery and injections of botulism (also known as Botox), while others dole out thousands of dollars at so-called "anti-aging" centers to undergo hormone replacement therapy. I honestly pass no judgment on either group; to each their own is what I say. However, it's still worth mentioning that there are natural and safe ways to slow down the hands of time, and none of them require going under the knife or sailing a Spanish galleon across the Atlantic.

• Eat fish once a week -- Researchers from the Rush University Medical Center in Chicago found that doing so can slow age-related cognitive decline by 10 percent
• Stop smoking -- Aside from the more obvious harm it causes your lungs, smoking also triples your chances of developing age-related macular degeneration (AMD), says a study from Cambridge University.
• Stay active -- A study from Rutgers University revealed that inactivity in older age is one of the major modifiable lifestyle factors that increased the likelihood of being placed in a nursing home over the next twenty years.

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Oh... a day at the spa. Sounds like a relaxing bit of heaven, doesn't it? How does a nail infection sound? Or a lethal overdose of hair-removal treatment? Spas offer a variety of services nowadays -- not just the run-of-the-mill facial and massage. So you should check your spa out as thoroughly as you would check out a new physician. Here are some tips:

• Don't make your first appointment over the phone. Visit the spa, ask for a tour, and see if it appears professional, organized, and sanitary.
• Ask questions! Ask if the staff is licensed and what their training was. You can also ask about the years of experience. If you're getting treatments such as Botox (and if you are, really, think twice) make sure whoever is administering it is a licensed physician or a nurse under a doctor's supervision.
• Ask friends if they've been to the spa before and see if the spa has an online rating.
  
• The spa should have a questionnaire or verbally ask you questions about existing health conditions, allergies, and so forth. If you don't feel an appropriate question has been asked, speak up! You have to advocate for you own health.

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Americans had more niping and tucking done in 2007 than in any year prior. According to a WebMD article, around 11.7 million people had nonsurgical cosmetic procedures performed last year, representing a 2 percent climb from 2006. Two percent may not seem like much of a jump, but to put things into perspective, the number of procedures has climbed by 457 percent since 1997.

According to statistics promulgated by the American Society for Aesthetic Plastic Surgery, 91 percent of cosmetic procedures were performed on women. And a growing number of men, who made up only a small percentage of the total number of people who had work done, are turning to cosmetic surgery (up by 17 percent since 2006).

Here are the total numbers of the top five cosmetic surgeries for 2007:

1. Liposuction: 456,828
2. Breast augmentation: 399,440
3. Eyelid surgery: 240,763
4. Tummy tuck (abdominoplasty): 185,335
5. Breast reduction: 153,087

Here are the total numbers of the top five nonsurgical cosmetic procedures for 2007:

1. Botox injection: 2,775,176
2. Hyaluronic acid: 1,448,716
3. Laser hair removal: 1,412,657
4. Microdermabrasion: 829,658
5. IPL laser treatment: 647,707

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In a post late last month, I shared Public Citizen recently requested the U.S. Food and Drug Administration (FDA) place a black box warning on Allergan Inc.'s Botox (botulinum toxin type A) and Solstice Neuroscience Inc.'s Myobloc (botulinum toxin type B). Adverse reactions, some serious and even fatal, were related to botulinum toxins spreading beyond the injection site to other parts of the body. This can cause muscle weakness, swallowing problems and aspiration pneumonia. Four of the 16 fatalities involved children under 18 years of age.

Now the FDA has placed Botox under review. Deaths being investigated by the FDA involve children, mostly administered high doses for spasticity in their limbs due to cerebral palsy, an unapproved use of the product. The FDA stated the adverse reactions could be related to overdosing. For example, a dose to treat a leg spasm could be 300 to 600 units, while a de-wrinkling facial injection is commonly 20 to 25 units.

Some doctors say this suggests there is less reason to worry about cosmetic use of the product. However, worried Botox-users should know the FDA is also investigating other reports of illnesses in people of varying ages using the product for a variety of conditions -- at least one woman was hospitalized after a wrinkle-reducing forehead injection. Beyond a black box warning, Public Citizen is also requesting prescribing doctors receive a warning letter highlighting potential complications and consumers receive a guide explaining the risks. Read the FDA's February 8, 2008 press release on Botox adverse reactions here.

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No Big Pharma company likes a black box warning on their drug product, but Public Citizen is asking for just that on Allergan Inc's Botox (botulinum toxin type A), and a similar injection by Solstice Neuroscience Inc. called Myobloc (botulinum toxin type B). Botox is used to de-wrinkle our vain selves and treat cervical dystonia (rigid neck muscles), among other approved uses. Myobloc is approved for cervical dystonia only.

Public Citizen, a national non-profit public citizen organization, reviewed 180 reports of adverse reactions submitted to the Food and Drug Administration by manufacturers, involving muscle weakness, difficulty swallowing or even aspiration pneumonia, a serious condition caused by breathing foreign material into the lungs. Sixteen cases were fatal, four involved children under 18, and some patients were hospitalized.

Director of Public Citizen's Health Research Group stated these complications occur if botulinum toxin spreads from the injection site to the esophagus, resulting in partial paralysis. This complication is included within instructions for both drugs, but Public Citizen is requesting the FDA order a black-box warning of the concern, along with a letter to doctors and a guide to consumers explaining the risks, to be provided by doctors at time of injection. Read their full petition here.

Last year, European regulators cautioned doctors about the dangers of botulinum toxin and posted warnings on its Web site. Public Citizen is basically saying a new, comprehensive system of warnings would raise awareness of potential problems, result in earlier medication intervention and could prevent more serious complications, including death. Makes sense to me.

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Plenty of men and women have turned to needles to slow the signs of aging (think Botox), but a method known as an acupuncture face lift or cosmetic acupuncture is drawing in customers who don't want surgery or chemicals, but are still seeking a younger look.

Facial acupuncture follows the same principles of conventional acupuncture and practitioners attempt to reduce muscle tension and unblock trapped qi that may be causing facial wrinkles. Whether it works or not has not been scientifically proven, but thanks to a growing interest in alternative treatments and youthful growing skin, the expensive treatments are gaining in popularity.

If I were to try an anti-aging procedure (and that's a very big if), I'd go for acupuncture before Botox. What about you?

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On my own with two children most hours of the day, I rarely make appointments at my hair salon. Instead, I have this really bad habit of passing the salon at the mall that accepts walk-ins and thinking, "Hey! Maybe I should get my haircut!" It's led to more than one bad haircut, but if nothing else, it's an adventure.

We all have our beauty blunders, and as this article from Self magazine points out, even pros have been known to make mistakes. Too much Botox, over-processed hair, ignoring skin cancer warning signs -- these women may have more knowledge and access to better beauty products, but they still make many of the same mistakes you and I do. It's an enlightening read and a reminder to us all that beauty shouldn't be about reinventing ourselves, but instead about enhancing the beautiful features we already have.

What's your worst beauty blunder?

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There's a new injectable beauty treatment out there, which is thought to take years off your skin by reducing wrinkles, scars and stretch marks. No, it's not botox. It's carbon dioxide, and it could be coming to a plastic surgeon near you.

It's called Carboxy therapy, and according to this article from the Daily Mail, it's revolutionary in the world of beauty. It even works on cellulite, loose skin and much more. It's all the rage in Britain, but is it safe? The jury's currently out on that question, as this type of therapy is rather new.

What do you think? Would you get carboxy therapy?

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As a rule, I'm against plastic surgery for a number of reasons. This includes botox. However, when reading this post called the Anti-Aging Skin Care Checklist, I was surprised to see that getting botox injections made the list. Why? Because apparently there's some evidence that Restylane and Juvederm, two popular injectable fillers, can help people produce more collagen naturally, which can reduce wrinkles. Hmmm. That might be true but I still don't think injecting your face with this stuff is safe.

I'm still a believer that the best treatment for wrinkles is prevention through steps like wearing sunscreen, eating a healthy diet and drinking lots of water. What do you think?

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The last time I checked, sticking out your tongue and rolling your eyes were great ways to call negative attention to yourself, not improve your appearance. But some New Yorkers have taken up the exercise -- a pose called "The Lion" -- in a new New York yoga class called facial yoga.

Just like a conventional yoga class, facial yoga attempts to tone and strengthen the muscles of the face through specific exercises. Instructors believe that the old principle "if you don't use it, you lose it" applies to facial muscles as well, and that by doing facial yoga you can prevent and reverse signs of aging.

So if you're looking for a Botox-free way to get firmer skin and fuller lips, face yoga just might be for you. Interested in learning more? Here's an interesting article that includes a few of the more popular poses.

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It seems that patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles. In a study published online on Tuesday by the Journal of the American Academy of Dermatology, the average wait time for someone with a suspicious mole in Boston was a horrendous 55 days longer than someone wanting to smooth out their wrinkles.

Even when patients reported a changing mole and were willing to pay out-of-pocket for a dermatology visit, the median wait time was 18 days longer than for botox in the 12 metropolitan areas that the research was conducted.

While I have no opinion on botox treatments, I do feel that the priority should be placed on the patients with life threatening concerns ... as one of those people who has to track color changes or irregular borders (yes, I was blessed with moles) and who has regular biopsies, I know that waiting is the worst part. And, while waiting times of a few weeks or more for a suspicious mole may not add up to significant progression of skin cancer if it is, indeed, present ... it's the not knowing that people have a hard time dealing with.

We are constantly told that early detection of cancer is key ... something is clearly wrong here.

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Kids who have cerebral palsy often have stiff muscles that sporadically contract, and over-react to stimulation. Gaining any additional control over muscle movement is seen a significant improvement -- and, according to a recent study, that's just what Botox might be able to provide.

Technically, this is old news, with the first reports of Botox's success in treating kids with cerebral palsy published in 1993. However, that initial report, and the many that followed, had difficulty determining just how much the drug was helping patients. But in the most-recent study, researchers were able to accurately measure the positive effects of Botox -- finding that worked to treat the physiologic and mechanical effects of cerebral palsy in a "genuine and measurable" way.

While this is certainly exciting news for those effected by the condition, researchers also note that the effects may not be dramatic enough to be perceived by patients and their families -- so they caution that patients' expectations should be managed accordingly.

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There's something to be said about aging gracefully, but if you're determined to slow the march of time across your face, you may be considering getting a wrinkle treatment like Botox. Before you make that first appointment, though, you might want to take a minute to read about what you're getting into and get a few tips on preventing problems. This article will get you started and includes information like:

• Plan to pay $500-$600 per session and beware ads that claim they can do it for under $100.
• Have your treatment done in a medical setting.
• Find a practitioner with plenty of experience and schedule a consultation ahead of time.
• If the doctor won't be doing the injections, make sure the person who will is properly trained, as well.
• Take your own before and after pictures.

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Recently yoga instructor Annelise Hagen in New York city was hit with inspiration as she surveyed her classroom, which was full of students with contorted faces as they stretched and balanced in various yoga poses. Why don't we exercise above the neck? she thought. And so "yoga face" classes were born, and eventually The Yoga Face book, with moves designed to tone the facial muscles and perhaps reduce a person's need for Botox or cosmetic surgery as they grow older.

So with facial "poses" like the "Marilyn Monroe" and "Lionface," do yoga techniques for the face really work? Some say yes and some say no, what do you think?

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