There are several main categories of facial skin rejuvenation, including:

• Topical products. These are drugs or cosmetics that are applied to the skin. They usually are used to treat fine lines, superficial wrinkles and other milder signs of aging. Some topicals can also be used to prevent skin damage or to reduce or delay the need for other procedures. Topical medications include tretinoin (a substance within the vitamin A family), alpha-hydroxy acids (derived from fruit and dairy products) and topical antioxidants (including vitamins C and E).
  
  
• Fillers. Soft tissue fillers are used to elevate facial furrows and hollows, reduce wrinkles and give the skin a smoother appearance. They are especially effective when used around the lips and mouth and for correcting depressions and scars. Substances used for this purpose include bovine collagen (fibrous protein substance derived from cows), fat removed from another part of the patient's body, hyaluronic acid derivatives, calcium hydroxylapatite, poly-L-lactic acid (PLLA), polymethylmethacrylate (PMMA), and silicone and polymer implants. Results from these procedures may last from several months to several years, depending on which filler was used. Some products may result in permanent changes.
  
  
• Botulinum toxin. This agent, a purified version of the bacteria that cause botulism food poisoning, can be safely injected in tiny amounts into individual muscles to create a nerve block that relaxes that muscle's movement. Botulinum toxin is used to treat lines and wrinkles associated with facial expression. The Food and Drug Administration (FDA) approved use of this product for glabellar wrinkles, or wrinkles between the eyebrows. However, many dermatologists and plastic surgeons also routinely treat other areas, such as forehead lines or crow's feet around the eyes, safely. Botulinum toxin also may be used to relax muscle bands that may be visible in the neck. Treatment results typically last for three to four months.
  
  
• Chemical peels. Chemical solutions such as alpha-hydroxy acids, trichloroacetic acid and glycolic acid may be applied to remove outer layers of aged, discolored or irregular skin. Depending on the specific type and concentration of the acid used, the skin exfoliates or peels over a period of days, leaving behind new skin that is smoother, has fewer wrinkles and is more even in color. Chemical peels are often used to treat wrinkles around the eyes and mouth, skin discoloration, age spots, mild acne scars and dull skin. They may range from mild peels (for fine lines and wrinkles) to medium-depth peels (for moderate skin damage, such as age spots, freckles and precancerous growths such as actinic keratoses). Chemical peels cannot remove deeper scars.
  
  
• Dermabrasion (or dermaplaning). Resurfacing procedure in which skin is mechanically "sanded" with an abrasive instrument, such as a rapidly rotating brush. This removes outer skin layers and smoothes the skin overall. It is used to treat significant scarring, including acne scarring, pigmentation and sun damage. Although healing time may take several weeks, results are often impressive and long-lasting. These procedures can be performed under local anesthesia or general anesthesia, depending on how much skin will be treated.
  
  
• Microdermabrasion. A technique similar to dermabrasion that uses either micro-particles or a diamond-tipped wand to remove part of the top skin layer (epidermis). This helps stimulate proteins involved in cell differentiation and growth. Key advantages of microdermabrasion are that it is noninvasive, does not require anesthesia and creates little or no discomfort. In addition, it does not require significant recovery time. It is usually performed in several treatment sessions, two or three weeks apart.
  
  
• Lasers. Used to remove layers of skin with laser light energy. Lasers work by creating an intense beam of light that travels in one direction. They may be either ablative (remove the top layer of skin) or nonablative (treat layers beneath the surface layer). Lasers are used to vaporize or improve wrinkles, scars, skin discoloration, broken blood vessels and precancerous skin growths. Lasers also may be used to treat lines and blemishes on the neck and to improve folds and creases by tightening loose skin. Finally, lasers often enhance other treatments, such as chemical peels, liposuction of the face and neck, and blepharoplasty (eyelid surgery).
  
  
• Intense pulse light (IPL). Makes use of broad-spectrum light that filters out harmful wavelengths. It is used to treat vascular (blood vessels) lesions and problems involving texture, pigmentation and pore size. IPL is often combined with techniques such as microdermabrasion or botulinum toxin.
  
  
• Light-emitting devices (LED). Makes use of light, delivered through light-emitting diodes (LEDs), to activate skin cell receptors, stimulating them to produce new collagen and elastin. It is used to treat fine lines, hyperpigmented lesions (brown spots and freckles) and other skin problems associated with sun damage. LED is often combined with other facial rejuvenation treatments such as botulinum toxin, dermal fillers and nonablative laser, IPL and photodynamic therapies.
  
  
• Radiofrequency technology. Using radiofrequency waves, these noninvasive techniques result in skin contraction and tightening that can lead to lifting of the face, brow and cheeks without surgery or a prolonged recovery time.
  
  
• Photodynamic therapy. Involves the application of a topical medication called 5-aminolevulinic acid (ALA) to the skin. ALA is left on the skin for a specified period of time. The area is then treated with colored light (blue, yellow or red) using LED, IPL or a pulsated dye laser. Photodynamic therapy also can effectively treat early precancerous changes of the skin.
  
  
• Surgical excision. Removal of tissue using a scalpel or other sharp instrument. Excision may be used to remove moles, scars and benign (noncancerous) skin growths that enlarge with aging. Surgical excision may also be used to treat droopy eyelids by removing excess fat pads and skin (blepharoplasty), reduce severe lines in the forehead, raise the eyebrows (browlift), and tighten and trim excess skin on the cheeks, chin, neck and around the mouth (rhytidectomy, or facelift).
  
  
• Liposuction. Surgical removal of local fat deposits by applying suction through a small tube inserted into the body. Liposuction can be used to remove excess fat and improve the contour of the face and neck areas. Local anesthetic is often used in liposuction procedures.
  
  
• Neck and jowl treatments. Many different techniques may be used alone or in combination to treat problems such as sagging jowls or double chins. Techniques include chemical peels, botulinum toxin therapy, laser resurfacing, liposuction, radiofrequency procedures and neck lifting.

The choice of technique used to treat a patient may vary depending on several factors. A patient's skin type and treatment goals are important factors in determining which technique is best. In some cases, a combination of techniques may produce improved results.