The best way to approach the treatment of wrinkles to stratify them into mild, moderate, and severe.
For mild (fine) wrinkles, good skin nutrition and topical chemical peels (e.g. Glycolic Acid Peel), or laser are very effective. Botox is helpful, but not necessary. These treatments resurface the skin, leaving the surface smooth.
For moderate wrinkles (dynamic wrinkles), in addition to the same treatment for mild wrinkles, Botox is the best choice. Botox works by paralyzing the underlying muscles which results in relaxation of the overlying skin. Botox also stops the cycle of stress on the dermis and helps prevent moderate wrinkles from turning into severe wrinkles. Deep chemical peels such as phenol are also useful for moderate wrinkles.
For severe wrinkles (deeps lines that are present at rest), in addition to the same treatment for mild and moderate wrinkles, you will also need either 1) dermal fillers to push out the wrinkles and/or 2) a surgical skin tightening procedure such as forehead lift or facelift. Additionally, these procedures can sometimes be combined with deep laser resurfacing to achieve even smoother results.
I hope this is helpful.
David Shafer, MD
Shafer Plastic Surgery
New York City
