Deep wrinkle treatment

Again, as is the case with most cosmetic rejuvenation questions, there is no 'best' answer. Each patient is different and each solution should be tailored to the patient's individual needs.

Another thing to consider with deep wrinkles is the location - what works for nasolabial folds may not work for forehead. As such, all permutations would be almost impossible to include.

Instead, I will focus on some of the options for dealing with deep wrinkles. Keep in mind that wrinkles can be due to action of the underlying muscle or from tethering of the skin to deeper structures.

1. Botox. Botox Cosmetic is indicated for 'temporary treatment of moderate to severe frown lines between the brows in people 18 to 65 years of age.' Botox works by paralyzing the muscle and as such is good for lines created with motion of muscle. It is not good for lines present at rest.
2. Fillers. Dermal fillers such as hyaluronic acid (Restylane, Juvederm, Perlane to name a few), collagen, Radiesse, and others aim to erase lines by filling in the underlying structures. These are temporary and at times cannot address deep wrinkles because it does not release the tethering that is creating the wrinkle.
3. Ablative Lasers - CO2 and erbium. These work on several levels. By taking off the outer layer of skin and promoting collagen tightening, ablative lasers can erase wrinkles and produce a more youthful, even skin texture. The down side to these is the intensive after care.
4. Undermining techniques. New techniques, such as the Surgiwire, aim to release the attachments of the skin to deeper structures which create the deep lines. This can be especially effective when combined with a filler or other substance from somewhere else on the body to prevent the lines from reforming.
5. Hydration and skin care. By providing hydration to the skin, some finer wrinkles can be erased. Similar to inflating a balloon, when skin is hydrated the cracks and crevices are obliterated.