What's the Best Treatment for Deep Wrinkles?

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.

Obviously, there are nonsurgical treatments for deep wrinkles. One can do fillers and botulinum toxins, but in general the optimal permanent treatment options are “Filling, Lifting, and Resurfacing” in that order especially in the areas around the perioral area.

It really depends on where the wrinkles are located. Wrinkles occur because of skin damage, loss of volume and progressive changes to the skin through continual muscle movement. What happens when you age is you progressively lose volume from losing thickness within your skin, loss of fat, bone atrophy, etc.

It is analogous to a grape shrinking into a raisin. Raisins obviously have a lot of wrinkles compared to a grape. We have traditionally improved the appearance of the raisin by cutting the raisins skin and removing it. The raisin may look better but it won't necessarily look much younger like a grape again. This is the same as it is in people.

Volumizing a persons face can make a huge difference in making someone look younger in a natural way. Volumizing also has the ability to increase the thickiness of the skin and its distance from the muscular envelope. This increase in distance makes it harder for the muscles to create wrinkles. Once the face is volumized, you can then improve the etched in wrinkles with resurfacing means such as lasers and chemical peels or dermabrasion. Botox prevents the appearance of wrinkles by preventing the muscle from moving.

There are many different ways to treat deep wrinkles. It depends on their location and cause.

• BOTOX Cosmetic may be used to prevent a wrinkle caused by repetitive muscle movement from getting deeper
• Injectable filler materials (e.g., Restylane, Juvederm, Radiesse) may be used to temporarily fill the wrinkle
• Lasers (e.g., carbon dioxide, erbium:YAG) may be used to resurface the skin
• Chemical peels and dermabrasion may also be used to resurface the skin

An evaluation by a physician is necessary to determine which treatments are best for a given patient. Minimizing sun exposure and using sunblock are also important to reduce the development of wrinkles and the risk of developing skin cancer.

The best option is really to visit a surgeon who will work out a customized treatment plan that’s designed to meet the specific needs of your face and skin type.

The preferred treatment for deep wrinkles depends on several factors, including their location and the reason they showed up in the first place. For example, dynamic wrinkles that are caused by repeated muscle contractions need BOTOX® to paralyze those muscles and give the skin a chance to smooth out. Deep wrinkles that are the result of volume loss will need a dermal filler to build the surface area back up again. Often, a combination of BOTOX® and injectable fillers is used for deep wrinkles. Laser resurfacing and other surface treatments can often improve the tone and texture of skin while minimizing the appearance of wrinkles as well.

Greetings~

Fortunately or unfortunately, not all wrinkles are the same and there is no one "best" treatment for all of them.  Without seeing or knowing what your specific concerns may be, it is nearly impossible to say what your options would be.  Some wrinkles can be treated with Botox and fillers... Some may need Botox, filler and some type of laser resurfacing...and still others may require all of these things in addition to surgery for the best result.  If the deep lines are from muscle movement and facial expression (like the lines between the brows and on the forehead) they may be addressed without Botox and laser and maybe one of the hyaluronic acid fillers.  Around the mouth a combination of these procedures would help and surgery is of little benefit.  If the deep wrinkles come from sagging skin with a loss of volume and elasticity, it may require surgery and fillers to restore volume. Your best way of getting the best answer is to have a face to face consult with someone who can review your specific treatment options with you and customize a treatment plan.  All wrinkles are not created equal. 

Good luck~

Dr. Grant Stevens

Web reference: http://www.marinaplasticsurgery.com

Filler Injectable Procedures such as Radiesse, Juvederm, and Restylane are excellent for deep wrinkles. However, the effective duration may be about 6 months.

For a longer term solution, laser resurfacing techniques such as erbium and profractional may prove beneficial.

Using fillers to volumize and solutions such as Botox or Dysport to treat the underlying tight muscles is a good course of action for deep wrinkles. Factors such as where they are located and how deep the wrinkles actually are will play a role in the type of treatment that may be most successful.

The best course of action is to schedule an exam with a Board Certified Plastic Surgeon, allow him or her to examine your condition, and then discuss the best treatment options available based on your particular needs.

The latest technology in cosmetic laser resurfacing and deep wrinkle treatment are lasers called Active FX for the facial surface areas and Deep FX for deep lines and wrinkles. It reduces wrinkles, particularly around the eyes and mouth, it tightens and firms up the skin, including the neck, and it eliminates dark or discolored areas.

This is a fractionated laser, much superior to Fraxel. I have not heard of a patient who has had Fraxel who didn't think this was much, much better.

There is about 3-4 days of downtime, and typically afterwards you look like you have been in the sun too long. By the 4th day, the skin has peeled off and you are left with a beautiful result! There is no bruising and no scabbing. When done along with Botox and injectable fillers, this gives you an amazing, amazing result!

Topica treatment with RR Retinoid Repair Cream, TCA peels, laser skin resurfacing, and deep fillers such as Radiesse can help with deep wrinkles.

Raffy Karamanoukian MD FACS

Los Angeles