All About Wrinkles


Wrinkles are lines that form in the skin. We all get them as we age; they are part of the normal aging process.  In order to understand the treatments for wrinkles, it is helpful to understand the two main types of facial wrinkles. 


Dynamic wrinkles form as a result of muscle motion—including the way we express ourselves—as well as from habitual movement, as is the case of vertical lip lines in smokers and crow’s feet in tennis players who often squint in the sun. When our facial muscles contract, the skin over those muscles stretches to accommodate the muscles. When we’re young, our skin bounces back after squinting, smiling or laughing. Eventually, however, our skin can no longer bounce back, and the dynamic wrinkles start to become more permanent. The most common dynamic wrinkles are across the forehead, at the outer corners of your eyes (crow’s feet) and between the eyebrows.


Static wrinkles are caused by gravity, the loss of fat and collagen, and the loss of the skin’s elasticity. These types of wrinkles are visible regardless of the muscle action. They are always there, hence the term “static.” Dynamic wrinkles eventually become static wrinkles. Some wrinkles are really more folds than lines, and may be dynamic or static. The deep lines that run from the nose to the sides of the mouth are called nasolabial folds. Lines that start at the corners of the mouth and go downward toward the jawline are called marionette lines. They form for three reasons: years of dynamic facial movements, static forces such as gravity, and chronological aging. 


There are many treatments for wrinkles available, including creams and lotions, chemical peels, Botox injections, fillers, dermabrasion and lasers.  The right choice for each person is based on the severity of their wrinkles, individual factors and the patient’s goals of treatment.
Effective topical creams and lotions contain some form of retinoic acid (Retin A or Vitamin A derivatives) that reduces wrinkles. These products cause skin cells to turn over faster, which reduces pore size and smoothes skin.  They also build collagen under the skin to help replace what is being lost in the aging process.  Topical Retin A is a prescription product, and comes in a number of strengths and formulations. The Vitamin A derivatives have weaker activity and are present in a number of over the counter beauty products.
Botox products are effective for dynamic wrinkles.  A tiny injection of Botox in just the right places weakens the muscle allowing it to relax and removes the wrinkle.  Botox is effective for wrinkles between the eyes, crow’s feet and forehead.  Dermal fillers can be effective for static wrinkles to replace lost volume and re-plump the tissue.  Two types of fillers are used, a deeper injection of thicker filler which serves to replace volume lost such as in the cheekbone area, or a thinner filler used to fill in finer lines around the mouth area.
Lastly, removing skin layers can be helpful to regain smoother more youthful skin.  This can be accomplished with a number of tools from chemical peels, and dermabrasion to laser skin resurfacing.  Chemical peels remove the top layer of skin and cause regeneration of new skin and collagen underneath.  They are best used in mild to moderate wrinkling and the strength of the peel can be adjusted.  Microdermabrasion is a skin care procedure that can be helpful with mild wrinkling whereas surgical dermabrasion can treat more severe wrinkling typically around the mouth.  Lasers can also be used to treat moderate to severe wrinkling.  Both non-ablative (which does not abrade the skin) and ablative (which damages the top layer of skin) can be used, either together or separately.  The non-ablative lasers work by heating the lower layers of the skin and stimulating collagen.  The collagen then plumps the skin and eliminates the wrinkles.  Ablative laser treatments (Fractional, erbium or CO2 laser) work by dissolving skin away and replacing it with new, fresh skin.  The ablative laser treatments do require down time, but are the most effective in reversing more severe sun damage and wrinkling.
Article by
Bonita Springs Oculoplastic Surgeon