47. Static accordion lines - what is the best treatment option? (Photo)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Given your age, slim build, and the presence of stubborn static accordion lines that haven’t responded well to CO2 laser treatments, Sculptra or Morpheus8 could both be excellent next steps, depending on your goals and skin type. Since these lines are static (meaning they’re visible even when your face is at rest), they’re typically a sign of volume depletion and collagen loss—common in leaner individuals as the fat pads in the face diminish over time. Sculptra could be particularly beneficial in your case because it works gradually to stimulate your body’s own collagen production, helping to rebuild the structural support beneath the skin and improve overall texture and firmness. It doesn’t “fill” lines in the way traditional fillers do, but it improves the skin’s quality from the inside out, making it ideal for diffuse, etched-in lines like accordion wrinkles. On the other hand, Morpheus8, which combines microneedling with radiofrequency, can also improve skin tightness and texture by targeting the deeper layers of the dermis and boosting collagen and elastin. This can help smooth the appearance of fine lines and crepey skin, though it typically requires a few sessions and is best for mild to moderate skin laxity. If your primary concern is texture and skin quality rather than volume loss, Morpheus8 might be the better choice. However, if the issue is more structural and due to thinning tissue, Sculptra may offer more long-term improvement, especially when combined with a collagen-supportive skincare routine. Some patients even benefit from a combination of both treatments for comprehensive rejuvenation. I hope this helps and best of luck!

Static accordion lines, which are common on the cheeks and around the mouth, can be challenging to treat, especially if previous CO2 laser treatments have not yielded satisfactory results. Here are some treatment options to consider:

Dermal Fillers: Hyaluronic acid-based fillers can be used to subtly plump the skin and smooth out fine lines. This option can provide a natural look and is minimally invasive.

Microneedling with PRP (Platelet-Rich Plasma): This combination can enhance collagen production, improve skin texture, and reduce the appearance of fine lines. It is a popular choice for those seeking natural-looking results.

Radiofrequency Microneedling: This treatment combines microneedling with radiofrequency energy to stimulate deeper layers of the skin, promoting further collagen production and tightening.

Topical Retinoids: Regular use of retinoids can improve skin texture and elasticity over time. While results are gradual, they can complement other treatments.

Non-Ablative Laser Treatments: Consider non-ablative lasers, such as Fraxel, which can promote collagen remodeling with less downtime than CO2 lasers.

Botox or Xeomin: While typically used for dynamic wrinkles, small amounts can sometimes help with static lines by relaxing the underlying muscle tension.

Before proceeding, consult with a board-certified dermatologist or plastic surgeon who can evaluate your specific skin condition and recommend a tailored treatment plan. They will consider your desire for a natural look and suggest options that best align with your aesthetic goals.

The best approach in treating this area would be Skinvive injections. It’s a newer form of micro droplets of hyaluronic acid which stimulates collagen and adds hydration in the area of injections and therefore helps to tighten the skin in the very natural way.

I have been treating this kind of problem for years with very gratifying results using a fanning injection technique for injecting a low viscosity, malleable, cohesive HA filler. Properly injected, this approach not only improves the static, I.e. at-rest, appearance of these type of lower face accordion lines (aka "parallel laugh lines"), but also serves to minimize their deepening with smiling.
Although usually not necessary, this treatment can be followed by a series of superficial peels treatments for any residual static crinkling component using high concentrations of glycolic or salicylic acid, Jessner's Solution, or low concentrations of TCA. You would be wise to consult with a board certified cosmetic dermatologist filler expert. Best of luck.

The lines you see in your face are there because your face has lost the great deal of volume. As a rule, the Laser will not do enough unless it is performed in a very aggressive manner. Just like a deflated balloon will smooth out when you fill it up, your face will do the same with fat grafting. When fat grafting is done properly, it should make you look 20 to 30 years younger without any scars and practically no signs of having had anything done. I hope this helps and good luck from Leonard Grossman, M.D. organic Plastic Surgery NyYC