How Effective is Fraxel Repair for Dynamic Wrinkles?

Question

I am 25 years old and after years of harshly treating my acne I am left with some mild scarring and bothersome dynamic wrinkles from smiling - these are not nasolabial folds, but instead lines that extend at abou 45 degree angles from the fold. These really bother me. What is my best option? I assume fraxel repair - but would consider traditional c02 if that offered better result potential.

Sanusi Umar, MD · Answer

You might benefit more by using a filler. The thing is, Fraxel repair laser technology is great when it comes
	to treating acne scars. It is also superb for non-dynamic wrinkles, however in the instance of dynamic
	wrinkles, I would advise going with botulinium toxins in the upper face and dermal fillers in the lower face.
	Pertaining to your issue, these neuromodulators should never be used because you are going to need those
	muscles to eat and speak.

Michael A. Persky, MD · Answer

Hi TK,

	Fraxel repair laser is excellent for the treatment of acne scars and non-dynamic wrinkles.  Dynamic wrinkles are best treated with botulinium toxins.  In the area of your concern, these neuromodulators should not be used as you need those muscles to be active for eating, speaking, and not drooling.  You may benefit from fillers.  Good luck and be well.

	Dr. P

John L. Burns Jr., MD · Answer

Dynamic rhytids refer to wrinkles caused by muscles of facial expression.  In the upper third of the face, these are evident as transverse lines on the forehead (frontalis muscle), lines between the eyebrows (corregator and procerus muscles), and crow's feet (lateral orbicularis oculi muscle).  While a resurfacing laser could help, these respond best to a chemodenervation agent (Botox) or a browlift where these muscles are surgically weakened. However, the lines you describe, lateral to the nasolabial folds, do respond to laser resurfacing.  While traditional CO2 would give an excellent result, there is a long healing time and oftentimes a waxy appearance to the skin.  The Fraxel Re:Pair would also give an excellent result with a shorter healing time and the neck could also be treated; thereby eliminating the telltale "line of demarcation" between the face and neck.

Joel Schlessinger, MD · Answer

Usually dynamic wrinkles are best treated by either fillers or botox or a combination of both.  Laser does a better job on the fine wrinkles, while it doesn't really do all that much for deeper ones or ones that occur when you smile.

	In the meantime, you should consult a board certified cosmetic surgeon to see if fillers can help.  Typically, that would be the best choice in this area.  Good luck!

D.J. Verret, MD · Answer

Carbon Dioxide lasers work very well to treat static wrinkles and scarring. In younger patients, fillers and botulinum toxin products often are more appropriate as significant rhytids are lacking and the carbon dioxide laser for wrinkles is often overkill. I would certainly recommend talking with a facial plastic surgeon who offers all of those treatments to help determine what would be best in your case.

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