Could laser resurfacing or chemical peel help dynamic wrinkles/crinkling skin? (Photos)

Question

I am a 52 year old man. The skin all over my body has aged since taking a medication many years ago. It crinkles when there is any loss of tension. The skin on the right side of my face has aged more than the left and although there aren't many visible wrinkles when my face is at rest, the right side of my face crinkles considerably when I smile. Doctors believe that I have a slight palsy on the left side of my face and that it would also crinkle when I smile if not for this palsy. I have been told that since these are dynamic wrinkles that laser resurfacing wouldn't really address this and the only potential solution would be Botox, although it could prove challenging as it could impact my smile. I was wanting a second opinion here with regards to resurfacing. I feel that it must improve things somewhat with regards my skin and whether ablative resurfacing or even phenol could help, or other approaches like filler or a face lift?. I have also lost subcutaneous fat to my face on stopping the drug and more so last year, particularly my right side. I also now have a significantly lax neck. I include photos.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing the details and photos—it really helps to get a clear sense of your concerns. From what you’ve described, the main issue is dynamic crinkling of the skin on the right side of your face, compounded by volume loss and skin laxity, especially after the medication-related changes.

You’re correct that laser resurfacing or chemical peels primarily target surface texture, pigmentation, and fine static lines, rather than dynamic wrinkles that appear with movement. Ablative lasers (like CO₂ or Erbium) or deep chemical peels can improve overall skin quality—they can make your skin feel smoother, reduce fine lines, and slightly tighten, but they won’t fully stop crinkling caused by movement, especially if the underlying cause is muscle activity. Phenol peels are more aggressive and can give longer-lasting skin smoothing, but again, their effect on dynamic movement wrinkles is limited, and the recovery is significant.

For dynamic wrinkles, options that address muscle movement—like Botox or neuromodulators—are the standard approach. As you mentioned, this can be tricky when there’s asymmetry or partial facial palsy, because weakening the muscle could alter your smile. This requires a very careful, customized injection plan, sometimes starting conservatively and adjusting over time.

Since you also have volume loss, particularly on the right side, dermal fillers can help restore some youthful contours and soften the appearance of folds and creases, even when moving. A facelift or neck lift could address skin laxity and jawline/neck sagging, and when combined with volume restoration, can give more structural improvement.

So in summary:

Laser resurfacing/chemical peels: Will improve texture, fine lines, and skin quality but won’t fully correct dynamic crinkling.

Botox: Can target movement-related lines but needs careful planning due to asymmetry.

Fillers: Help restore volume and soften creases.

Facelift/neck lift: Addresses skin laxity and sagging, providing a more structural solution.

Overall, resurfacing could be part of a broader strategy to improve your skin’s quality, but it likely won’t solve the dynamic wrinkles on its own. A combination of volume restoration and careful neuromodulation—or in some cases surgical tightening—tends to give the most noticeable and balanced improvement.

You’re approaching this thoughtfully, and it’s clear you want a natural, balanced result while addressing multiple changes from aging and medication effects.

Could laser resurfacing or chemical peel help dynamic wrinkles/crinkling skin? (Photos)

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