Understanding Wrinkles

To figure out what to do about wrinkles, it’s helpful to understand the causes. Then treatment is more effective. Wrinkles on the face are caused by four things:

1. Muscle action over time on a certain spot. Vertical frown lines are a good example of this – the “elevens.”
2. Damage over time to the outer layer of the skin (the epidermis). The main culprit here is sun and environmental damage and age. Example – tiny lines on the cheeks.
3. Loss of collagen/elastic/intracellular matrix over time in the deeper layer of skin (dermis). Example – the lines from the nose to the mouth or mouth to the chin.
4. Loss of deep volume of fat, bone and muscle due to aging and/or poor health. Example – sagging at the jaw line.More realistically as we get older, several of the above are involved.

If you understand what’s causing the wrinkles, then you can more easily choose a treatment or treatments that will help improve what bothers you most. So as you look at your face and try to figure out what’s bothering you and what you’d like to fix, look at the depth of the wrinkles in different areas. You may have fine lines, or grooves or folds. Do you have:

No wrinkles unless your face is moving. Example – just crinkling around your eyes when you smile.

Wrinkles that are very superficial (also called fine lines) even when your face is at rest?

Wrinkles that are grooves – deeper than fine lines on the cheeks, forehead, eye area, chin?Wrinkles that have really turned into folds like around the mouth – the nasolabial fold (nose to mouth) or the mouth to chin area (“marionette:”).

Loss of the “frame” of your face which is that natural oval or heart shape that most women have. The natural frame of the face is more rectangular for men usually.

Try to identify the three things that are bothering you most if you can, to help your board certified dermatologist or plastic surgeon help you!

So then …… how do you treat wrinkles? As far as “fixes” go, these are not set in stone but just guidelines. Superficial/fine lines respond best to either things like light peels or lasers that resurface the outer layer/epidermis or things that calm or relax the muscle action like Botox or Dysport around the eyes.

Deeper lines or grooves generally require some underlying support for the dermis as well as treatment for the superficial part. So for example, a deeper groove in the frown lines or around the eyes might require Botox or Dysport to relax the muscle plus fillers like Restylane, Juvederm, or Radiesse to plump out and support the base of the wrinkle itself.

To treat a very deep wrinkle or fold, remember it’s occurring because you have deep loss of volume of the fat pads and bone of your face, loss of collagen/elastic fibers in the mid layer (the dermis) and probably some sun damage to the outer layer, the epidermis. You might realistically need some deep volume and support of the area with Sculptra, Perlane, Voluma (not available in the U.S. yet), or Radiesse, and then, depending on the area and how much sun damage you have, Restylane or Juvederm to support the mid layer and the lines around the lips, and then something like a Fraxel laser or CO2 laser to improve the texture and color of the epidermis, the outer layer.

Can products help with any of these problems? Products can help prevent sun damage and help improve the texture, color and general glow of the epidermis (outer layer). They cannot replace changes in the fat, muscle, bone or do much (at this point in time) to regenerate the deeper collagen in the dermis. Don’t believe all that marketing hype – you’ll spend a lot of money and just be disappointed!!

Choose your board certified dermatologist or plastic surgeon wisely. Look for people who have been in business in the same area, with a good reputation, for at least 5-10 years. Don’t just rely on the web for info –it’s easy for a complete charlatan to put up a good website. If a doctor is advertising, ask yourself why? Most good doctors are booked up and don’t need to advertise. Take good care of yourself and your beautiful face!

See Dr. Irwin’s Guide to Botox and Dysport
See Dr. Irwin’s Guide to Fillers like Juvederm and Restylane
See Dr. Irwin’s Guides to Fractionated CO2 Laser for wrinkles and skin texture

Also, See Dr. Irwin’s expert answers to reader’s questions on wrinkles:
Would Botox Work for Upper Lip Lines?
Is CO2 Laser safe for Wrinkles on the eyelids?
Can Botoxing some muscles create other lines?
See all of Dr. Irwin’s expert answers to questions on wrinkles.