Wrinkles are a part of aging and there is no way to completely prevent many of them from happening. While topical creams and lotions once were the only players for wrinkle prevention and treatment, that has changed significantly over the past decade. Botox, injectable fillers and various energy-based device treatments (e.g., laser) have moved in to now play major roles in wrinkle treatment.
But those facial lines which develop are more complex than they appear. They are numerous causes of wrinkles which range from the movement of facial muscles to gravity and sun damage. This creates different types of facial wrinkles which are structurally different. Getting the best treatment results depends on matching the facial wrinkle type with the appropriate treatment. Facial wrinkles and lines can be divided into four general types.
The most common facial wrinkles are known as dynamic expression lines. They have become well known because of Botox injections, which are used to specifically treat them. They are known by a variety of names such as smile lines, crow’s feet and the ‘11s’. They develop due to the repetitive movement of muscles of facial expression and the wrinkling of the skin appears perpendicular to the direction that the muscle moves. The most obvious example are horizontal forehead wrinkles which develop because of the movement of the vertically-oriented large forehead frontalis muscle which runs from the eyebrows to the back of the head. By weakening these expressive muscles with Botox injections, the lines become less evident with movement. This works well around the eyes because less movement is always good. Around the mouth, however, less movement can affect how one smiles so injections are done more carefully or not at all.
Elastic skin creases occur in areas that are exposed to skin folding and have high sun exposure, most frequently on the cheeks and at the base of the neck. They are not the result of muscle movement but occur in those areas where the skin frequently becomes ‘creased’. This could be the result of sleeping repetitively on the side of one’s face (e.g., vertical or oblique skin creases in the forehead) or other external force that sheers against the skin. The best prevention is to avoid activities that crease the skin and keep it well moisturized.
Gravitational folds are not really wrinkles per se but lines that form from the effects of falling skin. They are the result of skin sagging and falling. The most well known are the nasolabial folds and marionette lines. Nasolabial folds appear and deepen as the cheek tissue above them descends, pushing lower cheek tissues against the fixed and non-falling upper lip tissues. The same occurs as jowl and facial tissues fall downward against the fixed tissue of the chin, creating marionette lines. Gravitational folds are best treated by either lifting procedures that pull the weight of the descending tissues upward and back (e.g., lower facelift, cheek lift) or by plumping the fold with an injectable filler material.
Atrophic wrinkles occur from thinning skin and loss of its elasticity. These are the fine smaller wrinkles that often appear between and around dynamic expression lines, elastic creases and facial folds. They create what is known as creapy skin and usually appear as one of the last wrinkle types to occur. Excessive sun exposure and smoking make huge contributions to their occurrence and are what creates the ‘prune-face’ appearance in those with a long-history of sun bathing and have developed a more leathery skin appearance. Exfoliative skin treatments such as laser resurfacing and chemical peels are very effective because these wrinkles are often very superficial and their appearance can be lessened by removing some of the outer skin thickness.
Between topical skin products, Botox, fillers, lasers and surgery, a wide variety of skin wrinkle treatments exist. But these treatments must be applied to the wrinkle type in which they work the best to get good results. Most patients need three or more of these over time to lessen the inevitable appearance of facial wrinkling.
Dr. Barry Eppley
Indianapolis, Indiana