Wrinkles

Not All Wrinkles Were Created Equal

Wrinkles are the most common sign of aging. We all get them…and we all want to get rid of them. Unfortunately, there is no simple solution when it comes to wrinkle removal. That’s because there are actually three different types of wrinkles, and each has specific treatments designed to treat them. On this page, Dr. Loftus will explain that the three types of wrinkles are dynamic wrinkles, fine wrinkles, and skin fold wrinkles.

Dynamic Wrinkles

Doctors call them dynamic wrinkles. Everyone else simply calls them smile lines and frown lines. No matter what you call them, they are the most troublesome of all wrinkles and often are the most difficult to treat. They are our crow’s feet, scowl lines, forehead creases, and lip wrinkles. They develop because each time we smile, laugh, or frown, our skin creases or folds in the same way. After making the same expressions time after time, our skin "remembers" these creases even when they are not there. Botox is the foundation of dynamic wrinkle treatment because it weakens the muscles that cause these wrinkles and makes them less severe. Maximal improvement often requires additional treatments beyond Botox and may include laser resurfacing, dermabrasion, deep chemical peels, Thermage, and injectable fillers. However, even if these treatments could vanish your dynamic wrinkles, your dynamic wrinkles will return without consistent Botox use, because you will continue to make the same facial expressions that caused them in the first place. Interestingly, if you have ever seen anyone who has had one half of their face paralyzed, you may have noticed that the paralyzed side appears younger. This is because they do not move that side of the face, so there are no dynamic wrinkles.

Fine Wrinkles

Fine wrinkles are seen on dry crepe paper skin (usually on the cheeks). These wrinkles are superficial and their removal is relatively easy through skin care, micropeels, and other simple treatments. (See table below).

Skin Fold Wrinkles

Skin fold wrinkles are the wrinkles that go from the corner of our noses, around our mouths, and down to our chins. They look like big parentheses around our mouths. They develop within the skin fold (called nasolabial fold by doctors) which is due to sagging cheeks. Sagging skin is caused by two major factors: deflation related to facial volume loss and skin sagging related to gravity. Because these wrinkles are due to sagging skin, the only way to treat them is by tightening the skin…through replacing volume loss with fillers and lifting tissues through a facelift. Just look in the mirror while you are pulling your cheek skin back toward your ears. You will see a dramatic improvement in your nasolabial folds, as well as the skin fold wrinkles. With this maneuver, your face may still lack the volume and shape you had in youth. This is where fillers can combine with facelifts to give you a better, more natural result.

How Wrinkle Treatments Work

Botox works by weakening the muscles that cause dynamic wrinkles and fillers work by restoring lost volume to re-inflate an aging face. The stubborn remaining wrinkles are etched into the structure of your skin and require a different kind of treatment. Chemical peels, laser peels, dermabrasion, and skin care may be used for these remaining wrinkles. These treatments are all guided by the same principles. But to understand them, you first must know a little something about your skin.
Your skin is made up of damaged superficial cells and healthier deep cells. Every day, your old superficial cells die, shed, and are replaced by younger cells. When you are born, the process of shedding a new skin cell takes about 30 days. By the time you are 60, the process takes about 60 days. Thus, as you get older, your complexion becomes dull and lifeless because the cells on your skin’s surface are, in fact, older.
Each treatment mentioned above causes uniform destruction and shedding of your old damaged superficial skin cells. This allows healthier deep cells to surface while they are still young and fresh. Each of these treatments organizes and expedites the process of skin turnover and helps you reclaim the skin of your youth. As a result, you will see improvement in some or all of the following skin problems: large pore size, loss of skin vitality, roughness, discoloration, fine wrinkles, acne scars, dynamic wrinkles, and loss of skin tone. (Fillers and Botox are guided by other principles).
Despite their similarities, each treatment works slightly differently and therefore yields a different degree of improvement. No one treatment solves all problems. In general, deeper treatments yield greater improvement but impose longer recovery. To optimize their results, many people employ two treatment options that complement one another, such as laser resurfacing and Botox injections.
The table below lists all treatments that address skin color, texture, tone, complexion, and wrinkles. Each treatment is evaluated for its effectiveness in each area. A zero indicates that the treatment does not affect the given skin quality. A plus sign means that it affects it a little. Two plus signs means that it affects it more. Three…even more. And 4 plus signs means that it affect that skin quality dramatically. As you can see, no one treatment does everything. Also, the more effective the treatment, often the longer the recovery tends to be. Your plastic surgeon should tailor a treatment plan that addresses your concerns, while also allowing you recover within a time frame that is suitable for your lifestyle. Visit the links below to find out more about each procedure.

	Fillers	Botox	Skin Care	Micro Peel	Medium Peel
Shrinks Pores	0	0	++	+++	+++
Increases Vitality	+	0	++	+++	+++
Smooths Skin Texture	+		++	+++	+++
Reduces Fine Wrinkles	+	0	+	+	++
Reduces Discoloration	0	0	+	+	++
Tightens Skin	+	0	+	0	0
Improves Acne Scars	0	0	0	0	+
Reduces Dynamic Wrinkles	++	++++	0	0	0
Recovery (Days)	0	0	0	0	5-7

	Erbium Laser	N Lite Laser	Derm- abrasion	CO2 Laser	Deep Peel
Shrinks Pores	+	+	+	+	+
Increases Vitality	+	+	+	+	0
Smooths Skin	+++	+	+++	+++	+++
Reduces Fine Wrinkles	+++	+	+++	++++	++++
Reduces Discoloration	++	+/-	++	++	+++
Tightens Skin	++	0	+	++	++
Improves Acne Scars	+	++	+	+	+
Reduces Dynamic Wrinkles	++	+	++	+++	++++
Recovery (Days)	4-7	0	7-10	10-14	10-14

Questions to Ask Your Plastic Surgeon

• What Treatment do you recommend and why?
• Will the treatment you recommend need to be repeated?
• How long will my results last?
• How many treatments will I need?
• What recovery should I anticipate?