The Most Common Wrinkle Treatments
The Most Common Spots for Wrinkles and How to Treat Them
As we age, we begin to etch lines on the face from sun exposure, genetics, and facial movement, and also environmental factors. Thankfully, there are many wrinkle treatments available. Let’s go through some of the common areas on the face we see wrinkles, and how best to treat each area.
We will start from the top down with forehead wrinkles. Wrinkles on the forehead are mostly from elevating your eyebrows and etching those lines. Over time, the lines become permanent even when you’re not raising your eyebrows. The best way to treat these lines is with a neuromodulator such as Botox® or Dysport®. Botox and Dysport are chemicals that inhibit the muscles from contracting, and over time as you’re not able to raise the eyebrows as much, those wrinkles will soften.
Between the Eyebrows
Moving down the face, the next area is the two lines between the eyebrows called the glabella. Some people refer to these as the “11’s” as they can be the most deeply etched lines on the face. People will squint with sun exposure or frown, causing these lines to worsen as we age. The best treatment for this area also is a neuromodulator such as Botox or Dysport. Treatment is administered every three to four months and the inhibition in this area also gives you a nice lift for the eyebrows, which can open the eyes quite nicely.
Around the eyes, we have a fine sunburst projection of lines on the sides of each of our eyes. This is from smiling, sun damage, and squinting in the sunlight. My primary recommendation for this area of wrinkles is to wear sunglasses. After that, we can soften these lines with a neuromodulator such as Botox or Dysport. Once we have good inhibition, we can also do laser resurfacing to soften these even more and stimulate collagen.
Under the Eyes
The line under the eyes – also known as the tear trough – is a very difficult area. Some people have this line and some do not. It is more prominent as we age due to volume loss in the central part of the face, as well as gravity. In this area, you have to have a very experienced injector. I treat this area with a small amount of filler such as Restylane® or Juvéderm® Ultra Plus. Being conservative is the way to go here as overfilling the tear trough can make you look puffy and tired. If done correctly, this can completely change people’s perception of whether you look tired.
Continuing to move down, there is a line on the cheek that is diagonally placed in the mid area called the malar crease. This crease is due to volume loss and gravity over the years. Again, some people have this anatomy and some do not. There is a new product from the Juvéderm family of products called Voluma®. Voluma became available in 2014 and is a thicker, more robust product that gives a lift to the cheek area. It masks that malar crease quite nicely. You can also use Radiesse® in this area, which is a calcium hydroxyapatite-based filler. Both work well to improve the malar crease.
Above The Mouth
Next is the nasolabial fold, or the line between the nose and the corner of your mouth. This line comes from gravity, natural aging, and volume loss, as well as the loss of some of the bony structure. When I treat the nasolabial fold, I try to first address the mid-face or cheek volume with Voluma or Radiesse, then go back and treat the nasolabial fold afterward. This gives a nice lift to the cheek, decreasing the amount of filler that we need in the nasolabial fold. There are times where only the nasolabial fold needs to be treated and we commonly put Juvéderm Ultra Plus or Perlane® in this area.
Upper Lip Lines
Next are the lines on the upper lip. These are some of the hardest wrinkles to treat. They are caused by the loss of volume in the upper lip, genetics, and loss of bone volume underneath. Smoking can also worsen these lines. I usually use a combination approach with four units of Botox every three months, small amounts of filler to soften the lines, and laser resurfacing.
Corner of the Mouth
Marionette lines are the lines from the corner of your mouth to your jawline, and are called marionette lines because they look a lot like the lines on the face of a puppet. This line is due to the combination of volume loss, laxity, and facial bone volume loss. They can be quite stubborn in a face with a lot of laxity or redundancy of skin. Sometimes I am not able to completely treat this area and the patient will need to first have the laxity removed by a facelift, but other times the lines are minor and we can do a nice job with Perlane or Juvéderm Ultra Plus in this area.
Lower Lip and Chin
The mental crease is the line between the lower lip and the chin bulb. This is prominent in some people and is one of my favorite areas to treat. Most people do not notice how much this line ages the face until I correct it with filler. Sometimes, I add four to six units of a neuromodulator such as Botox or Dysport to decrease the amount of contraction in this area. It is surprising how much mobility the chin can have.
The last area on the face with wrinkles that I would like to talk about is the pre-jowl sulcus. The pre-jowl sulcus is on the jawline behind the chin on both sides. This area becomes prominent as the cheek fat behind it falls down below the jawline, leaving an indentation on each side. This is amenable to the facelift of course, but if someone is not ready for a facelift, I can give him or her a significant improvement with Voluma, Juvederm Ultra Plus, Radiesse, or Perlane. I place these products on the jawline to rebuild that indentation. I have had many patients come to me, especially young people thinking they need a facelift when one or two syringes of filler have completely reversed this pre-jowl sulcus and allowed them to hold off on a facelift for many years.
In general, we can improve lines on the face with all of these measures, and sometimes we do all or some of these in combination with laser resurfacing. Laser resurfacing stimulates collagen and gives a nice smooth texture to the skin and can be used in conjunction with these treatments to improve your outcome.
If you are worried about your wrinkles, call our Reno dermatology and plastic surgery office any time to set up a consultation to get a customized treatment plan.
~ Dr. Jennifer Janiga