Best Treatment for Facial Wrinkles

I‘m often faced with the question, “What’s the best treatment for wrinkles”?  Most damage is from the sun, so the answer to this traces way back to our childhood.  Approximately 80% of our total lifetime’s sun exposure occurs before we turn 18 years old.  As the saying goes, an ounce of prevention is worth a pound of cure.   So clearly the best way to avoid wrinkles is to prevent their formation by limiting our sun exposure.  The problem is we tend to believe we’re invincible when we’re this young and we often ignore the advice.

The Three-Pronged Attack

So, now that we’re older and wiser, what can we do to treat those wrinkles?  I still uniformly advocate sun block to all my patients, no matter where they live, and even if they aren’t spending time outdoors.  This will help prevent further damage, and reduce the risk of skin cancer.  Beyond this, the key thinking is combination therapy.  My patients hear me refer to this as a “three-pronged attack.”  We can fight wrinkles from 1) below the skin (i.e. with facelift surgery, or with injections of Botox or Dysport); 2) within the skin (i.e. with injectable fillers); or 3) above the skin (i.e. chemical/laser peels or dermabrasion). Surgery (such as facelifting, necklifting or cheek implants)  is powerful, but really will not effectively change the outward appearance of the skin, so I will leave that topic for another discussion.  Let's focus on the non-surgical or minimally invasive options for facial rejuvenation.

Which Treatment Where?

Certain treatments work best in certain areas of the face, and some areas can benefit from all three.  When a patient says they want Botox or Dysport for wrinkles around the mouth, I will usually advise against it.  Wrinkles here are best treated by filling them with FDA approved fillers- collagen, Restylane, or Juvederm.  Adding volume to them will provide an immediately noticeable improvement by softening the appearance of the wrinkle.  Fillers will not paralyze muscle or change your ability to move.  Botox or Dysport, on the other hand, treats wrinkles by paralyzing muscle that causes the wrinkle.  It does not fill the wrinkle.  So, these medications will work best in wrinkles directly formed by muscular contraction, and these occur most often around the eyes and forehead:  the “frown lines” between the eyebrows, the “bunny lines” at the nose, the “worry lines” on the forehead, or the “crows’ feet” at the corner of the eyes.  Finally, in addition to filling the wrinkle, or paralyzing the muscle, I can recommend resurfacing the skin to combat the wrinkles.  This can be as simple as daily use of alpha hydroxy acids or Retin-A for mild wrinkles, or as involved as chemical and laser peels for more severe sun damage to yield a longer lasting dramatic change.

Clearly there is no magic bullet for all wrinkles, and each area of the face must be addressed separately.  But combining the protective effects of sun block with the strengths of injectable fillers, Botox/Dysport and resurfacing procedures is the strongest way to achieve the result you want.