Wrinkles (How to treat)

Wrinkles At A Glance

  • Best Results1-3 treatments
  • Treatment RecoveryVariable
  • Procedure Time1 - 50 minutes
  • Skin SpecialistNurse, Therapist, Me
  • Duration of ResultsOngoing
  • AnaestheticVariable
  • Back to Work0-9 days
  • Cost$-$$$$

Wrinkle Treatments

Wrinkles are a natural process of aging, caused by skin laxity, volume loss, or strong muscles. Treatments are directed at the causes of wrinkles. These include muscle relaxants, fillers, chemical peels, lasers & surgical modalities, depending on the severity of wrinkles. I believe in both treating wrinkles, but also developing a wrinkle prevention program. 

FactsFacts on Wrinkle Treatments

  • Wrinkles and lines develop with age, & are made worse with UV exposure
  • Wrinkles can be classed as static- present at rest, or dynamic, present when muscles contract
  • Dynamic wrinkle are treated with muscle relaxants
  • Static wrinkles are treated with fillers, peels, laser resurfacing or lifting
  • Mild wrinkles can be improved with AHA chemical peels & simple low downtime procedures
  • For facial harmony with natural results, the balance between skin texture, tone & volume is essential

What Wrinkles treatments do I perform?

Always identify the type of wrinkle, then employ methods to address it. Wrinkles at rest are static, wrinkles with movement are dynamic. In many cases dynamic wrinkles gives rise to static wrinkles. 

Injectables: Include muscle relaxants as well as dermal fillers. Fillers I perform include hyaluronic acid as well as collagen stimulating fillers (longer lasting). Muscle relaxing injections are best for dynamic wrinkles, eg. Frown lines, crow’s feet, forehead wrinkles. 

Lasers: I use over a dozen lasers depending on skin type (colour) as well as the depth of wrinkles. Shallow to medium depth wrinkles can improve markedly with fractional lasers including Fraxel, LaseMD, fractional CO2, as well as low downtime Tixel. Really deep wrinkles are treated with ablative lasers including erbium & CO2. The deeper the wrinkles, the stronger the lasers.

It all starts with an accurate clinical assessment.

Peels: Fine to medium depth wrinkles can be treated with chemical peels. The best results are with medium depth combination peels such as Jessner -TCA peels. Deeper wrinkles, eg; smokers lines are best treated with deep peels including phenol croton oil peels. 

Tempsure, HIFU, Thermage: are best for improving skin tone, not wrinkles.

HIFU is an excellent treatment for lower face laxity, however it must be carefully applied.

Tixel: is a non-laser treatment aimed at improving fine lines & wrinkles. Best for the under eye area.

Tixel can markedly improve under eye wrinkles with minimal downtime. Patient selection is critical for outcomes.

Skin care: is important after anti-wrinkle treatments. There is no such thing as an anti-wrinkle cream. Even strong prescription retinoids will not shift meaningful wrinkles. Creams are best at prevention. 

What treatments are available for frown lines and forehead wrinkles?

Frown lines & forehead lines can be relaxed using anti-wrinkle injections. These work by relaxing the muscles that cause wrinkles. A good injector knows how to make the results look & feel natural.  

Treatments take 1-2 minutes to perform & typically last 4-6 months. 

What treatments are there for eye wrinkles?

Eye wrinkles are one of the most requested wrinkles to soften or remove. 

If you have smile lines or crow’s feet the use of anti-wrinkle muscle relaxants can treat and prevent the progression of wrinkling. 

Under eye wrinkles or wrinkling of your upper eyelid can be treated with either surgical or laser procedure, know as blepharoplasty. This is suited for patients with poor skin tone around the eye area.

Gold standard eye rejuvenation combines lasers, surgery, fillers & energy devices.

I employ many different lasers & energy devices based upon the type & depth of wrinkles. Mild to medium wrinkles respond well to fractional lasers such as Fraxel, LaseMD, & hybrid lasers. Deep wrinkles are best treated with ablative CO2 or Erbium lasers.

Ablative lasers can make a significant impact in the eye area, for deep resurfacing, only one session is required.
Best results in 2-4 sessions.

How to treat wrinkles on the neck?

Even dermatologists find the neck & chest area challenging to treat. Here is how I do it.

Fine lines & wrinkles with minimal sun damage: Biostimulatory fillers, Profhilo or PLLA, Ca Oh apatite. Tixel.

Collagen stimulating fillers can improve lax & sagging skin on the neck & face.

Medium lines & wrinkles with sun damage: IPL with Biostimulatory fillers, Profhilo or PLLA, Ca Oh apatite. Option for radio frequency microneedling.

IPL can treat discolouration of the neck, chest & décolletage areas.

Deep lines & wrinkles with sun damage: Fractional lasers, IPL, dermal fillers & skin tightening devices. For significant laxity, a neck lift will give the best outcomes.

The earlier you address skin laxity, the higher the success.

What types of lasers do I use to treat wrinkles?

It is super complex as I do not follow a cookie cutter approach, & we get a new laser every month. Add to the fact that I often combine lasers, peels, threads, energy devices & fillers, the algorithm is complex. 

Level one lasers: include Q switch – pico dermal toning, Laser Genesis, Tixel non-laser rejuvenation, DermaV toning, Clear + Brilliant 

Best for: Pigment, pores, fine lines & wrinkles in all skin type.

Recovery: 0-1 day

Done by: My nurses

Level two lasers: include Fraxel, LaseMD, Hybrid 1570

Best for: Pigment, sun damage & deeper wrinkles & lines 

Recovery: 1-4 days

Done by: My nurses

Level three lasers: Fraxel HD, CO2 fractional medium power, Hybrid medium power laser resurfacing. 

Best for: Pigment, sun damage & deeper wrinkles & lines 

Recovery: 4-7 days

Done by: My nurses

Level four lasers: Thulium + CO2 + Hybrid combination

Best for: Sun damage, eye wrinkles, upper lip wrinkles

Recovery: 5-8 days

Done by: My head nurse

Level five lasers: CO2 or Erbium Fully ablative resurfacing.

Best for: Super deep wrinkles, epic sun damage, dull skin, pigment, scars.

Recovery:  7-12 days

Done by: Me, under conscious sedation.

Lasers provide the most reliable way of treating
deeper wrinkles. They can be tailored according to downtime.

Which type of chemical peel can remove wrinkles?

The peel type will depend on the depth of wrinkle. As a guide-

Very shallow wrinkles – wrinkle prevention: Retinoic acid peel, lactic acid.

Shallow wrinkles– Jessner peel, AHA glycolic acid peels.

Deep wrinkles– Jessner TCA, Phenol peels

Don’t under estimate the power of chemical peels. AHA peels have no downtime, however you will required 3-6 peels to get the best results. TCA peels can markedly improve medium to deep wrinkles. I occasionally combine it with CO2 laser resurfacing. 

What is RFM or radio frequency microneedling?

RF microneedling is a powerful treatment that can help reduce wrinkles around the jawline, upper lip, cheeks & neck. This treatment uses needles that deliver radiofrequency energy to pre-determined depths; ranging from 0.2 mm to over 5 mm.

Most patients require 2-4 sessions for optimal results. By combining laser, we can reduce the number of sessions to 1 or 2.

RFM is not as effective as ablative lasers, however they are useful in providing wrinkle removal in patients with mild to moderate laxity, & little or no sun damage. RF microneedling should be insulated. Patients will benefit from 2-4 sessions conducted monthly.

What is radio frequency & what type of wrinkles can be treated?

We have discussed RFM as above, however RF can also be delivered with a probe & not needles. Treatments include Thermage, Tempsure, Pelleve, & NuEra.  These devices can improve laxity & increase firmness of the skin.

Successful candidates should have no sun damage, with adequate dermal thickness & medium to low subcuttaneous tissue. These devices can help with the lower face-jawline-neck. 

My MO is to combine threads, collagen stimulating fillers, lasers & RF as this addresses wrinkles & laxity in all layers of the skin.

Tempsure or Pelleve only addresses laxity. One should consider volume replacement for natural outcomes.

Does LED therapy help reduce wrinkles?

No light emitting diodes or low level lasers do zero for rejuvenation. They are however useful when it comes to healing post lasers or procedures.

LEDs have very limited effects when it comes to wrinkle removal & or treating skin laxity.

Darker skin types should not use blue light LED as it makes skin pigmentation worse. 

What is Tixel & when do I use it for wrinkle removal?

Tixel is best around the eyes, however it has been marketed to treat many other areas of the face, neck & chest. Tixel is best for mild to moderate wrinkles in fine eyelid skin. 

Tixel resurfacing has a short downtime of 2-3 days. Most patients require a series of 3-4 sessions for best results. 

Tixel can markedly improve under eye wrinkles with minimal downtime. Patient selection is critical for outcomes.

What are collagen stimulating dermal fillers & how do they treat wrinkles?

Think of it as two groups of dermal fillers. Firstly fillers to improve volume loss by replacing collagen & fat with hyaluronic acid. Secondly a group of dermal fillers used to stimulate your own immune system to produce more collagen. This group is called the biostimulatory. In Australia there are three types; 

  1. PLLA; or poly-L-lactic acid. This group has the longest data & safety profile with nearly 2 decades of use. Good for biostimuation  on the cheeks, & hands.
  2. Calcium Hydroxylapatite; one of my favourite anti-wrinkle filler for the face, neck, chest & hands.
  3. Hybrid fillers called Profhilo. This filler can reduce wrinkles on the face, neck & chest. Recently introduced to Australia in 2022, it works well in mild to moderate wrinkles, include sun damaged skin. 

    Profhilo stimulates collagen with minimal volume displacement. This means improved skin laxity & tightening.

Why is it important to assess for sun damage & degree of laxity before attempting wrinkle removal procedures?

You will save a whole lot of time, effort & money if you understand the complexity of effective wrinkle removal. If you have sun damage (common if you live in Brisbane – Gold Coast, North Coast), then skin tightening procedures such as Tempsure, NuEra, RFM, Ultherapy & HIFU will not work. Why, because fragmented collagen will not contract. The answer lies in peels & deep laser resurfacing.

Once you repair broken collagen, then your skin can respond to contractile treatments. Repair the upper layers of skin BEFORE you try to contract the lower dermis.

Davin’s viewpoint on wrinkle treatments

Wrinkles are a natural process of ageing. Solutions are always possible, no matter how deep the wrinkles. Not all cases require long downtime laser resurfacing as newer technology can reduce wrinkles whilst keeping healing times to a minimum. 

As with all our procedures, we pick the correct method for your wrinkling, & not employ a cook-book approach. Depending on the severity of wrinkles & sun damage, the clinical team @cliniccutis have an array of treatments such as RF radio frequency treatments, skin needling,  all the way to lasers such as Fraxel, Pico, CO2 & Tixel. Fillers are often underestimated in how we can achieve wrinkle removal thru volume replacement & biostimulation.

Here is a concept that is not talked about in any meetings, primarily because the ‘platinum sponsors’ in all major cosmetic, aesthetic or dermatology conference includes companies that maker dermal fillers & or botulinum toxin. 

You won’t hear me voice out my two cents worth in these meeting, because I would like to be invited back every year. Here me out; I do think we are overdosing most of our patients with too much anti-wrinkle injections. Said another way, the industry is using too much Botox. Firstly too much frown & forehead lines injectables are used. When you stop muscles from moving, 2 things happen.

  1. The muscle gets weaker & smaller. The frontal muscles & the depressor muscles flatten to a point of atrophy, meaning the already thin area is getting thinner & weaker. Sure dermal fillers placed carefully can sort this out, but a simple solution is to use less Botox, namely to preserve a wrinkle free forehead at rest, but still have dynamic movement.
  1. Iatrogenic metophyma. Hear me out. The depressors & forehead muscle helps your lymphatic circulation clear out excess fluid. When these muscles are less active, lymphatic products tend to stay in one place. This forms an orange peel look over the frown lines & forehead. It is more common if your skin is inflamed- think rosacea.

Wrinkle prevention is just as important as wrinkle removal, simple muscle relaxants combined with good skin care is important. 

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