Wrinkles At A Glance
- Best Results1-3 treatments
- Treatment RecoveryVariable
- Procedure Time1 - 50 minutes
- Skin SpecialistNurse, Therapist, Me
- Duration of ResultsOngoing
- Back to Work0-9 days
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.
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.
Tixel: is a non-laser treatment aimed at improving fine lines & wrinkles. Best for the under eye area.
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.
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.
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.
Medium lines & wrinkles with sun damage: IPL with Biostimulatory fillers, Profhilo or PLLA, Ca Oh apatite. Option for radio frequency microneedling.
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.
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.
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.
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.
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.
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.
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;
- 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.
- Calcium Hydroxylapatite; one of my favourite anti-wrinkle filler for the face, neck, chest & hands.
- 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.
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.
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How can I treat lip wrinkles?
Fine lip wrinkles & lines can respond to skin laser toning & dermal fillers. Fillers can restore loss volume in and around the lip area, & provide a more youthful appearance.
Severe lip lines & wrinkles can be erased by laser resurfacing, most often using a combination of erbium and fractional lasers. Occasionally I perform deep chemical peels including Croton -Oil & Phenol, or Jessner TCA with or without fractional CO2 lasers.
What can I do for the jowl lines and marionette lines?
Jowl lines & marionette lines occur due to poor skin tone around the cheek and jawbone areas. This can be treated with –
- RadioFrequency to key areas. This treatment stimulates collagen over time improving skin tone.
- CO2 Fractional laser can be useful, especially if skin tone and texture needs to be addressed. This can be done as part of a laser face lift.
- Threads can give good, but short term results to some patients.
- Mini-S- face lifts are indicated if jowl lines are pronounced- this can give instant, long lasting lifts, that look natural. Deep plane face lifts gives the longest ‘lifting’ procedure.
- Fillers can temporarily hide jowl lines, but are especially useful for marionette lines.
What solutions are there for cheek lines, wrinkles and folds?
Non-surgical face lifting of the mid and lower face can be achieved using RF- Radiofrequency. This is a non-invasive treatment that can tighten collagen over time, reducing cheek wrinkles and lines.
CO2 Fractional laser is a step up from RF, and directs more heat into the skin, this results in better improvements of cheek lines, wrinkles and skin texture.
Fillers can be an excellent method to add volume, reduce lines, and provide a more balanced and youthful appearance.
For severe wrinkles, sun damage and marked loss of skin tone, laser face lifts & mini-s-face lifts give outstanding and natural results.
What is the best way to approach wrinkles?
Treating and preventing wrinkles in younger patients is not a problem, however as one ages, getting the balance correct is very important- this is known as facial harmony. Facial harmony balances skin texture, tone & volume.
Lasers & ways to improve wrinkles are largely predictable in my hands, what I really struggle to convey, is the balance of facial aesthetics, namely patients over look volume. Volume can not be addressed with lasers, or surgery. Fat transfer or dermal fillers gives good, predictable results for addressing volume.
Having a Specialist understand all aspects of ageing, including lifting skin, volume replacement, and of course wrinkle treatment is important for the very best, but natural results.
Can microneedling & PRP treat wrinkles?
Yes, to a limited degree. I do think there are more effective options available. My clinical team do provide this option as it is ‘mainstream’ treatment. My opinion? By the time you have 4-5 microneedling PRP treatments you would have spent enough coin to have had a straight forward fractional laser with my clinical nurses. Lasers give predictable decreases in wrinkles & improves skin quality.
For more information on the pros & cons of PRP & microneedling vs lasers, book a consult with my nurses. I am a firm believer of providing treatments that work.
Can Plasma Pen treat wrinkles?
In theory, yes. So can battery acid. There are safer & more predictable ways to treat wrinkles. I do think that a simple Jessner – TCA peel performed by an expert aesthetician is far, far safer & more effective than plasma pen. I see way too many side effects such as permanent scarring from this device.
Do I do thread lifts?
Yes. I do perform ‘dissolvable barbed’ or conical threads such as Silhouette Soft & Mint Threads, however it is important to know that even though results can be good, thread lifting does not last beyond 6-8 months at best.
My most commonly used threads are PDO monofilament , performed in specific key vectors. My position & density of these treats are very different in comparison to injectors as I tightly pack PDOs in a small area (high density PDOs). I also use cogged thread in suitable patients; namely thick dermal layer.
The key to successful thread ‘lifting’ & wrinkle removal is to keep the momentum with neocollagenesis. This means combined treatments, with the first session aimed at treating between 2 to 3 levels in the skin. This is then followed by no-downtime treatments aimed at deep stimulation of collagen. Most commonly I use radio frequency or HIFU-Ultherapy.
How much are wrinkle treatments?
This will depend on what treatments are employed. Clinical findings & your end goals are important to understand.
For simple rejuvenation procedures such as muscle relaxants, dermal fillers, & fractional lasers, my clinical team of nurse can assist.
For complex rejuvenation including fully ablative lasers, complex fillers, fat transfer & surgical modalities, please book a consultation with myself. Hope to help you out someday!
How do I use HIFU - Ultherapy to treat wrinkles?
HIFU is a treatment that requires a great deal of caution & candidate selection. This treatment is ideal for those who have mild to moderate wrinkles involving the lower 1/3 of the face. An ideal candidate should have a thick dermal layer & adequate fat.
Most often I use this treatment to tighten the fibrous tissue in the fat layer. Occasionally I use it to ‘melt’ fat (more like ‘controlled’ lipolysis or apoptosis of the subcutaneous layer.
If you have significant sun damage, HIFU will not work for you because your elastin & collagen bundles are fragmented.
What skin care is the best anti-wrinkle cream?
Skin care prevents, it does not reverse wrinkles. Even with super strength retinoids, the effects on wrinkles are marginal. Sorry to break this to you, but the wonderful results from retinol is actually the base working as a moisturiser.
A simple but effective anti-wrinkle skin care program goes this this:
AM: Antioxidants, followed by sunscreen.
PM: Retinol or retinoids, with AHA serum once every 7 to 10 days.
Other skin care ingredients with anti-wrinkle activity include-
Argan oil; used in the Middle East as a powerful antioxidant, it may have anti-wrinkle effects.
Why do ethnics respond better than most lighter skin counterparts?
Ethnics including Asian skin types usually respond better to wrinkle removing treatments such as Pico lasers, RF, HIFU, dermal filler & threads. There are 4 main reasons for this-
- Genetics, as discussed above.
- Pigmentation protects the underlying dermis from sun damage & collagen fragmentation.
- The dermal layer is thicker in ethnics, allowing for more contraction.
- The cells called fibroblasts are more reactive in ethnic skin, meaning more collagen laid per area, as compared to lighter skin.
It’s not all good news for darker skin, as they scar & pigment much easier.
Fact: ethnic skin types age less, & in general exhibit wrinkles a decade later than fair skin counterparts. Reason? Genetics & physiology. The lasers I use in fair skin types is different for ethnic skin. A typical wrinkle reducing program goes like this-
- Picosure or Picoway laser; 2-3 sessions.
- NuEra RF or HIFU.
- Profhilo bio-stimulatory Hybrid dermal fillers, 2 sessions
Can HALO laser resurfacing treat wrinkles?
Yes but it takes forever to get good results. I have the erbium side of HALO known as the Sciton Joule; expect HALO has 1/15 the power. With our portfolio of lasers, we can get the job done faster & with less overall down time at a fraction of the cost.
What is the best course of treatments for wrinkles if I don’t want any downtime?
It depends on your clinical findings. A low downtime- no downtime treatment is a combination of collagen stimulating Hybrid dermal filler (Profhilo) as well as a non-ablative laser like the Alma Hybrid. We can add no-downtime devices like deep HIFU & RF.
My staff & I will guide you as to the best combinations, taking into account your goals & limited time.
Why do some patients respond better than others to wrinkle treatments?
Genetics & environmental factors. Your ability to stimulate collagen is based on a bell curve, much like height, weight, & IQ. The lucky few who can generate & contract collagen efficiently lie on the right side of the curve, whilst some lie to the left.
Factors such as smoking, diet, stress, UV exposure & more come into the mix. Another well known variable is outlined below, namely ethnicity.
How to treat wrinkles at home?
I have covered this in another section, however this is a summary.
Microcurrent: I was sceptical at first, but I do think it works well in some people. Microcurrent does not remove wrinkles (as advertised), it can however improve your skin’s firmness by immediate collagen contraction though current.
Skin needling: can be useful as a DIY for wrinkles & enlarged pores. Use a 0.2 mm roller, concentrate on the technique. Don’t go deeper, it is counter productive.
Chemical peels: DIY peels are not a good idea, but some will try, hence this advice. I do believe that low strength TCA is easier to modulate & safer to use compared to say, glycolic acid (which requires neutralising agents). Stick to TCA 8% two to three coats. Apply monthly. This can reduce pigment as well as fine wrinkles – especially wrinkles around the eyes.
Home lasers: there are some companies that make home lasers for the treatment of eye wrinkles. These devices are non-fractional lasers with a max output of 3 mj/cm2. You need to use them daily for at least 3 months. Each session takes 4-6 minutes to perform.
Healthy living: Don’t underestimate the value of the diet, sleep, photoprotection, & self-worth. You know the drill, don’t smoke, alcohol in moderation, reduce stress, etc…
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.
- 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.
- 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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