Wrinkles in the skin (aka skin wrinkles, cutaneous wrinkles, rhytides) are a common sign of aging, and can be defined as ridges or furrows on the skin surface.

Causes are multi-factorial: a combination of intrinsic and extrinsic factors. Intrinsic factors are mostly the genetic background and cannot be altered. Extrinsic factors are sun exposure, smoking, alcohol, and nutrition – with sun (ultraviolet [UV] radiation) exposure being the main cause of extrinsic aging. Some studies show that UV radiation can be responsible for up to 80% of facial aging (Uitto J,1997). These extrinsic causes can be reduced with effort which can affect aging signs such as wrinkles. Other factors that can contribute to wrinkle formation include hormonal (especially estrogen and androgens) influences and skin dryness.

Wrinkles on close examination include signs of epidermal thinning, dermal-epidermal junction flattening, atrophy of the fat layer underneath the skin, loss of collagen, and/or degradation of elastin.

Types of Wrinkles:

  1. Dynamic wrinkles: Caused by repeated facial movements such as smiling, frowning, or squinting. Commonly seen on the forehead, glabella, and crow’s feet area. (See below images)

  2. Static wrinkles: These are visible even when the face is at rest and are commonly directly caused by motion of the facial muscles during expression. They are commonly located in the location of dynamic wrinkles and aggravate over time. Once static wrinkles are formed in dynamic wrinkle locations, complete reversal is very difficult. Therefore, prevention is an important strategy in wrinkle management. (See below images)

  3. Sleep lines: Caused by the pressure of skin against a sleeping surface (pillow, hand, etc). Commonly seen on the side of the forehead, cheeks, and/or jowls/chin. They are typically seen in locations not related to facial expressions. (See below images)

Treatment Options: Treatment options for wrinkles depend on the severity and type of wrinkles, as well as the patient’s skin type and medical history. Common treatment options include (Disclaimer: following list is not exhaustive, and results are variable depending on individual):

  1. Lifestyle Modifications: Reduce/Cease smoking, alcohol consumption.
  2. Sun exposure related habit modifications: Reduce/Cease tanning beds, diligent and proper sunscreen application before sun exposure, avoidance of excessive unnecessary sun exposure. Utilizing hats, clothing, shade when in sun.
  3. Routine health screening: to check for other health issues which may contribute to wrinkle formation.
  4. Topical cosmeceuticals: Mainly to provide skin hydration.
  5. Botulinum Toxin A: Act by relaxing the muscles that cause dynamic wrinkles which in turn can cause static wrinkles.
  6. Biostimulators: PDRN/Polynucleotides (PN), Hyaluronic Acid (HA) “skin boosters”, PLLA, PCL, Calcium Hydroxylapatite (CaHa)
  7. Energy Based Devices (EBD): lasers, Intense Pulsed Light (IPL), High Intensity Focused Ultrasound (HIFU), Alternating High Frequency Ultrasound, RadioFrequency (RF), Low Level Light Therapy (LLLT)/LED

While some wrinkles may not be completely eliminated, with proper treatment, the appearance of wrinkles can be significantly reduced. Treatments can also delay the onset of some wrinkles over time It is important to seek professional advice from a qualified medical physician for proper assessment of the wrinkles and to develop an effective and safe treatment plan.