As we age, the skin becomes thinner, drier, and less elastic and as a result of repeated facial muscle movement lines, wrinkles and creases form in the skin. Wrinkles and lines initially are present with muscle movement (dynamic wrinkles) and then become present without needing muscle movement (static wrinkles). The most frequent sites for wrinkles are between the eyes (frown lines), sides of eyes (crow’s feet), forehead (worry lines) and around the mouth.
The thing is to assess skin health and this can be helped by computerised skin analysis. Wrinkles and lines typically occur along with other signs of skin ageing and sun exposure such as alterations in skin texture, uneven pigmentation and increased redness.
Current skin care habits and lifestyle factors that can contribute to premature ageing of the skin also need to be considered.
Then when looking at a patient’s face to assess wrinkles, it is usual to think of the face as being in three areas: Top third (eyes to the hairline), middle third (eyes to mouth) and lower third (mouth to the neck). This is useful as the top third is the area that usually responds best to anti-wrinkle injections, the middle third usually requires volume replacement with dermal fillers while the lower third often needs a lifting effect.
Whatever wrinkle treatment a patient may undertake at our clinic we emphasise that this complements and does not replace good basic skincare and healthy lifestyle choices.
When someone frowns or concentrates, the central area between the eyes usually forms a single line or double line (“number 11”) depending on anatomy. This is the most universal wrinkle area that patients request treated because it is perceived as a negative appearance giving an angry or unhappy look. Thankfully this area responds particularly well to anti-wrinkle injection treatment. Some Dermal filler can be needed as well if frown lines have been longstanding and there are deep lines present at rest.
The lines on the outer corners of the eyes are called ‘crow’s feet’ as they resemble the pattern of a crow’s foot. They are very common and can start developing in the 20s. They are disliked because they give an aged appearance and are often regarded as making someone look tired and not relaxed. Excellent results can be achieved with anti-wrinkle injections. An injection can also be placed in the outer eyebrow to give a brow lift and help open up the appearance of the eye.
The lines on a forehead are often called ‘worry lines’ because they give a concerned appearance. Common in both men and women and especially common in people who spend a lot of time outdoors for work and/or sport. Care needs to be taken when treating low down on the forehead with anti-wrinkle injections, especially just above the outer eyebrow in older patients as it can result in a brow droop. Dermal fillers can also be used effectively.
The lines on the nose next to the inside of the eye are often called ‘wolf lines’ when they occur in women and ‘bunny lines’ when they occur in men. These lines can be softened with anti-wrinkle injections but can be challenging to remove completely. These lines are typically present but not always noticed by a patient until they start to have other facial treatments and more closely examine their own facial appearance.
The lines under the eyes can be very challenging to treat. Sometimes the best option is a topical cream such as ELASTIDERM. Anti-wrinkle injections can help in some patients, but if there is any skin laxity, this needs to be done cautiously to avoid possible weakness to the lower eyelid and causing sagging. Dermal needling and PRP in the right patients can give significant improvement. If there is an associated loss of volume in the tear trough, then dermal fillers are essential.
If lines and wrinkles high up on the cheekbone are caused by the lower fibres of the muscle around the eye (Orbicularis oculi) they are considered to be crow’s feet and can be improved with anti-wrinkle injections. If they are caused by the cheekbone muscle (Zygomaticus), they do not respond well to anti-wrinkle injections and trying to treat them can result in an uneven smile. If related to underlying volume loss, then dermal fillers will improve these lines. The Infini and PRP can be helpful in this area.
The vertical lines, especially on the upper lip, are not necessarily caused by smoking but are more frequent and severe in smokers (and ex-smokers). When the lines are not present at rest low dose anti-wrinkle injections can help slow the rate of these lines deepening. When the lines are present at rest dermal fillers can help, but when they are deep and longstanding there is often associated scar tissue, and laser resurfacing can be the best option.
The ‘mouth frown’ refers to when the corner of the mouth starts to curve and pull downwards. It is due to a combination of the overactivity of the muscle on the outside of the lip (called the DAO) and the loss of volume in the lower face. Treatment of the DAO muscle with anti-wrinkle injections can reduce the severity and slow the rate of deterioration. This is often treated in combination with relaxing the chin muscle, which can be contributing to the downward pull of the lower facial muscles.
‘Marionette lines’ refer to when vertical folds develop between the outer lip and the chin. Medically this is called the mentolabial fold. These lines give a grim and dissatisfied appearance. Combined treatment with anti-wrinkle injections and dermal fillers is needed. With ageing the skin can sag along or sink below the jawline, which is then termed ‘jowls’ and while early on skin tightening treatments such as the INFINI can help when significant sagging has developed a surgical lift procedure is usually needed.
These are also sometimes referred to as ‘smile lines’ or ‘laugh lines’ and are the curved vertical lines situated outside of the corner of your mouth that become more prominent when smiling. Anti-wrinkle injections do not work too well on these lines, and while dermal fillers can be helpful, it is a difficult area to achieve a great result with fillers alone. Better longer-term results can usually be achieved with radiofrequency energy through the Infini device. PRP either alone or in combination with skin needling is also a good option.
Before and after images are presented purely as a reference point of the results that can be achieved. Everyone is unique and outcomes will vary and realistic expectations need to be discussed on a case by case basis.
Got questions? Or ready to book in? Contact our experienced and friendly team to start your journey to healthy skin with us.