By Kate Dee, MD
Have you ever wondered why botox works on some wrinkles and not on others? Or maybe why we get wrinkles at all in the first place? If you are somewhat dismayed by the appearance of wrinkles that just won’t go away, you’re in good company. As experts in slowing that process down, we would like to explain how these wrinkles form in the first place. Once you understand the difference between static and dynamic wrinkles, you’ll understand better what works to make your skin look its best.
Dynamic wrinkles are those lines in the skin from active movement. Even kids have them! When you smile, lines form around your mouth and eyes. When you raise your eyebrows, long horizontal lines appear in your forehead. All of that is completely normal. When you’re a kid, the skin springs back and the lines disappear when you’re not making that facial expression. Those lines are dynamic wrinkles.
Static wrinkles are creases in your skin that are there all the time, even when you are not moving any muscles or making any expressions. Static wrinkles have a loss of collagen and elastin in the skin, with a permanent indent that does not spring back.
Dynamic wrinkles can become permanent over time as one makes the same movements over and over for decades. The skin loses elasticity and collagen over time, becoming thinner and less springy. The repeated wrinkle formation and loss of collagen results in static lines over time. This also happens in areas of the skin where laxity allows the skin to droop.
Botox and Dysport are neurotoxins that temporarily paralyze the muscles that cause wrinkles. For example, the frown lines between the eyebrows– often called the 11’s– are caused by 3 small muscles. These can be treated with Botox or Dysport and the furrows between the brows disappear. You also can’t make a mean angry face either. But unless you are an actor, loss of this expression is often a desirable result (especially if you have teenagers). The crinkles around the eyes (crow’s feet) and forehead lines are also commonly treated with Botox or Dysport.
Once wrinkles have been etched into the skin, it is not possible to completely get rid of lines with just Botox or Dysport. But to the extent that the lines are made deeper by a resting tension in the muscles, they can be greatly softened by neurotoxin. So even if your lines are static, Botox or Dysport can help diminish them.
There are a number of other treatments that can improve the skin and smooth over static wrinkles:
Dermal Filler: this is an injectable that fills the divot of missing collagen within the skin, with the goal of filling up the wrinkle itself.
Laser Resurfacing: fractional laser treatments are used to smooth out the surface of the skin, treating all the fine lines and wrinkles, in addition to stimulating the skin’s own cells to generate collagen
Sculptra: this is an injectable that stimulates the body’s own collagen to remodel and reduce wrinkles as well as lift the lower face
Chemical Peels, Microdermabrasion and Dermaplaning: these exfoliating treatments can help smooth the skin by removing the surface layer to reveal smoother skin underneath. Though these treatments are great and smoothing the skin surface, they do not treat the underlying collagen loss.