What causes wrinkles?
As we get older, collagen and elastin fibres in the skin decrease, the skin becomes thinner and its capacity to hold moisture falls. This is natural ageing determined by our genes, and it cannot be stopped. In addition, there is ageing linked to the environment and lifestyle; its most important source is the sun’s ultraviolet rays. Smoking, sunbeds and facial movements repeated over many years also contribute to lines becoming noticeable earlier.
Each of these factors produces a wrinkle with a different appearance. It is important to know which type predominates, because a method that works for one type may do nothing for another.
Types of wrinkle
| Type | How to recognise it | Typical areas |
|---|---|---|
| Expression (dynamic) lines | Appear only when you frown, smile or raise your forehead; disappear or become much fainter when the face is at rest | Between the eyebrows, forehead, outer corners of the eyes |
| Static lines | Visible even when the face is completely still; often expression lines of many years’ standing that have become established in the skin | Between the eyebrows, forehead, outer corners of the eyes, around the lips |
| Fine lines due to sun damage | Widespread fine wrinkling, rough texture, dark spots and dullness are found together | Cheeks, under the eyes, upper lip, neck, décolleté, backs of the hands |
| Folds due to volume loss and sagging | More like a groove or a shadow than a line; lessens when the skin is lifted slightly upwards with a finger | The fold running from the side of the nose to the corner of the mouth, the line running from the corner of the mouth to the chin, the jawline |
In most people several of these types are present together. Sleep lines caused by always lying on the same side may also be seen; because these do not arise from the muscles of facial expression, they do not respond to procedures that relax the muscle.
Sun protection: the first step supported by evidence
A significant proportion of early wrinkles on the face are linked to sun damage. In a randomised controlled trial in adults in Australia, signs of skin ageing progressed less over about four and a half years of follow-up in those who used sunscreen regularly every day than in those who used it only when they thought it necessary. This is one of the strongest pieces of evidence we have that sunscreen slows the formation of wrinkles.
- Apply a broad-spectrum sunscreen with a sun protection factor of at least 30 to exposed skin every day, including in cloudy weather and in winter.
- Do not neglect shade, a hat and sunglasses; by reducing squinting, sunglasses may also help with lines at the corners of the eyes.
- Avoid sunbeds and tanning.
- If you smoke, stopping helps to slow skin ageing.
- Using a moisturiser regularly plumps the skin and temporarily reduces the appearance of fine lines; it does not remove the line.
Sun protection does not erase existing deep lines; its purpose is to slow the formation of new ones and the progression of existing damage. It is also a basic condition for preserving the effect of any procedure you have.
Creams supported by evidence
A great many products are promoted as anti-wrinkle; however, few ingredients have an effect that has been shown in controlled studies.
- Tretinoin (a prescription retinoid): the cream ingredient with the most studies behind it for fine lines, rough texture and dark spots due to sun damage. The effect appears slowly over months. Redness, dryness and peeling are common; it should be used on a physician’s advice and with follow-up.
- Retinol and similar non-prescription retinoids: these are weaker than tretinoin and the evidence for them is more limited; on the other hand, they usually cause less irritation.
- Vitamin C, niacinamide, peptides and similar ingredients: benefit has been reported in some small studies; however, the evidence is limited and there are large differences between products.
Creams containing retinoids are not used during pregnancy or when planning a pregnancy; for details, see the article “Medical Aesthetics in Pregnancy and Breastfeeding: Which Treatments Should Be Postponed, and What Should You Discuss with Your Physician?”. No cream removes deep static lines, folds or sagging; what can be expected of creams is a modest improvement in fine lines and skin texture.
Wrinkles are not a single problem; expression lines, established lines, sun damage and volume loss respond to different methods. Which type predominates becomes clear on examination; at every age, though, the first step supported by evidence is regular sun protection.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
Which procedure helps with what, and what does it not help with?
The table below offers a general framework. Which method is suitable for you is decided together with the physician after your face has been examined and your medical history assessed.
| Method | Mainly for | What it does not help with | Note |
|---|---|---|---|
| Botulinum toxin type A | Expression lines: between the eyebrows, forehead, outer corners of the eyes | Folds due to volume loss, sagging, textural damage due to sun damage | The effect is temporary; established deep static lines may soften but may not disappear completely |
| Hyaluronic acid filler | Folds due to volume loss and some static lines | Lines formed by facial expression, widespread fine wrinkling, marked sagging | The effect is temporary; there is a rare but serious risk of vascular occlusion |
| Chemical peel | Fine lines due to sun damage, rough texture, dark spots | Expression lines, deep folds, sagging | As depth increases, so do the effect, the recovery time and the risk |
| Fractional laser and laser resurfacing | Fine lines, skin texture, sun damage | Expression lines, volume loss | The risk of pigmentation is higher in darker skin |
| Radiofrequency, radiofrequency microneedling, focused ultrasound | Mild laxity and skin texture | Deep lines and folds | The effect is usually modest and varies from person to person |
| Surgery (facelift, eyelid surgery) | Marked sagging and excess skin | Skin quality, fine lines, expression lines | Carries the risks of an operation and a recovery period |
The effect of botulinum toxin type A on facial wrinkles has been examined in a large number of randomised controlled trials. A Cochrane review bringing these studies together reported that the treatment reduces lines between the eyebrows in particular within four weeks, while probably increasing the risk of a drooping eyelid. The same review also states that the evidence on the long-term results of repeated treatments is insufficient. For details of the procedure, see the article “Botulinum Toxin”.
Fillers work by supporting the line from beneath or by replacing lost volume. Which one is considered in which situation is explained in the article “Botulinum Toxin or Filler? The Differences and What Each One Is Used For”, and how filler is given and its risks in the article “Hyaluronic Acid Filler: What It Is, How It Is Done and What the Risks Are”. For methods aimed at renewing the skin surface, you can look at the articles “Chemical Peels: What They Are, Who They Suit and What Recovery Involves” and “Fractional Laser: How Suitable Is It for Acne Scars, Wrinkles and Skin Texture?”.
The evidence for the effect on wrinkles of options such as collagen supplements, facial exercises, massage devices and light devices used at home is limited. They can be tried; however, they should not be expected to take the place of the methods above.
After a procedure: which symptoms are an emergency?
After injection procedures, mild redness, swelling and bruising are common and mostly pass within days. The symptoms below, however, are not expected.
Do not wait if you have these symptoms
- Blurred vision, double vision or loss of vision after filler: call 112 (or your local emergency number) immediately
- Severe and increasing pain in or around the filler area, whitening of the skin, net-like bruising: contact the physician who performed the treatment without delay; if you cannot reach them, go to an emergency department
- Difficulty swallowing, speaking or breathing, or widespread muscle weakness after botulinum toxin: go to an emergency department
- Swelling of the lips, tongue or throat, a widespread itchy rash, shortness of breath: call 112
- Redness, warmth, pain, discharge or fever in the treatment area that increases over days: see a physician the same day
The warning signs after filler are described in detail in the article “After Fillers: When Is It an Emergency? Vascular Occlusion and Other Warning Signs”.
When should you consult a physician?
Wrinkles on their own do not require a visit to a physician. However, in sun-damaged skin some changes may appear alongside wrinkles and need to be assessed. If you notice rough, scaly, crusting patches on sun-exposed areas that do not go away, a sore that does not heal or that bleeds, or a mole that is changing in colour, shape or size, see a dermatologist.
If you are considering a procedure, tell the physician about the medicines you take, any tendency to bleed, your previous procedures, and whether you are pregnant or breastfeeding. Who will carry out the procedure, and under what conditions, is as important as the result; the article “Who Can Perform Medical Aesthetic Treatments? What You Need to Know as a Patient” may be a useful guide on this.
Realistic expectations
- No method stops ageing; procedures improve the appearance for a time, and the effect of most of them lessens over time.
- No single method works for every type of wrinkle; sometimes more than one approach is needed, and sometimes doing nothing is a reasonable choice.
- Established deep lines can be softened; in most cases they should not be expected to be erased completely.
- The same procedure can give different results in two people; skin thickness, the degree of sun damage, habits of facial expression and age all affect the result.
- A motionless, expressionless face is not the goal; the aim is usually to soften lines while preserving natural expression.
- Be cautious about treatments that promise a big change in a short time, make no mention of risk or recommend products whose contents are unclear.
Questions to ask your physician
- Which type of wrinkle predominates in my case: expression lines, established lines, sun damage or volume loss?
- Which of these types is the method you recommend aimed at, and which will it not affect?
- How much change can I realistically expect, and how long will it last?
- How far can I get with sun protection and creams alone, without any procedure?
- Is a cream containing a retinoid suitable for my skin, and how should I start?
- What are the common risks of this procedure, and the rare but serious ones?
- If there is a problem after the procedure, how and at what times can I reach you?
- Is there also a spot or mole on my sun-damaged skin that needs to be checked?
Frequently asked questions
Do wrinkle creams really work?
Tretinoin, a prescription retinoid, is the cream ingredient with the most studies behind it for fine lines due to sun damage; its effect is modest and appears over months. For most non-prescription products the evidence is more limited. No cream removes deep lines or sagging.
What is the difference between an expression line and a static line?
Expression lines appear only when the face moves. Static lines are visible even when the face is at rest. This distinction matters, because treatments that relax the muscle are effective mainly on expression lines; on established lines the effect may be more limited.
Does sunscreen prevent wrinkles?
A controlled study has shown that regular daily use of sunscreen slows the progression of signs of skin ageing. It does not erase existing deep lines; it helps to slow the formation of new ones.
Can botulinum toxin be used for every wrinkle?
No. Botulinum toxin type A is effective on lines created by the muscles of facial expression. It does not provide the expected benefit for folds due to volume loss, for sagging or for textural damage due to sun damage.
Does having a procedure at a young age prevent wrinkles?
Long-term evidence that treatments given before lines have formed prevent wrinkles later is limited. At every age, the basic measures supported by evidence are protecting yourself from the sun and not smoking. The decision to have a procedure should be based on the findings of an examination, not on age.
Does filler get rid of wrinkles completely?
Filler can noticeably soften folds due to volume loss and some established lines; however, its effect is temporary, and it is not a suitable option for lines formed by facial expression or for widespread fine wrinkling.
Do facial exercises or collagen supplements work?
The evidence for the effect of these methods on wrinkles is limited. Those that are harmless can be tried; however, they should not be expected to take the place of sun protection or of treatments supported by evidence.
When should I see a physician about wrinkles?
Wrinkles are not a health problem; seeking advice is a personal choice. By contrast, if you notice a sore that does not heal, a rough crusting patch or a changing mole on sun-exposed skin, you need to see a dermatologist without delay.
Sources
- 11 ways to reduce premature skin aging — American Academy of Dermatology (AAD)
- Sunscreen and prevention of skin aging: a randomized trial (Hughes MC et al.). PMID: 23732711 — Annals of Internal Medicine, 2013
- Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety (Mukherjee S et al.). PMID: 18046911 — Clinical Interventions in Aging, 2006
- Botulinum toxin type A for facial wrinkles (Camargo CP et al.). PMID: 34224576 — Cochrane Database of Systematic Reviews, 2021
- Dermal Fillers (Soft Tissue Fillers) — U.S. Food and Drug Administration (FDA), 2023
- Many ways to firm sagging skin — American Academy of Dermatology (AAD)
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
