How to get rid of wrinkles?

A cream for three hundred zloty. A serum that "reduces wrinkles in 14 days". Two months of diligently patting it in every evening.

And in the morning, in the mirror, the same line between the eyebrows.

That does not mean the product was bad. It means it was doing something other than what it promised. Good skincare can prevent wrinkles from forming. It will not remove the ones that are already there.

Why they appear at all

Wrinkles are a completely natural phenomenon. Two processes are responsible for them.

Myoaging — that is, the work of the facial expression muscles. You furrow your forehead, squint your eyes, raise your eyebrows. Every such movement leaves its imprint on the skin, and after years the mark stops smoothing out.

Photoaging — that is, the effect of radiation, mainly UV light.

On top of that comes the ordinary ageing of the body: regenerative capacity declines, collagen and elastin fibres slacken, the skin becomes more susceptible to gravity.

Sooner or later wrinkles will appear in every one of us, unless we prevent it. Aesthetic medicine does not stop that clock — but it can slow it down considerably and preserve what matters most: a natural appearance.

If you are looking for the one thing that gives the most for the least effort — it is sunscreen used every day, not only in summer. In a randomised trial lasting four and a half years, people applying sunscreen every day showed 24% less skin ageing than people using it only occasionally. It is the only anti-wrinkle method with that level of evidence — and the only one that works before a wrinkle forms.

The distinction that decides everything

Before we move on to treatments, one thing worth remembering. It determines whether the chosen treatment will work, or whether you will simply spend money.

A dynamic wrinkle is created by the work of a muscle. You can see it when you smile, frown or squint. Its cause is movement — and it is movement that has to be limited in order to smooth it out.

A static wrinkle is visible at rest. You do not have to do anything with your face — it is simply there. It forms where the skin has lost firmness, density and volume, and the collagen fibres have stopped keeping it taut.

These two types are treated completely differently. Relaxing a muscle will not help a wrinkle that came from collagen loss. And the other way round — filling a wrinkle driven by an overactive muscle is working on the effect, not on the cause.

Where the individual wrinkles come from:

• Dynamic — The work of the facial muscles — they form exactly where the movement happens · Driven by muscle movement.
• Sun-induced — Exposure to sunlight; often accompanied by discoloration · Visible at rest.
• Sleep — The way you settle down to sleep — the worst thing for the face is sleeping on your stomach · Visible at rest.
• Gravitational — The skin loses firmness and density, it stops resisting gravity · Visible at rest.

Everyone is exposed to gravitational wrinkles. It is a matter of time, not of lifestyle.

Crow's feet, the frown line, marionette lines — who is who

In the clinic and on the internet there are amusing names going round that simply say where a wrinkle sits. They are worth knowing, because patients and doctors then speak the same language.

• Crow's feet — The corners of the eyes — from the work of the orbicularis oculi muscles · Dynamic.
• The frown line — Vertically between the eyebrows · Dynamic.
• Horizontal forehead lines — Across the forehead · Dynamic.
• Nasolabial folds — From the nose to the corners of the mouth · From loss of volume. They form when the tissue of the cheek loses volume and slides downwards, and not from the work of a muscle — which is why they are treated by rebuilding the volume of the mid-face, not by weakening muscles.
• Bunny lines — The sides of the nose, most often in mature age · Dynamic.
• Smoker's lines — Around the mouth — from the work of the orbicularis oris muscle · Dynamic.
• Marionette lines — From the corners of the mouth downwards, all the way to the chin · Gravitational.

One correction regarding "smoker's lines": yes, they do appear in people who smoke and in fans of drinks with a straw. The tendency can run in families, but genetics does not have the last word here — what most strongly affects the look of the area around the mouth is what can be changed: giving up smoking and daily protection from the sun.

When to start?

The honest answer is: the earlier, the better. Prevention is better than cure — and in aesthetic medicine that principle holds true exceptionally well.

But there is another side to it.

It is never too late. Even when wrinkles have already appeared and are deep and set, the doctor can select a treatment plan, procedures and products that will genuinely improve the appearance of the skin.

It is just worth knowing from the outset what you can count on. Aesthetic medicine does not turn the clock back and it cannot be measured in years. Realistically we are talking about softening wrinkles, improving the tone and the colour of the skin — and about how long such an effect lasts. But it does let you feel better and look younger — and that is usually exactly the point.

Botox: working at the source

This is usually where it starts. The reason is simple: most first wrinkles come from myoaging, that is, from the work of the facial expression muscles.

Botulinum toxin — popularly called botox, and sometimes botulinum poison — is a neurotoxin. It blocks the transmission between a nerve cell and a muscle cell. The facial muscle relaxes, and the wrinkle "straightens out".

This is how the frown line, crow's feet, wrinkles under the eyes, horizontal forehead lines, bunny lines and smoker's lines are treated.

The treatment itself is quick and minimally invasive. The pain is comparable to a mosquito bite.

As for the effect:

• the first result usually after 3–5 days, depending on the product
• maximum therapeutic effect after 14 days
• it usually lasts closer to 4 than to 6 months, and in men for a shorter time than in women

We will not perform the treatment during pregnancy and breastfeeding, in diseases of the neuromuscular junction, in case of allergy to the ingredients of the preparation, or with inflammation at the injection site. Tell us about all your medications too — some antibiotics intensify the action of the toxin. The most common side effects are mild and temporary: redness, slight swelling, a bruise, sometimes a headache for the first few days. Less often there is temporary drooping of the eyelid or brow — it resolves on its own, but you need to know about it before the treatment, not after it.

When botox alone is not enough

There are deep wrinkles that formed where facial expressions worked really hard for years. In such cases relaxing the muscle alone does not settle the matter.

The therapy starts with the cause — that is, with limiting the work of the muscle. And two weeks after the botulinum toxin injection comes filling with hyaluronic acid.

Why this particular combination? Because it hits the cause and the effect at once. A relaxed muscle means the wrinkle will not deepen any further. The filler smooths out what has already formed.

With fillers there is one thing that has to be said plainly. Very rarely the product can block a small blood vessel. The warning signs are pain that is disproportionately severe or increasing after the treatment, paling of the skin, net-like redness and, in the eye area, any disturbance of vision. If you notice any of these, call the clinic immediately, do not wait until morning. Hyaluronic acid has an antidote — an enzyme called hyaluronidase — and the outcome depends on how quickly it is given.

Hyaluronic acid also works well where botox has nothing to relax by definition: in the lower part of the face and with deep wrinkles.

The skin loses its tone — what then

It happens that stubborn dynamic wrinkles are already under control, and yet the skin still demands something more. Less elastic, less dense, as if tired.

This is where revitalising treatments come in.

Needle mesotherapy involves injecting into the skin a product meant to revitalise it quickly and to stimulate the fibroblasts to produce collagen and elastin. Hydration and elasticity improve.

The effect depends on what ends up in the syringe. It may be hyaluronic acid alone — then it is mainly about hydration. It may also be a product with vitamins, trace elements, biomimetic peptides and antioxidants.

Fractional microneedling radiofrequency combines two things at once: punctures with microneedles and the simultaneous emission of RF energy, that is, radio waves. The skin is lifted, the pores reduced, and the wrinkles shallower.

With static wrinkles resulting from a loss of collagen and volume, there are also biostimulators — polylactic acid and calcium hydroxyapatite — as well as PDO threads, which tighten the skin and at the same time stimulate it to produce collagen. What makes sense in a particular case is decided by the doctor after looking at the face.

And what if you are afraid of needles?

It is more common than you think. Our clinics in Krakow and Warsaw regularly see patients who want to get rid of their wrinkles but feel faint at the sight of a syringe.

Aesthetic medicine has an alternative for them.

The fractional laser works by damaging the dermis in columns — in a fully controlled way. During the natural healing process the damaged cells are replaced by new tissue. The skin becomes healthier and younger-looking.

There is just one "but": after such a treatment the skin needs time to regenerate. Not every patient can afford a few days without going out among people.

For them there is laser wrinkle reduction with an Nd:YAG laser — a non-ablative treatment that makes wrinkles shallower with no recovery time.

What to expect and what not to

Wrinkles can be made shallower. Some of them — especially fresh, dynamic ones — can be smoothed out practically completely.

But it is worth knowing where the limit lies.

A deep, set furrow after years of facial expressions will not disappear after one treatment, and it will not disappear without a trace. Skin that has been losing collagen for decades will not rebuild it in a month. And the effect of botox lasts a few months, not a few years — after that time the muscle goes back to work.

This is not bad news. It is simply a realistic picture of how aesthetic medicine works: in series, according to a plan, at a sensible pace.

The best plan is the one that comes out of looking at your face — not out of reading an article. Because only then can you see how much of those wrinkles is muscle and how much is lost collagen.

In practice it looks like this: we calm dynamic wrinkles with botulinum toxin, and we fill furrows and wrinkles caused by volume loss with hyaluronic acid. We often combine both methods in a single plan.

This article was prepared by the team of the Dr Kuschill MEDESTETIS clinics.

Medical supervision: Joanna Kuschill-Dziurda, MD, PhD — specialist allergist, internist, aesthetic medicine physician.