Facial wrinkles

Some facial wrinkles are easy to get rid off through cosmetic surgery and related procedures, and others are notoriously difficult to treat.

Forehead wrinkles can be treated by a forehead lift, which is fairly efficient but has the annoying consequence of pushing the hairline up.

I therefore recommend a forehead lift only to balding men who will have a hair transplant after the forehead lift. The scars of the forehead lift would initially be located on a non-hair covered part of the forehead, which later would be covered with hair through a hair transplantation.

For those who do not want to consider this, Botox is the better solution for forehead wrinkles.

The vertical glabella wrinkle between the eyebrows also is best treated with Botox.

The vertical nasal fold is best augmented through facelifts.

The facial wrinkles most difficult to treat are those in the corners of the mouth, and underneath the lip. They cannot be gotten rid of by a skin pull in any direction, and because they also are not the result of a persistent muscle contraction (like the glabella wrinkle), Botox injections also won’t make them disappear once they are there.

One can, however, spare a small amount of Botox for the area below the lower lip when one takes regular (half yearly) summary Botox injections distributed over several areas of the face, as I anyway recommend. Such applications of Botox into the area below the lower lip will not approve one’s appearance, but they will contribute towards avoiding a further slide down the path of looking older.

As Botox and lifts can’t improve the presence of wrinkles in the area below the lower lip, considerable effort has been put into finding other solutions, unfortunately with little success… And I speak from experience, as I have tried them all.

The first recommendations have been various fillers, usually collagen, as they are not very invasive. However, the effect was minimal, and the injections were expensive, more expensive even then Botox. There are newer fillers on the market now, and as they are partially synthetic, they are supposed to have a more lasting effect, because their molecules are too large to be absorbed and carried away through the lymph and blood streams. However, these fillers with allegedly more dramatic effects are recommended only for deep wrinkles, such as the nasal fold.

But there, I don’t need fillers. The nasal fold responds best to facelifts.

In areas with finer wrinkles, such as in the corners of the mouth, these fillers with synthetic components cannot be used because there is the considerable danger of bumps forming. And these bumps could not be treated when they are there. These partially synthetic fillers are also not indicated for the half moon-shaped wrinkle above the chin (below the lower lip), for the same reason: the danger of bumps.

I am no longer spending money on fillers.

The next, more radical, procedure I tried for the area below the lower lip was a laser abrasion. The theory is that when the top layer of skin is removed over a certain area, new, younger, skin forms there which will be more leveled.

Well, the new skin does form alright. But from my own experience, I can tell that the wrinkles won’t be gone.

Initially, the whole area that has been treated in an abrasion will be one open wound over which crust forms. The crust will fall off, first from the area that has previously not have had any wrinkles at all, and last from the parts that have had wrinkles.

Now, if unwrinkled skin would form under this crust, this would just be fine. But it won’t. The deeper the wrinkle has been before the dermal abrasion, the longer the crust will take to fall off. And once if has fallen off, the wrinkle will still be there.

Not just that. There even is considerable danger that skin that has been treated in a laser abrasion will look worse after the procedure.

First, there will be reddening. The reddening will disappear soon from areas that have been flat before the derma-abrasion, and last from the wrinkles. Thus, wrinkles that have healed after a derma-abrasion will first appear more pronounced than they were previously, because of the red coloration.

And then, if crust is peeled off before the skin has healed, small scars can persist forever; they just look like pock marks.

I have had one derma-abrasion, and I won’t go for another one. I still may try another filler if a sensational new product enters the market.

And what do I do until then? I use Retin A cream. It does not have a dramatic effect, but there is sound research that shows that it is better than no Retin A. I myself have not seen much effect, but at least, it doesn’t make things worse.

And I still spear these tiny amounts of Botox, so that wrinkles won’t get deeper.

Apart from that, I pursue a new idea that so far, I haven’t seen reflected in any treatment plans.

Like most people, my face looks younger when I am above my ideal weight. I just accumulate fatty tissue in various spots of the face, that all make for a smoother look. This effect is better than that of any filler (but probably not as good as the effect of a facelift).

But a strategy to be above my ideal weight for facial appearance, of course, leaves me with a less than attractive waist line.

But I am not populating beaches, and at the time a woman sees me undressed, I don’t have to work for her heart any longer.

Thus, my preferred treatment for facial wrinkles is: tummy tucks. I go beyond my ideal weight for all parts of my body, especially the face. And around the waist, I have excess fat cut away.

Sure, it’s an expensive solution. Tummy tucks are a rather costly procedure, and as I do them only under local anesthesia, I cannot get rid of more than 2 kilos in a single session.

Furthermore, there are scars. But as I said, I am not much around undressed. And my strategy has clear priorities: I must look young enough to appear as an attractive marriage option for women around 20 (otherwise their love will be fake). For that, the most important rationale is not to look too old. This is more important than to be good-looking.

And, by the way, or as a closing remark, to be above the ideal weight also looks younger not just for the face but also the upper body… it’s more of a V shape without much time at the gym.


1 Kazue Tsukahara, Yoshinori Takema, Haruhito Kazama, Yukiko Yorimoto, Tsutomu Fujimura, A photographic scale for the assessment of human facial wrinkles , Journal of the Society of Cosmetic Chemists, Vol. 51, No. 2, 127-139

2 Gary L. Grove, PhD, , Mary J. Grove, MEd, James J. Leyden, MD, Optical profilometry: An objective method for quantification of facial wrinkles, Journal of the American Academy of Dermatology Volume 21, Issue 3, Part 2, September 1989, Pages 631-637

3 Claude Lassus M.D., Expanded PTFE in the treatment of facial wrinkles , Aesthetic Plastic Surgery 1991, Volume 15, Issue 1, pp 167-174

4 Lijun Yin, Anup Basu, Generating Realistic Facial Expressions with Wrinkles for Model-Based Coding , Computer Vision and Image Understanding Volume 84, Issue 2, November 2001, Pages 201-240

5 Camil Castelo-Branco, , Francesc Figueras, Maria J Martia nez de Osaba, Joan A Vanrell, Facial wrinkling in postmenopausal women. Effects of smoking status and hormone replacement therapy , Maturitas Volume 29, Issue 1, 20 May 1998, Pages 75-86

7 Manuel A.M. Sarrabayrouse, Indications and Limitations for the Use of Botulinum Toxin for the Treatment of Facial Wrinkles , Aesthetic Plastic Surgery July 2002, Volume 26, Issue 4, pp 233-238