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What are wrinkles?

Wrinkles are visible creases and folds in the skin. They develop as a person ages, when the skin’s structure changes. At first, fine lines are visible only when a person makes facial expressions or gestures. Over time, the skin’s natural support structure (collagen, elastin, hyaluronic acid) weakens. This causes expression lines to develop into permanent wrinkles.

Wrinkles – The Aftertaste of Life

Wrinkles form when the skin can no longer fully recover its smoothness after facial expressions, stretching, or other forms of strain. Not everyone is bothered by wrinkles and other signs of aging. We all have different ideas about beauty, which is a wonderful thing.

Superficial lines and deep wrinkles

Not all wrinkles are the same. Some are small expression lines, while others are deep furrows that have etched themselves into the skin over the years.

• Fine lines are among the first signs of aging. Their formation is accelerated in particular by dry skin, exposure to UV radiation, and the body’s inevitable loss of collagen.
• Deep wrinkles extend into the deeper layers of the skin. They are caused by long-term facial expressions, a decrease in collagen and elastin, and changes in the subcutaneous fatty tissue, muscles, and bones.

Dynamic and Static Wrinkles

Wrinkles can be classified based on whether they are visible only when making facial expressions or also when the face is completely relaxed.

This classification helps explain why not all wrinkles respond to the same treatments. Many people have both dynamic and static wrinkles at the same time.

• Dynamic wrinkles appear when the face moves. They are caused by repeated muscle contractions and are common, for example, on the forehead, between the eyebrows, and at the corners of the eyes.
• Static wrinkles are visible even when the face is at rest. They indicate that the skin’s collagen, elastin, and other supportive structures have weakened over time.

Ultimately, all roads lead to gravity.

What causes wrinkles?

Wrinkles don't appear overnight, nor are they caused by a single factor. They form as time, genetics, the sun's UV rays, lifestyle, and repetitive facial expressions change the skin over the course of years and decades.

The years show on your skin—and there's nothing wrong with that

Visible signs of skin aging begin in one’s twenties, though changes become noticeable in the mirror later on. Over the years, the skin’s renewal cycle slows down, collagen production decreases, and the skin loses its elasticity. At the same time, moisture evaporates from the skin more easily than before.

All of this first appears on the skin as fine lines and eventually as permanent wrinkles.

Aging is a natural part of life, but the appearance of visible signs of aging can be slowed with proper skincare and a healthy lifestyle.

The Dark Side of the Sun

If one had to name the single most significant external cause of wrinkles, it would be the sun's UV radiation.

The skin on the face is exposed to the sun almost every day. UV radiation slowly but surely damages the skin’s structural framework. People who spend a lot of time in the sun develop wrinkles earlier than their peers who make a point of using sunscreen.

• UVA radiation penetrates deep into the skin. It breaks down collagen and elastin and accelerates premature skin aging.
• UVB radiation affects the outer layers of the skin. It causes redness and, together with UVA radiation, contributes to long-term skin damage.

The skin's natural support structure weakens

The skin's support structure relies on three components: collagen, elastin, and hyaluronic acid.

The support structure of young skin is strong because it contains large amounts of collagen, elastin, and hyaluronic acid.

• Collagen is the skin's most important structural protein. Up to 70% of the skin's protein is collagen.
  Collagen makes the skin firm and the features well-defined.
• Elastin is responsible for the skin's elasticity. Thanks to it, the skin returns to its smooth state after being subjected to pressure, stretching, and stress.
• Hyaluronic acid binds large amounts of water. The body's own hyaluronic acid makes the skin plump and soft.

The levels of collagen, elastin, and hyaluronic acid begin to decline around the age of 25. Around the ages of 40–50, the weakening of the skin’s support structure accelerates significantly. The skin becomes thinner, loses its firmness, and recovers slowly after stress. Shallow expression lines turn into deep wrinkles.

The skin remembers surprise, a frown, and even laughter

Facial expressions are an important part of communication. We smile, squint, furrow our brows, and raise our eyebrows thousands of times a day. Young skin returns to its original state after every expression. Aging skin can’t keep up. Decades of repeated muscle movements leave permanent marks on the skin.

The first permanent wrinkles often appear on the forehead, at the corners of the eyes, and between the eyebrows.

E-cigarettes and nicotine pouches

Smoking accelerates skin aging through a variety of mechanisms. These changes become visible on the skin before they become visible or noticeable elsewhere in the body.

• Nicotine constricts the small blood vessels in the skin, and carbon monoxide reduces the flow of oxygen to the tissues. The skin receives too little oxygen and nutrients and takes on a dull appearance.
• Acrolein and other harmful compounds in cigarette smoke trigger the activity of enzymes that break down collagen. As collagen is lost, the skin becomes saggy and wrinkled.
• Free radicals in cigarette smoke damage skin cells. The oxidizing compounds in smoke increase oxidative stress in the body, which accelerates premature skin aging.
• Nicotine weakens the skin's protective barrier and slows down its repair mechanisms. The skin dries out easily, feels rough, and takes longer to recover than before.

The effects of smoking eventually show up on the face. Vertical “smoker’s lines” form especially around the mouth. The skin on the entire face begins to look saggy, dull, and older than it actually is. The longer you smoke, the more noticeable these changes become.

Unfair Genes

Genes influence how thick the skin is, how much collagen it contains, and how quickly signs of aging begin to appear. That’s why some people develop their first wrinkles as early as their thirties, while others’ skin remains smooth for decades.

Everyday Choices

Everyday choices also show up on your skin. A single poor choice won't cause wrinkles, but the cumulative effect of consistently making poor choices can accelerate skin aging.

• Heavy alcohol consumption dries out the skin.
• Lack of sleep weakens the skin's natural repair mechanisms.
• Prolonged stress slows down collagen production.
• An unbalanced diet impairs skin regeneration.
• Insufficient sun protection exposes the skin to photoaging all year round.

Where do wrinkles form?

Wrinkles do not appear on the skin at random. They first form in areas of the skin that move frequently or are highly exposed to external stressors. Thinning of the skin, a decrease in fatty tissue, and, ultimately, gravity explain where wrinkles first appear.

The first wrinkles often appear on the forehead, at the corners of the eyes, or between the eyebrows. Later, signs of aging also begin to appear around the mouth, on the cheeks, on the neck, and along the jawline. Wrinkles form through slightly different mechanisms in each area of the face. Therefore, wrinkle treatment methods also vary.

Forehead wrinkles

Forehead wrinkles form when the forehead muscle raises the eyebrows day after day. At first, the lines are visible only when you make facial expressions. Over time, they begin to show even when your face is at rest.

Read more in our guide about forehead wrinkles and how to treat them.

Sibelius wrinkle

A Sibelius wrinkle forms as a result of repeated furrowing between the eyebrows. It can give the face a tired, worried, or angry expression, even if the emotion does not match the expression. Learn more about the Sibelius wrinkle and its treatment options.

Magpie's Toes

Crow’s feet are small expression lines that form at the corners of the eyes and become more pronounced when smiling or squinting. Crow’s feet are often among the first visible signs of aging, as the skin around the eyes is extremely thin. Pronounced crow’s feet can be treated with Botox if necessary.

Learn more about crow's feet and other wrinkles around the eyes.

Nasolabial lines

Nasolabial folds run from the sides of the nose to the corners of the mouth. They deepen as collagen, elastin, and fatty tissue decrease. Smiling and facial expressions accentuate nasolabial folds. Ultimately, the root cause of nasolabial folds lies in gravity and biochemical changes in the body.

The treatment method is selected based on whether the causes of nasolabial folds are related to the skin, soft tissues, or both.

Puppet Strings

Marionette lines extend downward from the corners of the mouth toward the chin. They can make the face look sad or tired, even when the expression is neutral. These lines are caused by gravity, the loss of collagen in the skin, and the gradual sagging of the facial supporting tissues. Changes in the jawline and cheeks also affect how pronounced the marionette lines appear.

Wrinkles around the lips

Vertical lines that form around the lips are common signs of aging.

Although the vertical lines on the upper lip are often called "smoker's lines," they can also appear in people who have never smoked.

For example, drinking through a straw, pursing the lips, and other repetitive movements can accentuate wrinkles around the mouth over the years. Thinning skin, a decline in collagen, and a reduction in lip volume make these lines more visible.

Wrinkles on the neck

The skin on the neck is thin and is constantly exposed to the sun, gravity, and repetitive head movements. As we age, the neck may develop sagging, horizontal wrinkles, and vertical lines. Read more about sagging neck skin and treatment options.

Getting Rid of Wrinkles at Home—How?

You can't stop time, and you can't fool a mirror forever. The good news, however, is that you can improve the evenness of your skin.

Every morning you apply sunscreen, every evening you finish your routine with a retinol cream, and every healthy choice you make in your daily life is a small deposit into your skin’s savings account. The sooner you start taking care of your skin, the more your skin will thank you later.

The Sun—the Skin's Worst Enemy

The sun is a source of light, heat, and vitamin D, but it also damages the skin. The sun’s UVA rays act like invisible sandpaper: they slowly break down collagen and elastin, even if the skin never gets sunburned. You won’t notice the change today or even next week, but years from now, the mirror will remind you of those wonderful days at the beach.

A broad-spectrum sunscreen for daily use is your skin's best friend. It's a good idea to use it year-round.

UV radiation can penetrate even through clouds to reach the skin.

Hydrated skin is like a plump grape…

… and dry skin is a pain.

When the skin is sufficiently hydrated, it looks plumper, softer, and more radiant than usual. Fine lines are more noticeable on skin that is dry on the surface.

• Hyaluronic acid helps the skin retain moisture.
• Ceramides help repair the skin's protective barrier and prevent moisture from evaporating through the skin's surface.
• A consistent skincare routine is better for your skin than an occasional luxury product.

Moisturizer doesn't make wrinkles disappear. However, moisturized skin looks plumper and smoother—for a short while, sometimes even for a few hours.

A product's price, packaging, and marketing claims do not necessarily say anything about its effectiveness.

Retinoids – Your Skin's Personal Trainer

Retinoids, or vitamin A derivatives, are clinically proven to be effective ingredients for preventing wrinkles and moderately reducing the appearance of fine lines.

Retinols and other vitamin A derivatives boost skin renewal, slightly stimulate collagen production, and help the skin repair itself. Results don’t happen overnight, but persistence pays off.

• Retinol is a fairly gentle option for first-time users. By adjusting the product’s retinol concentration, you can also adjust the treatment’s effectiveness.
• Retinal (retinaldehyde) is slightly more effective than retinol.
• Tretinoin is a prescription medication with strong scientific evidence supporting its anti-wrinkle effects.

Smoking leaves marks on the skin

Smoking shows on your face. Every cigarette constricts the blood vessels in your skin, reduces oxygen supply, and accelerates collagen breakdown. Gradually, your skin loses its radiance, elasticity, and ability to repair itself.

• Cigarettes are strongly linked to premature skin aging and wrinkles.
• Cigars and pipes expose the skin to the same harmful compounds.
• Snus and nicotine pouches do not contain smoke, but the nicotine they contain still slows down blood circulation and skin regeneration.
• E-cigarettes often contain the same toxins as regular cigarettes. More research is needed on their long-term effects on the skin.

Your skin loves the simple joys of everyday life

Healthy skin doesn't come from a single "miracle" cream or a perfect diet. It's built on small, daily choices.

• Eat a varied diet and give your skin the nutrients it needs.
• Get enough sleep—the night is your skin’s time to recharge.
• Exercise regularly and keep your blood flowing.
• Also, calm your mind, because long-term stress shows on your face.
• Remember the 80/20 rule—your skin doesn't need to see a perfect life, just a good everyday life.

Your skin doesn't keep track of the occasional indulgence or sleepless night. Above all, it remembers how you treat it most of the time.

Wrinkle Treatment at an Aesthetic Clinic

Medical Skin Care

This is medical skincare:

• Research evidence guides our choices. For the treatment of wrinkles, we select products for which there is clinical evidence of effectiveness.
• A personalized treatment plan. Products that reduce fine lines are selected based on skin type.
• Consistency is key. Medical skin care treatments don't work as quickly as, say, Botox.
• Simple works. A few well-researched active ingredients are usually a better option than a multi-step skincare routine.

Medical skincare refers to skincare based on medical research evidence. Its goal is not to follow rapidly changing skincare trends, but to use active ingredients for which high-quality scientific evidence regarding their efficacy and safety has been published. The treatment is tailored to the skin’s needs. The treatment is designed by a professional in aesthetic treatments.

In medical skincare, the focus is primarily on which active ingredients the products contain, the concentrations of those active ingredients, and how they are used.

Tretinoin is at the heart of medical skincare

If one had to name a single effective, topically applied medication for treating skin aging, the answer would be tretinoin. Tretinoin is a prescription-only vitamin A derivative. Its effectiveness in smoothing out fine lines has been supported by decades of research.

Tretinoin accelerates skin renewal, increases collagen production, and, over time, reduces the appearance of fine lines. However, results do not appear within weeks but become visible only after several months of regular use.

• The strongest scientific evidence on locally applied anti-wrinkle creams.
• It specifically improves signs of photoaging and early fine lines.
• Requires a prescription and a doctor's office visit.
• Does not remove deep expression lines.
• At the start of treatment, the skin may become red, dry, and flaky.
• The tretinoin concentration in the medicated ointment is either 0.025 or 0.05 percent, and treatment almost always begins with the 0.025-percent concentration.

Tretinoin cream (e.g., Avitcid) is not suitable for everyone. It should not be used during pregnancy. In the early stages of treatment, the skin may become irritated and dry. Treatment with tretinoin should always be started according to a doctor’s instructions.

Botox treatments

The skin on your face is like a sheet of paper. When the same origami fold is made thousands of times, the crease eventually becomes permanent. Many wrinkles form exactly this way: Every smile, squint, and furrow of the brow leaves a momentary crease in the skin. Over the years, that crease begins to show even when your face is at rest.

Botulinum toxin relaxes the muscle beneath the skin. The muscle does not become completely paralyzed; rather, its contraction is reduced in a controlled manner. As the muscle relaxes, the skin overlying it also smooths out.

In Europe, the officially approved aesthetic indications for botulinum toxin products include, among others, the glabellar lines, forehead wrinkles, and crow’s feet.

In the United States, botulinum toxin is also approved for the treatment of the platysma muscle. The platysma is a superficial muscle in the neck; when it becomes excessively tense, it accentuates vertical lines on the neck and pulls the jawline downward. Relaxing the platysma with botulinum toxin reduces signs of aging in the lower face and neck for a few months. This treatment is often referred to as the “Nefertiti lift.”

Botox treatments are the best choice when wrinkles are caused by muscle activity.

Learn more about Botox treatments.

Filler treatments

Fillers reinforce the face’s natural structures. As we age, the face gradually loses fat tissue, collagen, and the support provided by the bones. As the underlying structure weakens, the surface begins to sag.

Hyaluronic acid-based fillers can restore lost volume to facial features and smooth out deep lines. The goal of the treatment is not so much to fill a single wrinkle as it is to balance out the areas where the causes of wrinkles lie.

Learn more about filler treatments.

Collagen-stimulating treatments

Collagen stimulators work more slowly than Botox and filler treatments. Their goal is not to fill in wrinkles but to activate the skin to produce new connective tissue protein.

When Treating Wrinkles 

• Results are almost always achieved through a series of treatments
• The results of these treatments are often more subtle than those of botulinum toxin and filler treatments
• On the other hand, the results last longer than, say, those of Botox treatments

Collagen stimulation treatments are also referred to as biostimulation treatments. In practice, both terms refer to procedures that trigger the skin’s own repair and regeneration processes.

Examples of collagen-based biostimulators

• Profhilo
• Profhilo Structura
• Polynucleotides
• mesotherapy
• Harmonyca
• Radiesse
• Sculptra
• SkinPen microneedling

The results of all biostimulation treatments develop gradually over the weeks and months following treatment, as new connective tissue proteins (collagen and elastin) are produced in the skin.

Learn more about collagen stimulation treatments.

Laser treatments smooth out wrinkles

Laser treatments are a wide variety of light-based procedures. Some laser treatments are ideal for reducing wrinkles and other signs of aging.

Laser treatments can be categorized in two ways:

1. Ablative and non-ablative lasers (how intensely the skin is treated)
   • An ablative laser selectively removes part of the skin's outermost layers
   • A non-ablative laser does not remove skin but heats the tissue
2. CO₂ and erbium lasers (which type of laser is used)
   • _{A CO2—}or carbon dioxide—laseris suitable for reducing deep wrinkles and promoting intense skin rejuvenation. The recovery time is often quite long.
   • An erbium laser reduces superficial and medium-depth wrinkles. The recovery time is relatively short, but achieving good results often requires a relatively long course of treatment.

A fractional_CO2 laser is often the best option

Many carbon dioxide and erbium laser treatments can be performed using a fractional approach. In fractional laser treatment, the laser beam is divided into small spots. The fractional laser does not completely ablate or treat the skin, but only partially . Untreated tissue is left between the treated areas. This laser treatment method accelerates skin healing and shortens recovery time.

Chemical Peels Using AHA, BHA, and TCA Solutions

In a chemical peel, an acid solution is applied to the skin to gently remove the outer layers of skin. At the same time, skin renewal is accelerated, which can help smooth out shallow wrinkles.

Chemical peels are particularly effective for treating fine lines. at VM Aesthetics perform chemical peels.

Microneedling

Microneedling tricks the skin into thinking it absolutely needs repair. During the procedure, thin, sterile needles create microscopic channels in the skin. The formation of these channels stimulates the body to produce large amounts of new collagen.

SkinPen is one of the most extensively studied microneedling devices. Microneedling is particularly suitable for treating the following signs of premature aging:

• Superficial wrinkles
• Fine lines around the eyes
• The first fine lines on the cheeks

Learn more about microneedling.

Surgical Options

If wrinkles are accompanied by significant skin laxity and excess tissue, a surgical facelift or eyelid surgery may be the most appropriate option.

Surgery does not stop the aging process, but it can correct advanced changes more effectively than injectable or device-based treatments. The most appropriate treatment option is always assessed on an individual basis during a consultation with a plastic surgeon.

Which treatment is best for which type of wrinkle?

Prevention and Treatment of Wrinkles

• Superficial treatments: moisturizing skincare products, retinoids, microneedling, and mild laser treatments.
• Dynamic facial wrinkles: Botox treatments are generally the most effective option, as they reduce the muscle movements that cause wrinkles.
• Static wrinkles: Filler treatments, collagen-stimulating treatments, and laser treatments can reduce the depth of and fade permanent wrinkles.
• Wrinkles caused by photoaging: sunscreen, retinoids, fractional_{CO2 laser}, microneedling.
• Nasolabial folds: dermal filler treatments, Profhilo Structura, Harmonyca.
• Marionette lines: fillers, collagen-stimulating treatments, or combination treatments.
• Neck wrinkles and vertical lines: Botox treatments (on a case-by-case basis), collagen stimulation treatments, laser treatments, and, depending on the situation, surgery.
• Comprehensive skin aging: The best results are achieved by combining multiple treatment methods.

Wrinkle	The most common reason	Types of Treatment
Horizontal lines on the forehead	Recurring Expressions	Botox treatments, retinoids, laser treatments
Sibelius wrinkle	Furrowing the Brows	Botox treatment
Magpie's Toes	Smiling and Winking	Botox treatments, laser treatments, microneedling
Nasolabial lines	Sagging of the facial supporting tissues	Filler Treatments, Profhilo Structura, Liquid Facelift
Puppet Strings	Gravity and Collagen Loss	Filler treatments, collagen stimulation treatments
Wrinkles around the lips	Aging, smoking, facial expressions	Botox and filler treatments, Profhilo, laser treatments, retinoids
Wrinkles on the neck	Aging, age-related changes in the platysma muscle, UV radiation	Botox treatments, collagen stimulation treatments, laser treatments, surgery

Treating wrinkles is like repairing a car. If a tire is flat, an oil change won’t help. If the engine is sputtering, just washing it isn’t enough. Once you identify the cause of the problem, you’ll also find the best solution.

When Appearances Tell the Wrong Story

Wrinkles are a natural part of life, and treating them is neither a measure of well-being nor an obligation. Many of us embrace our wrinkles with pride and joy.

Sometimes, however, the reflection in the mirror begins to tell a story that doesn’t feel like your own. Your expression constantly looks angry, worried, or tired, even when you’re feeling great. In such a situation, seeking aesthetic treatments isn’t about an obsessive pursuit of youth, but rather about wanting one’s appearance to reflect how one feels inside.

At a cosmetic clinic, a consultation often begins not with a recommendation for a specific cosmetic treatment, but with the sharing of information. Once the client and the professional understand what causes wrinkles and what can—or cannot—be done about them, it’s easy to make decisions.

The best starting point for cosmetic treatment is that you make the decision for yourself, not to please others.

If wrinkles are bothering you, we at VM Aesthetics be happy at VM Aesthetics your options with you. Sometimes the best solution is a cosmetic treatment. Other times, sun protection, high-quality skincare, and the understanding that not all changes need to be corrected are enough.