Wrinkles: why they appear and what treatments exist

Why do wrinkles appear?

Facial ageing does not occur solely at the surface of the skin.

Over the years, different structures change: the epidermis, the dermis, collagen, elastin, facial fat, ligaments, muscles, and even the facial skeleton.

This is why facial ageing is a three-dimensional process. It is not simply a matter of 'the skin wrinkling'.

Collagen changes over time

Collagen provides an important part of the structural support of our dermis.

With ageing, the capacity to maintain and renew that dermal matrix progressively declines.

Changes also occur in elastin and other structures of the extracellular matrix.

The result is skin that becomes progressively thinner, less elastic, less resilient, and more prone to forming lines and wrinkles.

The sun: one of the great accelerators

There is a distinction between chronological ageing and photoageing.

The former occurs simply with the passage of time. The latter is caused primarily by cumulative exposure to ultraviolet radiation.

UV radiation promotes the degradation of collagen and other changes in the dermal matrix, as well as irregular pigmentation and alterations in skin texture.

This is why two people of the same chronological age can present completely different skin depending, among other factors, on their history of sun exposure.

Daily photoprotection is one of the most important interventions for limiting photoageing.

What are dynamic wrinkles?

These are the ones that appear mainly when we move our facial expression muscles.

For example: we raise our eyebrows → forehead wrinkles appear; we frown → frown lines appear between the brows; we smile → the well-known crow's feet or eye wrinkles appear.

When we are young, many of these lines practically disappear completely when the muscle relaxes.

But we repeat those movements thousands of times. Over time, and with the progressive changes that occur in the skin, some of them begin to remain visible even at rest.

The dynamic wrinkle then begins to also take on a static component.

What are static wrinkles?

These are lines that remain visible even when the face is relaxed.

They can result from different mechanisms: photoageing, loss of elasticity, changes in the dermis, repeated movements over many years, and structural changes related to facial ageing.

Here we can already begin to understand why no single treatment exists.

And what about folds?

There are structures that we colloquially call 'wrinkles' but that have a much greater three-dimensional component.

For example, certain facial folds can become more visible due to changes in deep structural support and redistribution of the fat compartments.

In these cases, simply placing product directly into each line may not be the most natural strategy.

Sometimes we must first study which structure has changed.

Why does facial volume change?

Facial fat does not form a single uniform layer. It is organised into different compartments.

With ageing, some structures lose volume, others shift position, and support structures also change.

In addition, the facial skeleton undergoes remodelling over time.

This is why temporal hollowing, changes in the malar region, deeper grooves, alterations to the jawline contour, and loss of support in certain tissues can appear.

An aged face is not simply a young face with more wrinkles. Its architecture has changed as well.

So, what treatments exist for wrinkles?

It depends on which mechanism we want to address.

We can work on muscle movement, skin quality, support, volume, pigmentation, and photoageing.

And very often the most natural result comes from combining strategies in a considered way.

1. Botulinum toxin: when the problem is movement

Botulinum toxin temporarily reduces the contraction of certain muscles.

This is why it is particularly useful for dynamic wrinkles, such as certain forehead lines, frown lines, and the periocular region.

The AAD notes that botulinum toxin is used to temporarily soften wrinkles caused by muscle contraction.

The goal should not be to leave a face completely immobile. The goal is to modulate muscle strength while preserving expression.

Can it prevent a wrinkle from becoming more pronounced?

When a line repeatedly appears as a result of muscle contraction, reducing that contraction decreases the repeated folding of the skin.

This can help prevent certain dynamic lines from continuing to deepen.

But it does not mean, either, that all people need to start botulinum toxin at a certain age.

We treat anatomy + movement + need — not a number on an ID card.

2. Hyaluronic acid: it is not simply a wrinkle filler

When someone searches for a wrinkle filler, they usually think of hyaluronic acid straight away.

But using it correctly is far more complex than introducing product beneath every line.

Hyaluronic acid fillers can be used to add volume or support in selected areas and to soften certain folds and depressions. Their effects are temporary, and the indication depends on the anatomy and on the product used.

In some patients we treat a specific area directly. In others, the most natural result appears when we discreetly restore support to another structure that is contributing to the fold.

More product does not mean more rejuvenation

This point is fundamental.

Trying to erase absolutely every fold by progressively filling the face can alter its proportions and end up producing an artificial result.

My philosophy is different: we are not chasing a face without lines. We are looking for a rested, well-proportioned, and natural face.

3. Biostimulation: improving the structure of the skin

There are treatments whose main objective is not to fill a wrinkle immediately.

They aim to stimulate dermal remodelling processes and collagen production.

Among them we find certain biostimulators, such as calcium hydroxyapatite or poly-L-lactic acid in selected indications.

Results appear gradually because they depend on a biological response from the tissue.

That is why we talk more about skin quality and structure than about 'filling a line'.

4. Skinboosters and intradermal treatments

In certain patients, our primary goal is to improve hydration, elasticity, and surface quality.

Intradermal treatments can form part of a global rejuvenation strategy.

But they do not replace botulinum toxin when a significant muscular wrinkle is present.

Nor do they replace a structural treatment when there is a loss of support.

Each tool has a different function.

5. Fractional lasers

When photoageing, irregular texture, and fine lines are present, fractional treatments can be particularly interesting.

They create controlled microscopic treatment zones and trigger skin repair and remodelling processes.

Depending on the device, we can use ablative or non-ablative technologies.

Resurfacing lasers can improve fine lines, texture, and other signs of photoageing.

Here we are not filling a wrinkle. We are working on the skin that forms that wrinkle.

6. Chemical peelings

Peelings use chemical substances to produce a controlled renewal of specific skin layers.

Depending on their depth, they can help improve texture, pigmentation, luminosity, and certain superficial lines.

Not all peelings have the same depth or the same level of risk.

And once again: more aggressive does not automatically mean better.

7. Retinoids

Retinoids are one of the topical tools with the strongest evidence base for photoageing.

They can promote epidermal renewal and modifications of the dermal matrix and, over time, improve certain fine lines and pigmentary changes.

But they require consistency. Real skin rejuvenation does not happen in seven days.

8. Photoprotection: the treatment that begins before the wrinkles

We can use botulinum toxin. Hyaluronic acid. Laser. Peelings. Biostimulation.

But if we continue accumulating daily ultraviolet damage, we keep promoting one of the main mechanisms of skin ageing.

That is why photoprotection is not simply something we recommend after a laser treatment. It is part of a skin ageing prevention strategy.

Can wrinkles be completely eliminated?

Here we must be very clear.

When someone searches for wrinkle removal or the elimination of wrinkles, they may picture completely smooth skin. That should not be our goal.

We can soften wrinkles, prevent certain dynamic lines from deepening, improve skin quality, restore support where indicated, and treat photoageing.

But a completely immobile face with no lines whatsoever is not necessarily a rejuvenated face. It can also be an overtreated face.

Which treatment is best?

There is no single answer. Because it depends on what we are treating.

If muscular movement predominates: botulinum toxin.

If there is loss of support or volume: we may consider hyaluronic acid or other structural strategies.

If the predominant issue is loss of dermal quality: bioestimulation and selected regenerative treatments.

If we have superficial lines and photoageing: lasers, peelings and topical treatment may have a role.

And if several mechanisms are present: we can combine them.

At what age should we start?

There is no correct age.

A 35-year-old with intense sun exposure may have different needs from a 50-year-old with excellent skin quality.

Genetics, phototype, facial movement, tobacco use, sun exposure, skin care and anatomy all play a part as well.

That is why we do not treat ages. We treat faces.

And what about upper-lip wrinkles?

Upper-lip wrinkles are a good example of a multifactorial problem.

Repeated movement of the orbicularis muscle, photoageing, changes in the dermis, progressive loss of support and individual anatomy all play a role.

That is why simply filling all of them directly does not always deliver the most elegant result.

We may need to combine skin, movement and support treatment depending on the patient.

What does rejuvenating naturally mean?

For me, it means something simple.

That after the treatment, someone tells you: 'You look great.' And not: 'What have you had done?'

Aesthetic medicine should not try to erase every feature that shows a person smiles, gestures, or has truly lived.

The goal can be to improve certain consequences of ageing while preserving expression, proportions, and identity.

What I want you to remember

Wrinkles do not all appear for the same reason.

Some appear primarily because we move our muscles. Others because the skin has progressively lost collagen and elasticity. Others reflect years of sun exposure. And some lines appear because the deep architecture of the face changes as well.

That is why there is no single treatment for wrinkles. There are treatments for the different mechanisms that produce those wrinkles.

Botulinum toxin to modulate certain movements. Hyaluronic acid when we need support or volume. Biostimulation to work on the dermal structure. Lasers and peelings for certain surface alterations and photoageing. And photoprotection to try to prevent some of that damage from continuing to accumulate.

That is why, when someone asks me: 'Doctor, how do we get rid of this wrinkle?', I prefer to start with another question: 'Why is it there?'

Because when we understand the cause, we can choose the right treatment. And very often we need far less product than we had imagined.