American Academy of Facial Plastic and Reconstructive Surgery

I am 35 years old and have a lot of facial wrinkles.

Question: Would Botox be a good alternative to a facelift?

Answer: Yes, absolutely.  Botox, or neurotoxin, is the preferred method to manage facial wrinkles of the upper face.  Facelifts really do not offer any benefit to wrinkles since a facelift is used to lift and suspend sagging of underlying facial muscles.  With repeated injections of Botox, the facial muscles of the upper face start to relax, and the skin begins to heal.  Long-term neurotoxins are so powerful in terms of their ability to help you with helping skin have better texture, tone, and fewer wrinkles.  Early-on consistency is the key so that over time you need less Botox.  The earlier you start the better.  If you wait until wrinkles get very deep, it takes longer to heal the skin.

I’ve been looking into wrinkle treatments.

Question: Which is the best injectable for facial wrinkles?

Answer: The problem with this question is to divide wrinkles into static (non-moving) and dynamic (moving) wrinkles.  Another way to categorize wrinkles is to focus on upper versus lower facial wrinkles.  The upper face tends to have more dynamic wrinkles and the lower face tends to have more static wrinkles like the smile lines between the nose and the sides of the mouth.  For dynamic wrinkles, neurotoxins (like Botox) are truly the preferred way to address them in many cases since the neurotoxin helps to target the cause (movement) rather than the effect. By blocking bad habits like frowning, over time the skin will heal and the wrinkles start to diminish.  When the wrinkle gets very deep and you are impatient for the neurotoxin to work, then additional fillers may help but with the thin skin of the upper face, fillers may not be the ideal way to go.  With the lower face, neurotoxins carry the risk of speech problems if done in the wrong areas so in general lower facial folds and larger wrinkles are better candidates for injectable fillers.  Which filler is best?  That all depends on a conversation with your treating surgeon.  Why he would prefer one filler over another based on ability to fill a certain wrinkle characteristic, longevity, permanence, ease of correction if there is a problem with the filler, etc.  He would be better to counsel you on your specific type of wrinkle and his experience level with treating that wrinkle with a certain type of filler.

I have a lot of wrinkles on my face and forehead.

Question: Would you recommend a facelift?

Answer: Facelifts really do not work to help wrinkles.  Facelifts are intended to help with sagging muscles like jowls and neck hanging.  Depending on how the surgeon defines “facelift” it can either describe a lift of just the lower face and neck or also to include the sagging cheek and/or brow region.

Even though when you pull your face up with your fingers the wrinkles go away, this type of movement is really not indicative of what a lift can do.  I call this the “two-finger rule”, meaning when you lift with two fingers this really does not indicate what a facelift can achieve.

So how do we fix wrinkles?  We have to divide the wrinkles into two types:  static (not moving, present all the time) and dynamic (wrinkles only appear during movement like during smiling, frowning, etc.)  Dynamic wrinkles of the upper face (but rarely of the lower face) are managed with botulinum toxin (e.g., Botox) since neurotoxins block the upper face from moving so that dynamic wrinkles do not appear.  Recurrent and steady use of neurotoxins every 3 to 4 months can lead to ongoing diminishment of wrinkling even sometimes to the point that dynamic wrinkles do not appear as deep when the neurotoxin has completely faded away.  Also, steady use of neurotoxins can help even diminish static lines if they are not too deep.

With the occurrence over time of static wrinkles, neurotoxins can still help diminish them with steady application, as mentioned above.  However, sometimes sun-damaged skin with significant wrinkles may require chemical peels or laser resurfacing to help modify these types of wrinkles.  Wrinkles of the lower face are harder to manage a with a neurotoxin.