Fine Wrinkles vs. Deep Wrinkles: Do Treatments Differ?

Yes, deep wrinkles often require volume-replenishing treatments because surface management alone is insufficient. Deeply etched wrinkles, such as nasolabial folds, result not only from skin texture issues but also from a loss of volume in the deep dermis and subcutaneous tissue, combined with tissue sagging. Therefore, the correct approach is to fill the sunken space or support the structure.

For immediate volume, HA Filler is the basic option. There are also options like Sculptra and RADIESSE®, which also induce collagen production, and Re2O®, which reinforces the dermis with human-derived collagen (hADM) components. The choice of material depends on the depth of the wrinkle, the area, and skin thickness. If sagging is a major contributing factor, considering a lifting procedure first may ultimately reduce the amount of filler needed.

You can distinguish them by making a neutral expression in front of a mirror. Wrinkles that appear only when you make facial expressions, such as smiling or frowning, and disappear when your face is at rest, are dynamic wrinkles. Wrinkles that remain even without making any expression are static wrinkles. Wrinkles on the glabella, forehead, and around the eyes often start as dynamic wrinkles and, with repetition, become fixed as static wrinkles.

This distinction is important because the treatment tools are completely different. If you only fill volume for wrinkles caused by muscles, or only relax muscles for wrinkles caused by volume loss, it is difficult to achieve satisfactory results.

Botulinum toxin type A is a treatment suitable for dynamic wrinkles caused by the contraction of facial muscles. Its principle is to temporarily reduce nerve signals to the muscles, thereby alleviating excessive expression-related contractions. The glabellar lines, forehead wrinkles, and crow's feet are representative areas of indication, and the effect is generally known to last for about 3 to 4 months.

On the other hand, for static wrinkles that are already deeply etched and remain even without expression, botulinum toxin type A alone has limitations. However, consistent management during the dynamic wrinkle stage can help slow the progression of wrinkles becoming fixed as static ones, so it also has significance as a preventive measure to start when wrinkles are still shallow.

A combined approach that divides treatment by cause is the answer. In reality, wrinkles after the 40s are mostly a mix of facial muscle strength, volume loss, and skin texture aging. Therefore, roles are divided: botulinum toxin type A reduces excessive expression-related contractions, dermal fillers or collagen injections fill the remaining deep grooves, and Skin Boosters or radiofrequency refine fine wrinkles and texture.

The typical sequence is that if the skin lacks muscle volume, volumizing is done first, followed by lifting to organize the foundation and then complementing the skin texture. Botulinum toxin type A can be combined with any treatment. The right combination and sequence vary by individual depending on the type and proportion of wrinkles, so it is recommended to determine your priority through a diagnosis by a dermatologist.