Smile lines and frown lines—they seem to be an inevitable part of aging. In general, dermatologists refer to them as rhytides, but there are also different names for them depending on where they develop. The vertical frown lines between the eyebrows (they often look like the number 11) and the horizontal ones that go across the forehead are glabellar lines…laugh lines—the parenthesis shapes framing the corners of your lips—are nasolabial folds…smoker’s lines above the lip (they also come from pursing the lips) are radial lines…and crow’s feet on the outer corners of the eyes are periorbital wrinkles. But no matter what you call them, chances are you’re not a fan.
Mariam Mafee, MD, FAAD, FACMS, dermatologist, division chief of dermatological surgery, explains how these lines occur…and what to do about them.
What Causes Smile Lines and Frown Lines?
The human face is so expressive because of our ability to use facial muscles to show emotions, from the broad smile of happiness to the furrowed brow of frustration or anger. When we’re younger, the lines that form when we make faces usually disappear when we relax our face, but as we age and use our facial muscles more and more, along with environmental factors such as sun exposure, those lines can become etched into the skin, remaining “static” if they are visible when your face is in a relaxed state. Note: These lines are different from folds that develop as the face loses volume, especially in the nasolabial area, from the loss of fat, collagen and elastin, and the skin droops.
How to Get Rid of Smile Lines and Other Wrinkles
There are many treatments available to lessen or soften the appearance of lines when administered by a skilled dermatologist or cosmetic surgeon. Cost generally depends on the practice and which product is used.
Neuromodulator injections freeze facial muscles with a toxin. As the muscles relax, the lines in the skin relax, too. Botox remains the best known, but there are newer competitors including Daxxify, Xeomin, Dypsort, Letybo and Jeuveau. Results are immediate and can last up to four months…six months with Daxxify. Some people with certain neurological conditions should not get Botox, but it is generally safe for most people. Side effects, including headache and bruising, are typically mild. If the neuromodulator travels, it can cause paralysis of unwanted muscles—for example, the eyelid might droop—but this is very uncommon.
Fillers, often made of hyaluronic acid and with brand names including Juvederm and Restylane, fill out lines to ease them. They can be used on fine radial lines around the lips and deep forehead furrows. Caution: Injecting requires a very high level of skill because if the filler material gets into a blood vessel near the eyes, it could cause blindness. Board-certified dermatologists and board-certified plastic surgeons are providers that are skilled in this area. Results are immediate and can last from six months to two years depending on the filler and location.
Ablation lasers use an intense beam of light energy to remove the outer layer of skin while stimulating the dermis below to produce more collagen. Because of the relatively short downtime after the procedure (about two weeks), lasers have taken a lot of the excitement away from peels. Full results can take three to six months to see because you’re waiting for that new collagen, but the results can last a few years.
Chemical peels use varying concentrations of acids to remove the etched layers of skin. Deeper peels can cause one to two weeks of peeling and can leave some redness for several weeks as the skin heals. Peels can be used on the whole face but can also be applied to localized areas to target things like undereye darkness and scars
Practitioners often target different facial lines with different modalities—there isn’t always one solution for all types of wrinkles. Example: You might have Botox to treat furrows and a laser on the lip area.
Is At-Home Wrinkle Relief Possible?
Many products marketed to consumers are not well-studied, regulated or FDA-approved, so buyer beware. Look for a knowledgeable practitioner to guide you on which products offer the best bang for the buck.
Topicals
Prescription-strength retinoid products such as Retin-A (tretinoin) can help with fine lines and wrinkles and typically are applied nightly. If you have only very fine lines, a topical retinoid can ease them if you’re very diligent and use it for a long time, but it really is more of a preventive or to keep wrinkles from worsening than a full solution. There are many over-the-counter retinoid products…some are well-regulated such as Differin.
Light therapy
You may have seen ads for face shields that emit red and near-infrared (NIR) LED light. There is some literature showing that light therapy does help, but because people using this device may also be using other products, it’s hard to tell which one is making the difference. You must be dedicated about using it and get guidance from a dermatologist to make sure you use a reputable device and use it safely.
Most important piece of advice: Speak to a dermatologist first. These doctors know what has been studied and which techniques have science behind them. There are many brands of every skin-rejuvenating treatment, each with its own benefits and risks, so a one-on-one consultation is the best first step.
