Types of facial wrinkles: does each one need a different fix?
“What should I do to get rid of my wrinkles?” To this question I always ask back, “Which wrinkles?” It may sound offhand, but each wrinkle forms for a different reason, so the answer differs too. I will set it out so you can tell them apart yourself in front of the mirror.
The short answer
Yes. Facial wrinkles fall into roughly five types depending on why they form, and the way to treat them differs too. Expression lines that appear only when you make a face call for botox to rest the muscle; deep lines that show even at rest call for botox plus filler or boosters; fine lines in the skin texture call for sun protection, retinoids and skin boosters; sagging folds formed as tissue comes down (nasolabial, marionette) call for volume and lifting; and for sleep wrinkles formed by sleeping position, I look at the position first. Several types are usually mixed on one face, so sorting them by type is the first step. At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700, we look at them type by type.
What types of facial wrinkles are there?
| Type | How to tell | Typical areas | Considered first |
|---|---|---|---|
| Expression lines | Appear only when frowning or smiling | Forehead, between the brows, around the eyes | Botox |
| Deep lines (static) | A line remains even with a neutral face | Forehead, between the brows | Botox + filler or boosters |
| Fine lines and texture | Thin and dense, more visible when dry | Under the eyes, cheeks, around the mouth | Sun protection, retinoids, skin boosters |
| Sagging folds | Tissue that has come down folds over | Nasolabial, marionette, jawline | Volume restoration, lifting |
| Sleep wrinkles | Deeper in the morning, not aligned with expressions | Side of the forehead, cheeks, chest | Sleeping position, pillow |
How can I tell them apart in the mirror?
- Once with a neutral face, once frowning — if it shows only when frowning it is an expression line; if it remains at rest it is a deep line
- Gently spread the skin with your fingers — if it smooths out, it is a texture and firmness issue; if the line stays, it is deeply set
- Gently lift upwards — if nasolabial or jawline lines fade when lifted, they are sagging folds
- Compare morning and evening — a line that is deep only in the morning is likely a sleep wrinkle
There is a review noting that sleep wrinkles differ from expression lines in why they form, where they are and their shape. Sleeping on your side or face down presses and pushes the face, creating lines that run in a different direction from the expression muscles. That is why botox often does not smooth these lines.
Can cream get rid of fine lines?
Some of them. Among topical products, the one with the longest-standing evidence is retinoids (tretinoin). In a double-blind trial that followed 99 people with photoageing for 48 weeks, both 0.1% and 0.025% improved more than placebo, with similar effects, but irritation such as redness and peeling was more common with 0.1%. It is a prescription ingredient and is not used in pregnancy.
And sunscreen. In a randomised trial that followed 903 people for 4.5 years, those who applied it daily had 24% less skin ageing. It does not erase existing wrinkles, but it is the basis for stopping more fine lines from forming.
Wrinkle patches press the skin flat while they are on, so the lines return when you take them off. I could not find a study confirming a lasting effect.
Why don’t sagging folds smooth out with botox?
Nasolabial and marionette lines are largely not folded by muscle but formed by tissue above coming down and folding over. So botox, which rests the muscle, changes them very little. The approach has to be filling the hollow cheeks or lifting the tissue that has come down.
What if one face has several types of wrinkle?
Most do. Expression lines on the forehead, fine lines under the eyes, sagging folds at the nasolabial area, and so on. So I first ask which wrinkle bothers you most, and start with one treatment that suits that type. Doing everything at once makes it hard to know what worked, and the cost grows too.
Sometimes age still shows even when every wrinkle is gone. That is when firmness and volume play a bigger part than wrinkles.
Types of facial wrinkles: frequently asked questions
Is botox always the way to get rid of wrinkles?
No. Botox suits expression lines. For sagging folds I consider volume and lifting first, and for fine lines, sun protection, retinoids and skin boosters.
Do wrinkle creams work?
Prescription retinoids (tretinoin) improved photoageing in a 48-week trial. The effect of ordinary creams varies by ingredient, so it is hard to sum up in a word.
Do wrinkle patches have a lasting effect?
They press the skin flat while on, so the lines return when you take them off. I could not find a study confirming a lasting effect.
Where can I get a facial wrinkle consultation in Daegu?
At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
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Related treatments: Lifting · Fine lines · Facial sagging consultation
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Sleep wrinkles — Anson G, Kane MAC, Lambros V. Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep. Aesthet Surg J 2016;36(8):931-40. PMID 27329660.
- Topical retinoids — Griffiths CE et al. Two concentrations of topical tretinoin cause similar improvement of photoaging but different degrees of irritation. Arch Dermatol 1995;131(9):1037-44. PMID 7544967. 99 people, 48 weeks.
- Randomised sunscreen trial — Hughes MCB et al. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013;158(11):781-90. PMID 23732711. 903 people, 4.5 years.
- Twin study — Guyuron B et al. Factors contributing to the facial aging of identical twins. Plast Reconstr Surg 2009;123(4):1321-31. PMID 19337100. 186 pairs of identical twins.
- Korean medical advertising law — Korean Medical Service Act Article 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives). This is why this column carries no prices, reviews or before-and-after photos.
- Miso Clinic practice guidelines — for hollow cheeks, dissolvable hyaluronic acid filler is considered first; no RF treatment that day if there are metal or electronic implants, pregnancy or skin inflammation; botox is offered for all areas of the face.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.