How Professional Injectors Deal with Wrinkles in 4 Spaces of the Face

In our gilded 20s, there are barely any to be seen. By our mid-30s, they really start to make themselves known. By 40, we’re used to seeing at least one or two lines getting too comfortable on our foreheads, a little crinkling around the eyes, and a handful of lines around our mouths to indicate that we have indeed, “Lived, Laughed and Loved.” Here, we explore the various strategies for treating and preventing lines and wrinkles when it’s time for intervention.

According to New York dermatologist Marina Peredo, MD, three fundamental ingredients to slow the hands of time are a good SPF, antioxidants and DNA repair enzymes. “In addition to these, I suggest using retinoids, peptides, alphahydroxy acids (AHAs), and growth factors to truly optimize the skin.” “The single product I recommend using is tretinoin (Retin-A) every evening,” adds West Palm Beach, FL dermatologist Kenneth R. Beer, MD. “I also advise pairing it with a topical vitamin C each morning, some niacinamide and 500 mg of oral vitamin C.” When it comes to eye creams, doctors say that if you want to look younger, don’t skip them. “You can help repair skin damage and avoid lines by using ingredients like hyaluronic acid, growth factors, antioxidants, peptides, retinol, or kojic acid for dark circles,” says Dr. Beer.

Forehead Lines Wrinkles

here include horizontal lines, as well as vertical frown lines known as “11s” that appear between the brows. “The best nonsurgical option for these are injectable neurotoxins,” says Boca Raton, FL oculoplastic surgeon Steven Fagien, MD. “They work best on ‘dynamic lines,’ or lines that are seen with animation. But, once the lines are etched in, neurotoxins have limited effects.”

For static lines, Dr. Beer says fillers, such as Belotero Balance, can be used off-label and cautiously, especially in the lower forehead: “Microneedling with radio-frequency and lasers can also help retexturize the brow area.”

Around the Eyes

Delray Beach, FL facial plastic surgeon Miguel Mascaró, MD says neurotoxins work best to soften crow’s-feet. “If you just have mild hollowness, off-label under-eye filler is a good solution because the metabolism there is low,” he explains. “Because there is little movement in that area, filler or microfat injections can last longer.” However, Dr. Fagien cautions that under-eye filler is not a one-size-fits-all fix: “While it can be beneficial for some, for others, an upper or lower eyelid lift may be recommended.” Around the brows, Dr. Peredo likes Ultherapy for a “nonsurgical browlift,” and lasers to address crepiness.

The Cheeks

When we think of the cheeks, volume restoration is the common goal, but radial cheek lines and sagging skin may need more than a pinch of filler. “In these cases, I place fillers deeply along the arch of the cheek to elevate the cheekbones,” explains Dr. Peredo.

For sagging and radial cheek lines, Smithtown, NY plastic surgeon James Marotta, MD prefers deep laser skin resurfacing to restore elasticity. “We can also smooth those lines with hyaluronic acid filler, fat injections or PDO threads, but for those with severe sagging, a facelift may be needed.”

Smile + Lip Lines

For marionette lines, which run vertically from the mouth to the chin, and the barcode lines that form on the lips, fillers are often used to plump skin and flatten the lines. “We often use a medium-thickness filler like Juvéderm Ultra or Restylane,” explains Dr. Beer. “I find that injecting directly into these deeper lines can decrease their depth and make laser resurfacing more effective.”

“Ultherapy and PDO threads can also help treat nasolabial folds,” adds Dr. Peredo. “We often use a combination approach that includes Ultherapy, fillers and neurotoxins all done in one session. Vertical lip lines can be more difficult to treat, but patients can expect to see about 50-percent cumulative improvement.”

Fillers like Restylane Kysse can fill superficial lip lines, but microdose injections of neurotoxin along with microneedling can also resurface these wrinkles. “I also recommend nonablative laser treatments, but we are also seeing great improvement in the area with radio-frequency microneedling,” adds Dr. Beer.

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