How has wrinkle treatment changed over time?

The treatment of wrinkles has changed as the theories behind their formation have evolved over time and with the development of more advanced less invasive treatments such as botulinum toxin, dermal fillers, chemical peels, and lasers therapy.

In times gone by…

Previous theories behind facial ageing were based around increased amounts of spare skin and fatty tissue occurring as we get older. As a consequence surgeons concentrated on removing this excess skin and fat to tighten the skin over the underlying tissues and reduce the appearance of wrinkles. For example, it was thought that gravity stretched the eyelid skin over time as we age and that this allowed fat to protrude above the eyes so surgeons developed ways of removing this excess skin and fat whilst leaving minimal scarring. However, this technique led to an unsatisfactory outcome in some, leaving patients feeling gaunt with a reduced fullness to the facial features.

Current thoughts…

It is now thought that there are other processes involved in ageing that contribute to the formation of wrinkles in addition to the increased amounts if redundant skin, and these have had a bearing on current wrinkle treatment. The descent and deflation of facial features as we age plays a major role as does volume loss of all facial tissues including the skin, facial fat and bone.

Facial fat reduces with age and this results in areas of the face which appear hollowed out such as the cheek, temple, and around the eyes, with the bony features of the face becoming increasingly visible. The loss of bony volume can also accentuate the appearance of facial drooping, particularly of the eyelids, eyebrows and nasolabial folds, the skin folds that run from each side of the nose to the corners of the mouth.

Exposure of the face to the sun results in photoageing, premature ageing if the skin due to ultraviolet light exposure, which is most often visible in the form of wrinkles and discolouration. Photoageing is commonly treated with chemical peels.

Implications for current wrinkle treatments

There has been a change in the theory behind wrinkle formation from a perception of excess skin and fat to one of volume loss. This has meant that surgeons are now able to utilise the non-surgical and less invasive techniques, such as the injection of dermal fillers or fat, to augment or ‘inflate’ areas of the face for wrinkle treatment rather than removing perceived areas of excess skin and fat.