What causes wrinkles?

There are many reasons why skin wrinkles. The most common are:

Aging

Wrinkles are a by-product of the aging process. As people age, skin cells divide more slowly, and the middle layer of the skin, called the dermis, begins to thin. The dermis is composed of a network of elastin and collagen fibers, which offer support and elasticity. As this network loosens and unravels with time, depressions are created on the skin surface. Aging skin is also less able to retain moisture, less efficient in secreting oil, and slower to heal. All these factors contribute to the development of wrinkles.

Facial muscle contractions

Lines on the forehead, between the eyebrows (frown lines), and jutting from the corner of the eyes (crow's feet) are believed to develop because of small muscle contractions. Smiling, frowning, squinting and other habitual facial expressions cause these wrinkles to become more prominent. Over time, these expressions coupled with gravity contribute to the formation of wrinkles.

Sun damage

Excessive exposure to ultraviolet (UV) radiation from the sun can result in premature aging of the skin, also known as photoaging. Exposure to UV light breaks down collagen fibers and leads to the production of abnormal elastin. When ultraviolet light damages skin tissue, an enzyme called metalloproteinase is produced. This enzyme creates and reforms collagen. During the process, however, some healthy collagen fibers are damaged, resulting in solar elastosis—the disorganized formation of fibers. Wrinkles develop when the rebuilding process occurs over and over, less efficiently each time.

Smoking

Healthy skin constantly regenerates. Old collagen is broken down and removed, and new collagen is produced. Researchers have found that smoking causes a marked reduction in the production of new collagen. Decreased collagen results in the development of wrinkles.

What are the treatment options for wrinkles?

Removing skin layers to reduce wrinkles or irregular depressions is an effective way to regain smoother, more youthful looking skin.

Dermabrasion (scraping layers away) and chemical peels (dissolving skin away) are two of the traditional methods used in skin resurfacing. Additional techniques have been developed to repair prematurely aging skin. These include the following:

Laser skin resurfacing

Laser skin resurfacing is a treatment to reduce facial wrinkles and irregularities caused by sun damage or acne. The laser technique directs short, concentrated pulsating beams of light at irregular skin. Ablative laser skin resurfacing removes skin very precisely, layer by layer, which stimulates the growth of new collagen fibers. This mode of laser also results in fewer problems with hypopigmentation (lightening of the skin). Non-ablative laser resurfacing promotes the development of new more healthy collagen, helping to restore the skin contour and appearance with minimal downtime. Fractional laser technology is also available. The laser light is delivered in a grid allowing normal, untreated skin to remain within the treated area, which leads to quicker healing. You are an ideal candidate for laser skin resurfacing if you have:

  • Fine lines under or around the eyes, forehead or mouth.
  • Wrinkles under or around the eyes, forehead or mouth.
  • Scars from acne.
  • Non-responsive skin after a facelift.

If you have active acne, you should wait until your acne is well controlled before pursuing laser treatment. Patients who were recently treated with Accutane® should wait for at least six months after their last dose before laser resurfacing. Laser resurfacing is generally better suited for fair-skinned individuals, as dark skinned individuals have a higher risk of hyperpigmentation (darkening of the skin) with certain treatments. Exposure to the sun after this treatment should be avoided for three months.

Botulinum toxin type A (Botox®) injection therapy

Botox® is a medicine derived from the botulinum toxin. It blocks the chemical signals that cause muscles to contract. Botox is injected into the muscles whose contractions cause wrinkles, such as between the eyebrows (frown lines) and the lines that radiate from the corner of the eyes (crow's feet). The effects of Botox usually last for three to four months. When the Botox wears off, the muscles again become active and the wrinkles will begin to reform. The treatment would then be repeated. If you choose not to repeat the injections, your wrinkles will return to no worse than they were initially.There might be temporary redness, bruising, or stinging around the Botox injection site(s). In extremely rare cases, there might be a slight lid droop for several days after the injection, but all reported side effects have been temporary.

Fillers

Wrinkles that remain at rest may require filler to fill-in or lift up skin that is depressed. Prominent folds around the mouth, nose and chin are the most commonly treated. Hyaluronic acid, a natural occurring sugar polymer, is the most common filler used. Most fillers are temporary, providing improvement for around four to six months, at which time the treatment would need to be repeated. Side effects may include bruising, temporary swelling, and pain.

Facelift

A facelift is a surgical procedure during which excess skin and fat is removed from the face and neck. Tightening of the muscular and connective tissue layers is also performed. The results usually last 7 to 10 years.

Last reviewed by a Cleveland Clinic medical professional on 10/10/2019.

References

  • National Institute on Aging. Health & Aging: Age Page: Skin Care and Aging. Accessed 5/20/2020.
  • American Academy of Dermatology. Wrinkles. Accessed 5/20/2020.
  • Walsh J, McNamara M. Chapter e6. Women’s Health Issues. In: McPhee SJ, Papadakis MA, Rabow MW, eds. CURRENT Medical Diagnosis & Treatment 2012. New York: McGraw-Hill; 2012.

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