Lines and wrinkles

Reviewed by Dr Ong Jin Khang

Not all lines are the same problem. Some appear only when you frown, smile or raise your brows. Others have settled in and stay put when your face is completely at rest. The first kind responds to relaxing the muscle that folds the skin. The second kind barely responds to that at all, and treating it as if it would is how money gets wasted.

A line that moves and a line that stays are different problems.

What is actually going on

Expression lines are creases folded into the skin by muscles doing their job: frowning, raising the brows, squinting into this country's light. Early on, the line vanishes the moment the muscle relaxes. With years of repetition, and as collagen thins, the fold starts to print, and a dynamic line gradually becomes a static one that sits there even when the face is still.

Some of what reads as wrinkling is not folding at all. Volume loss can drop a shadow that looks like a line, and rough, dehydrated skin shows fine lines that are really a surface problem. Which mechanism is at work decides which treatment has any business being offered.

The honest map

For lines that show with movement, between the brows, across the forehead, at the corners of the eyes, anti-wrinkle injections ease the muscle that creates the fold. Botulinum toxin, dosed with restraint and mapped to how your face actually moves, softens the line while leaving the expression intact. The same principle slims the masseter along the jaw. The skill is in the map and the dose, not the brand on the vial.

Treating a dynamic line early also has a preventive logic: a fold that is never printed never needs erasing. That is an argument for treating lines that already show with movement. It is not an argument for treating a face with nothing on it.

Static lines are a different conversation. A line that sits at rest usually needs the layer beneath it addressed, which may mean volume and structure or skin quality work, and sometimes a combination in sequence. Relaxing a muscle under a printed line improves it only modestly, and we say so before treating, not after.

When we would say no

We do not chase every line. Some movement belongs to a face, and removing all of it produces the flat, edited look this treatment is unfairly blamed for. If the request is a full freeze, we will talk you out of it or decline.

We also say no when the line is fully static and the honest fix lives at another layer, and when a face with no visible lines asks for prevention it does not yet need. Waiting costs nothing. The wrong treatment costs twice.

Common questions

Do anti-wrinkle injections fill wrinkles?

No. They relax the muscle that folds the skin, which softens lines created by movement. They add no volume. A line that sits there at rest usually needs a different approach entirely, which is exactly what the assessment sorts out.

Will I look frozen?

Only if the dose or the placement is wrong. The frozen look is a function of too much product or the wrong muscle, not of the treatment itself. A measured dose mapped to your movement softens the line and leaves the expression alone.

Should I start treatment in my twenties to prevent wrinkles?

Usually not. Prevention makes sense once lines already show with movement, because easing the fold stops it printing. Treating a face with nothing visible is spending, not prevention, and we will say so.

Why is my line still there after treatment?

Most often because the line had already become static, printed into the skin rather than folded by muscle. Relaxing the muscle improves a printed line only partly. The remainder is a skin or volume conversation.

How long does the effect last?

The effect fades over three to four months as the nerve signal returns, beginning to show in three to five days and fully developed by about two weeks. Duration varies by individual and by the muscles treated.

From the journal

Which kind are your lines? Bring them in.

In person, with Dr Ong. He watches how your face actually moves, maps what is dynamic and what has printed, and recommends accordingly, which sometimes means less than you came in for.

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