Quick answer
Lines made by muscle movement (forehead, frown, crow's feet) are matched to botulinum toxin; folds from lost support (smile and marionette lines) to hyaluronic acid filler; fine surface lines to skin quality treatments. A doctor decides by watching the face move and at rest.
- Forehead, frown ("11") lines and crow's feet: botulinum toxin. In two 2025 trials, 52.3% and 49.5% were frown line responders at day 30, 66.5% and 57.7% forehead line responders, 51.7% and 32.4% crow's feet responders, against none on placebo.
- Smile lines: hyaluronic acid filler, judged superior to an older collagen filler in 56.9% of people at 6 months.
- Marionette lines: hyaluronic acid filler; 69.9% improved by at least a point at month 1 and 51.3% at month 6 in an open-label study.
- Fine lines: skin quality treatments, with small trials only.
What is the difference between dynamic and static wrinkles?
A dynamic line appears when a muscle moves and fades at rest, while a static line stays visible with the face relaxed. A review of upper-face ageing describes the picture as volume loss and descent, loss of skin elasticity, dynamic lines from facial muscle action, and static wrinkles, and notes that toxin and filler are often combined in a plan made for the individual.
The distinction matters because toxin relaxes the muscle that makes a crease and does not fill the crease. A forehead line that began as a movement line can become a line that stays, and then the muscle plan may need a skin or support plan beside it. The wider map of four problems is in wrinkle treatments in Malaysia.
What treats forehead lines?
Forehead lines, the horizontal creases made when the eyebrows lift, are treated with botulinum toxin placed in the forehead muscle. In ULTRA I and ULTRA II, two placebo-controlled trials of incobotulinumtoxinA (Xeomin) with 362 and 368 treated adults, 117 of 176 (66.5%) and 105 of 182 (57.7%) people treated across the upper face met the forehead line responder standard at day 30, against 0 of 90 and 0 of 94 on placebo. That standard was strict: a score of none or mild and at least a two-grade improvement, agreed by both the investigator and the participant. On the investigator's rating alone, the gap from placebo in ULTRA I was 92.0 percentage points.
The effect was evident after 4 to 5 days, and in people who did not need re-injection it was still seen at up to 150 days. Merz Aesthetics funded the trials. The main area-specific risk is brow position: the forehead muscle is the one that lifts the brows, so relaxing it too far can leave the brow low or heavy, which is why it is planned together with the frown muscles that pull the brows down. Bruising was the most common injection-site event, at 8.8% with toxin and 8.5% with placebo in ULTRA II. The general risks are set out in anti-wrinkle injection side effects.
What are frown lines or "11 lines", and what treats them?
Frown lines, the vertical creases between the eyebrows often called "11 lines", are made by the muscles that draw the brows together, and they are treated with botulinum toxin. They are the area used in many pivotal toxin trials. In a 2002 trial, 203 people received 20 units of onabotulinumtoxinA (Botox) in five sites and 61 received placebo; frown line severity fell more with the toxin than with placebo at every follow-up visit, and the effect was maintained in many people through day 120.
More recently, in ULTRA I and ULTRA II, 92 of 176 (52.3%) and 90 of 182 (49.5%) met the strict day 30 frown line responder standard against none on placebo. The risk specific to this area is eyelid drooping, because the injections sit close to the muscle that lifts the lid: in the 2002 trial, mostly mild blepharoptosis occurred in 5.4% of the toxin group. Placement and dose are the doctor's control over that risk, and it is worth asking about before treatment.
What treats crow's feet?
Crow's feet, the lines that fan out from the outer corner of the eye when you smile, are treated with botulinum toxin placed in the muscle that circles the eye. In ULTRA I, 91 of 176 (51.7%) met the day 30 crow's feet responder standard against 0 of 90 on placebo; in ULTRA II the figure was 59 of 182 (32.4%) against 0 of 94. Crow's feet gave the lowest response of the three areas in both trials on this strict standard. On the investigator's rating alone, the gap from placebo in ULTRA I was 77.9 percentage points.
The skin beside the eye is thin and bruises easily, and injection-site bruising was the most common event in the trials. Crow's feet that persist at rest are partly a skin quality line, which is why the fine lines section below matters. Botulinum toxin around the eye covers the eyelid and brow cautions in more detail.
What treats smile lines (nasolabial folds)?
Smile lines, or nasolabial folds, run from the side of the nose to the corner of the mouth and are treated mainly with hyaluronic acid filler, because they are folds shaped by lost support and not only by muscle movement. In a split-face trial of 138 patients, hyaluronic acid gel (Restylane) was compared with bovine collagen on opposite sides of the face; at 6 months a blinded investigator judged the hyaluronic acid side superior in 56.9% of patients on one scale and 62.0% on another, against 9.5% and 8.0% for collagen. Injection-site reactions were similar between the two.
Two limits apply. The comparator was an older collagen product, not no treatment, so the trial shows hyaluronic acid lasting longer than that collagen, not what a fold looks like untreated. And it measured the fold alone. The usual local effects are swelling, bruising and lumps; the rare serious risk with any filler is a blocked blood vessel, which is why filler belongs in the hands of a doctor trained to recognise it. Dermal filler risks lists the warning signs.
What treats marionette lines?
Marionette lines run down from the corners of the mouth towards the jaw and are treated with hyaluronic acid filler, sometimes with toxin to the muscle that pulls the corner of the mouth down. They are the edge of a shadow where support has softened, so easing the surface line alone changes little. Lines around the mouth explains the muscle and support parts.
The evidence is thinner and less controlled. A 12-month open-label study of a hyaluronic acid filler (VYC-17.5L) in 83 completers found at least a one point improvement on the investigator scale in 69.9% at month 1, 58.2% at month 3 and 51.3% at month 6, declining further to month 12. Pain or tenderness was reported by 80%, mostly mild and lasting 1 to 3 days; 14 device-related adverse effects were reported in 13 people. There was no control group and the maker supported the study, so it describes what happens, not what is better than doing nothing.
What treats fine lines and crepey skin?
Fine surface lines are matched to skin quality treatments, such as skinboosters, which aim to improve hydration and texture rather than relax a muscle or fill a fold. The trial evidence is small. In a split-face study of 30 adults, three sessions of non-cross-linked hyaluronic acid on one side and saline on the other were compared ten days after the last session: crow's feet depth had changed by -10% on the treated side against +7% on the saline side, hydration was up 35% and firmness up 27%, and the investigator rated 82% as improved or much improved against none on the saline side.
The study was short, small and written by authors including employees of the maker, so it shows a direction and not a lasting result. The local effects are bruising and small bumps that settle. Skinbooster or filler: which does what sets out where each belongs.
Which treatment for which line? A summary table
The table lists the treatment type the evidence supports for each line, not a product recommendation.
| Line | What causes it | Treatment type the evidence supports | What to ask |
|---|---|---|---|
| Forehead lines | The forehead muscle lifting the brows, repeated over years | Botulinum toxin | How will the brow position be protected? |
| Frown lines ("11 lines") | The muscles that draw the brows together | Botulinum toxin | How is the eyelid droop risk kept low? |
| Crow's feet | The muscle circling the eye, plus thin skin | Botulinum toxin; skin quality treatments for the fine part | Which part is movement and which is skin? |
| Smile lines (nasolabial folds) | Lost support and a fold in the cheek, shaped by the mouth | Hyaluronic acid filler | Which product, and how is a blocked vessel recognised and treated? |
| Marionette lines | Lost support at the mouth corner, pulled down by a muscle | Hyaluronic acid filler, sometimes toxin | Is the lower face support the problem? |
| Fine lines | Thin, dry or sun-aged skin | Skin quality treatments | What can be measured, and over what time? |
Who performs anti-wrinkle injections, filler and skinboosters at The Retreat Clinic in Setia Alam?
The Retreat Clinic offers anti-wrinkle injections, dermal fillers and skinboosters, and Dr Ong performs the injections himself, after looking at the face at rest and in expression. The clinic pages set out each treatment: anti-wrinkle injections, dermal fillers and skinboosters.
