When the skin ages and is exposed to harmful external environments, lines and wrinkles begin to appear. While there are many steps you can advise your patients to take to delay the appearance of the signs of aging, the best way to prevent them is to understand their causes.

Types of Wrinkles (Rhytids)

1. Glabella lines

These are the vertical marks that appear on the forehead between the eyebrows. Glabella lines are caused by the contraction of muscles between the brows that occurs when we make expressions such as frowns. With the repetition of these facial movements, the lines become more permanent. These are common wrinkles that often appear as early as in a patient’s mid-20s.

2. Lip lines

Lines around the mouth are mostly attributed to the process of aging. However, there are many factors that contribute to these wrinkles, making them appear earlier, deeper or more noticeable. These factors include sun exposure and smoking due to the increased movement in the muscles around the mouth. That is why the vertical lines around the lips are often referred to as ‘smoker’s lines.’

3. Under eyes

In addition to age, the horizontal lines and wrinkles that appear under the eyes can be caused by smoking, sun damage, muscle movements caused by smiling and squinting, and even sleeping position. The wrinkles in this area are commonly uneven, with one side showing more lines than the other. This can be attributed to both the way a person smiles and the way they sleep, if one side is more contracted during smiling or one side is slept on more than the other.

4. Crow’s feet

The lines that run from the corners of the eyes outward are some of the most common wrinkles and the earliest to form. They are caused by the repetition of certain facial movements and appear when you smile or squint.

5. Worry lines

Forehead wrinkles, sometimes referred to as worry lines, or even more generally as expression lines, are the horizontal lines that appear across the forehead. As the alternative names suggest, these wrinkles are primarily caused by frowning and other expressions of worry. These lines become permanent as the skin ages.

6. Marionette lines

Marionette lines are another kind of crease that appears around the mouth. They begin at the corner of the mouth, running run down the chin, and become apparent as the skin loses collagen due to aging and harmful environmental factors.

7. Nasolabial folds

These folds begin at the edges of the nose and run down to the sides of the mouth. They are sometimes referred to as “smile lines,” as they appear when we make this expression. As the skin ages and begins to sag, particularly as the cheeks begin to sag downward, these creases deepen and become permanent.

8. Tear troughs

Tear trough deformity is what we generally refer to as under eye bags. Though it appears to be discolouration, it is actually caused by skin and muscle tissue laxity, which becomes more of an issue with age or through a lifestyle that causes the skin to age prematurely.

9. Mental crease

Also referred to as a labiomental crease or groove, this facial fold is the horizontal line that appears between the lower lip and the chin. Its appearance is due to a combination of muscle contractions caused by movements such as pouting, as well as the process of aging.

10. Neck

Lines that appear on the neck are affected greatly by gravity and the loss of volume and muscle support caused by aging. Horizontal lines can also appear due to repeated movement, such as staring down at a smartphone.

11. Deflated or sagging brows

Also known as brow ptosis, this is caused by a combination of the skin losing elasticity due to aging and the repeated contractions of the muscles underneath the brow. The eyebrows are a very expressive feature of the face, and this area becomes particularly saggy as the deep fatty layers of the skin deplete with age.

12. Hollow temples

Sunken or hollow temples are caused primarily by aging. Along with loss of elasticity, aging also causes the loss of fat and tissue volume, which can lead to gauntness or sunken areas of the face.

13. Pitted scars

Pitted scars are those marks on the skin that appear as small, sunken holes. A big cause of these scars is cystic acne, as the cysts that form are deep set at the bottom layers of skin, leaving a bit of a gap when they scar. This, combined with thin skin – which can be caused either by genetics or the loss of collagen due to age – causes the scarring.

Treatments

Hyaluronic acid

Hyaluronic acid helps the skin retain moisture, but as we age the production of this natural substance slows. Re-introducing hyaluronic acid to aged, dry, or sagging skin restores plumpness and volume, leading to a smooth, wrinkle-free appearance. Many popular dermal fillers contain hyaluronic acid as their primarily ingredient.

A thread lift is a non-surgical facelift that treats wrinkles and folds by lifting and tightening sagging skin. The process involves absorbable sutures being threaded through the skin.

Chemical peels can help treat the early signs of aging. They peel off the superficial layer of skin cells, revealing new, healthier cells beneath. These cells appear smoother and less wrinkled, though this option is less effective on more severe wrinkles.