The wrinkles that appear on the facial skin have different origins and the treatment or treatments depend of this. When we are evaluating the patient we have to distinguish the wrinkles caused by sun overexposure from the ones caused by the normal function of the facial expression muscles and also from those which are thicker, obvious and permanent, as the ones caused by the aging process and gravity 

 A.- The wrinkles caused by solar photo damage can be prevented by avoiding direct sun exposure, and if this isn’t possible, the  use of sun blockers in the morning and afternoon, also the use of moisturizing creams are  strongly recommended.  Sun rays are the cause of microscopic changes in the epidermis, the skin thickens and cellular atipias appear; the dermis also suffers changes. Sun wrinkles are fine wrinkles that don’t disappear even when the patient’s expression is serious; the skin looks dry, stiff and thick. To treat these wrinkles they have to be eliminated or evaporated from the superficial skin layer, with any of the following methods: Rejuvenating laser, surgical derma-abrassion, or chemical peeling.
 

B. - The other types of wrinkles are those that appear because of the normal function of the facial expression muscles. These usually appear at middle age, and they are evident, mostly when the person laughs, is surprised, or gets angry; they disappear when the person is serious.  If they are not treated properly, the wrinkles will leave permanent marks on the skin. For that reason the most important treatment is prevention. 

 The use of the Botulinum Toxin Type A – BOTOX® helps us with this objective (read the article “Botulinum Toxin Type A – BOTOX®: An excellent option for facial rejuvenation”). However, if you long for a more radical and permanent treatment, the selective surgical extirpation of specific muscular fibers is recommended (you must read the article “Surgery for facial rejuvenation”). There is another method which fills the wrinkles, it doesn’t cure the cause but it camouflages it.

Any of these techniques can help wrinkles disappear from the forehead, brow, and the so called crow‘s feet. The peribucal wrinkles and deep nasal creases can be dealt with the use of the Botulinum Toxin Type A – BOTOX® or with filling.  

C.- Wrinkles that appear because of the aging process and because of the effect of gravity as when the facial and neck  skin starts to sag, or  the facial and cervical muscles are flabby; can be corrected only with a surgical stretching, facial lifting, or a facial Rhitidectomy. Botox, dema-abrassion, peeling, creams, or massages can’t cure these as radically as a facial lifting (Read article on Surgery for Facial Rejuvenation.) 

That is why the evaluation of the patient is very important so he or she will be satisfied after the procedure. The treatment could be just one or a combination of treatments, this depends on the diagnosis. The use of tensing cosmetic creams, moisturizing creams, sun blockers, and massages will give the skin the sensation of smoothness that delays the effects that imminently arrive with time and life.