There are two types of wrinkles - Wrinkles in Motion and Wrinkles at Rest

    Wrinkles in motion are those created by expression, such as smiling and frowning.  These wrinkles disappear when you stop making the expressions.  Over time, however, these lines become permanent.  Here's an analogy: if you fold the page of a book over and over, the crease you create will deepen.  This same process occurs in our skin.  As lines deepen they become permanent, also known as a wrinkles at rest.  Different agents are needed to treat each type of wrinkle.



    Originally used medically to prevent involuntary eyelid closure (blepharospasm), Botox® (botulinum toxin) is now also used to treat these active wrinkles.  It works by paralyzing the voluntary muscles underlying the skin which form wrinkles during contraction. 

    Treatment:  Ice is first applied to the skin over the area of treatment.  Multiple (5-10) small injections in the areas of active wrinkles help smooth the lines and prevent creation of permanent wrinkles.  Suggested areas of treatment include the frown lines between the eyelids and brows, crow’s feet at the outer corners of the eyelids, and forehead lines.

    In the jaw, the masseter muscle can enlarge and give the face a square appearance.  Botox® can treat this condition by weakening the jaw muscle on each side of the face, causing it to eventually shrink in size.  Chewing is unaffected.

    The effects of Botox® are seen three to seven days following injection and can last up to four months.



    Juvederm® was approved by the FDA for treating facial folds and wrinkles. It is a facial filler that adds volume to your face, plumping it up and smoothing out wrinkles at rest.  

    As we age, the body produces less collagen and loses hyaluronic acid. With less matrix support, the skin starts to sag. There are other factors that contribute to wrinkles such as sun damage, dry skin, and repeated facial expressions. Juvederm® can have an excellent smoothing effect because it is based on hyaluronic acid, which attracts water. It binds to water molecules and holds the water in that location, and this creates more volume beneath the skin surface. The human body naturally has hyaluronic acid in connective tissue such as collagen, nerve tissue and the skin. A person weighing about 150 pounds has about half an ounce of it.

    Treatment:  Juvederm® is placed in the skin’s middle layer, the dermis, with a very thin needle. The dermis is the layer that holds many structures such as hair follicles, oil glands, blood vessels, nerves, and the small muscles that create goosebumps. It also has a matrix of collagen and elastin fibers that provides skin support, creating a smooth surface. Juvederm® is pre-mixed with lidocaine so you feel only the first injection.  Once the lidocaine begins to numb the nerves, the procedure should be relatively pain-free.

    The effects of this filler are immediate and can last up to a year or more.



    Essentially a thicker version of Juvederm®, Voluma® is used to firm up and augment the skin at the cheeks and cheekbones, giving definition to the latter.  This product is injected in the same way as Juvederm®, however, it can last two years or more when administered to the cheekbones.  This product has essentially replaced the midface lift as a way of elevating the cheeks.