Is it possible to act on deep facial wrinkles?

Deep wrinkles are the result of a complex biological process involving the gradual degradation of skin structures. With age, the production of collagen and elastin decreases, two essential proteins for maintaining the firmness and elasticity of the skin. Simultaneously, the activity of fibroblasts, the cells responsible for their synthesis, slows down, while enzymes such as matrix metalloproteinases (MMPs) accelerate the degradation of existing fibres. This imbalance leads to a generalised skin sagging and the formation of grooves, particularly around the eye contour and lips, areas that are frequently used, for example when we smile. To these endogenous factors are added external elements, notably exposure to UV rays, which generate free radicals in skin cells.

Some techniques can help to reduce the appearance of deep facial wrinkles.

Cosmetics, a gentle approach but with limited results on deep wrinkles.

Cosmetics provide a gentle, non-invasive initial solution to mitigate the signs of skin ageing. While certain active ingredients have demonstrated real effectiveness against wrinkles, their impact on deep wrinkles remains limited. Indeed, skincare products applied to the skin primarily act on the surface and struggle to target the degradation of the dermis's structural proteins. Despite this limitation, certain groups of molecules, such as retinoids and alpha-hydroxy acids (AHA), can help maintain skin firmness.

The retinol, often considered the cosmetic benchmark for reducing wrinkles, works by stimulating cellular renewal and strengthening the structure of the dermis. Once applied to the skin, it is converted into retinoic acid, its biologically active form. This molecule binds to certain receptors of keratinocytes and fibroblasts, triggering a cascade of signals that promote the synthesis of collagen and elastin. In parallel, retinol accelerates the removal of dead cells on the surface, reducing the appearance of wrinkles. As for AHAs, they are primarily known for their exfoliating action. However, some, like mandelic acid, have also shown interesting effects on skin ageing and would have the ability to stimulate the production of collagen and elastin by fibroblasts.

Although cosmetics possess intriguing properties and can alleviate some signs of skin ageing, their effectiveness remains limited when it comes to deep wrinkles.

Aesthetic medicine, for a noticeable reduction of deep wrinkles.

For more visible results and a more intensive action on deep facial wrinkles, it is necessary to turn to aesthetic medicine techniques. Here are some of the most popular and most suitable ones in the case of deep wrinkles.

Hyaluronic acid injections.
Hyaluronic acid is a molecule naturally present in the skin that is essential for its hydration and structure. However, with age, its concentration decreases, leading to a loss of volume and the appearance of deep wrinkles. Its injection in the form of a cross-linked gel helps to restore the skin's volume by filling in the grooves. Indeed, thanks to its strong hygroscopic power, it attracts and retains water, smoothing the skin's surface while stimulating the production of collagen by fibroblasts, which strengthens the firmness of the dermis.
Hyaluronic acid injections are suitable for various areas of the face and can address deep furrows, such as nasolabial folds, as well as crow's feet and perioral fine lines. As hyaluronic acid is a biodegradable molecule, the results achieved are temporary and typically last between 6 and 24 months. Although this treatment is generally safe, temporary side effects such as redness or bruising may occur. It's also worth noting that it is contraindicated for pregnant or breastfeeding women, as well as individuals on anticoagulants, suffering from an autoimmune disease, or presenting a skin infection. Furthermore, sun exposure should be avoided in the days before and after the procedure.
Botulinum toxin injections (botox).
Botulinum toxin is a neurotoxin that works by temporarily blocking nerve transmission to the muscles, which are responsible for expression lines. By reducing their contraction, it helps to soften deep forehead wrinkles, as well as those around the eyes. It's worth noting that, unlike dermal fillers, botulinum toxin does not restore volume to the skin, it simply relaxes it, thereby giving it a smoother appearance. The effect of botox injections is progressive, reaching its peak after two weeks, and lasts for about four to six months. The effect is said to be potentiating as the action lasts increasingly longer with each subsequent injection.
If botulinum toxin is poorly distributed or in excessive quantity, it can cause facial asymmetry or a frozen expression, hence the importance of consulting an experienced aesthetic doctor. As for side effects, they are generally mild and transient, resembling small bruises or a feeling of tension. Finally, it is important to know that botox injections are not recommended for pregnant women, people taking anti-inflammatory drugs, and those suffering from neurological diseases.
The fractional laser (CO2, erbium).
The fractional laser, whether CO₂ or erbium, works by creating controlled micro-lesions in the skin, thereby stimulating its repair process. Moreover, by heating the deep layers of the dermis, it triggers the production of collagen and elastin. This gradual regeneration improves the skin's texture and reduces deep wrinkles. The CO₂ laser, being more powerful, is particularly effective on pronounced wrinkles and deep furrows, while the gentler erbium laser is more suited to superficial corrections.
Following the session, the skin undergoes a phase of peeling and redness before renewing itself over several weeks. While fractional laser treatment provides visible and lasting results, it requires a recovery period proportional to its intensity, which can range from three days to a week. Moreover, for complete results, three to six sessions, spaced six weeks apart, are often necessary. Side effects, such as swelling or redness, are common but gradually fade. A rigorous sun protection is essential before and after the treatment to avoid hyperpigmentation, as the treated skin remains vulnerable to UV rays.
Radiofrequency.
Radiofrequency is a technique that utilises electromagnetic waves to heat the deep layers of the skin, thereby stimulating the production of collagen and elastin. By generating controlled heat in the dermis, it causes a immediate contraction of the fibres and triggers a gradual remodelling of the tissues, helping to reduce deep wrinkles while firming the skin. Unlike lasers, radiofrequency does not create surface lesions, making it an appealing option for sensitive skin or individuals wishing to immediately resume their activities.
The sessions, generally painless, provide a visible tightening effect from the first applications, although the results improve over the months. A protocol of about ten sessions is often necessary to achieve optimal results. The side effects are minimal, limited to slight redness or temporary warming. However, the action of radiofrequency on wrinkles is temporary and lasts about twelve months. This technique is also not recommended for pregnant women, as well as individuals with a skin infection or cancer.
Chemical Peels.
Chemical peels involve applying an exfoliating solution to the skin to stimulate cellular renewal and improve its texture. Depending on their depth of action, they can act on the epidermis (superficial peels with fruit acids), the middle dermis (trichloroacetic acid), or deeper (phenol). Medium and deep peels, which can reduce deep wrinkles, are not suitable for all skin tones and can lead to persistent redness, significant flaking, or even an infection, such as herpes. Sun protection is essential in the weeks before and after the session, which ideally takes place in winter. Regarding deep peels, it is also important to note that a local or general anaesthesia is necessary as phenol is toxic to the heart.
Deep peel treatments are among the most effective solutions for deep wrinkles, but they require extensive post-operative care and significant social downtime.
Thread lifts.
Finally, thread lifts are an aesthetic medicine technique aimed at firming the skin using absorbable threads. These threads, often made of polydioxanone (PDO) or polylactic acid (PLLA), are inserted under the skin using a fine needle, creating a immediate lifting effect and stimulating long-term collagen production. The threads work by providing tension, thus supporting sagging areas and allowing a discreet repositioning of the facial contours, generally appreciated for the natural effect it offers. The placement of thread lifts is often well tolerated but only offers temporary results, lasting between 12 and 18 months. Moreover, while the risks of side effects are rare, they are not non-existent and include bruising, infections or irregularities in the placement of the threads.

The list of aesthetic medicine methods presented above is not exhaustive. If you are considering using any of them, it is strongly advised to seek a competent professional whom you trust and to thoroughly follow their pre- and post-operation recommendations.