Wrinkles develop as skin ages, dynamic wrinkles deepen with facial muscle contraction. Furrowed deeper over time, and often accelerated by sun damage, wrinkles become permanently visible even when facial muscles are relaxed — we term these static wrinkles.

BOTOX® is famous for wrinkle reduction, but most people are mistaken in thinking that the main benefit will be static wrinkle reduction. It helps some, in particular if BOTOX® is used repeatedly over time, some of the deeper wrinkles may not develop. Recently, Q-switched lasers are benefitting many people by tightening static wrinkles.

Combination therapy with BOTOX® and fillers like JUVÉDERM®, have long been known to ofter produce a superior result than either treatment alone. Q-switched laser makes an excellent complementary treatment to BOTOX® therapy, and can be administered in the same visit. Q-switched laser works particularly well on the fine lateral wrinkles around the eyes (i.e. crow’s feet).

With care, bags under the eyes can be pulled down under the orbital rim, and tightened with laser. Last week I treated a lady with horrible bags under her eyes. She was amazed how much better they looked before she left the office! I informed her maximum benefit was in the 2-6 month post treatment range.

While BOTOX® works by relaxing muscular contraction, the Q-switched ND-YAG works by stimulating collagen synthesis deep (up to 10 mm in skin!). This tightens skin from underneath, with the process showing benefit progressively months after treatments.

Treatments are most effective in a series, and laser can be repeated every 3 weeks in most patients. The benefit is long term, but does benefit from upping wrinkle reduction every 1-2 years. It seems to work on subsequent visits, and patients like the natural, youthful look laser treatment imparts. Over-reliance on BOTOX® alone for wrinkle reduction can give a frozen, or “plastic,” look.

Combination therapy is best, every patient unique. For nasolabial folds and marionettes lines (the sad grimace line under the mouth), I like to use JUVÉDERM® fillers to augment laser tightening benefit — again giving a fuller-more natural look, than just one modality.