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Wrinkles

Wrinkles are the creases, folds and ridges that develop in skin over time. Fine wrinkles measure under a millimeter in width and depth; coarse wrinkles are a millimeter or more. The underlying change is a loss of collagen and elastin, whose production falls by roughly one percent a year, thinning the dermis and weakening the fiber network that holds skin taut. Repeated facial expression, gravity, ultraviolet exposure and lifestyle then convert that weakened structure into permanent lines. For treatment purposes the useful division is between dynamic lines, which appear when a muscle contracts and disappear when the face is at rest, and static lines, which are visible even when the face is still. Dynamic lines respond to botulinum toxin. Static lines need volume, collagen stimulation, or a change in the skin's surface quality, and often a combination. Dr. Julia Tzu works across all three routes at the practice's Financial District office and plans treatment around which category a given line falls into.

5 min read·Last updated: 2026-02-08·Reviewed by Dr. Julia Tzu, MD, FAAD, FACMS

At a Glance

  • Photoaging from UV exposure is responsible for approximately 90% of visible changes to the skin[3]
  • Collagen and elastin synthesis decreases by approximately 1% each year as skin ages[7]
  • Fine wrinkles are less than 1 mm in width and depth, while coarse wrinkles are 1 mm or more[7]
  • Botulinum toxin injection has been shown to be more effective than placebo at improving wrinkles for up to 120 days[5]
  • Visible signs of skin aging may begin to appear after age 25[3]

What are the symptoms of Wrinkles?

  • Fine lines appearing around the eyes (crow's feet)
  • Horizontal lines across the forehead
  • Vertical lines between the eyebrows ("eleven" lines, frown lines or glabellar lines)
  • Lines extending from the corners of the mouth (marionette lines)
  • Creases running from the nose to mouth corners (nasolabial folds)
  • Thin, less resilient skin texture
  • Loss of skin elasticity and firmness
  • Skin appearing looser or more saggy

When should you seek care for Wrinkles?

  • Lines that remain visible when your face is completely at rest
  • Interest in professional evaluation of cosmetic treatment options across injectables, lasers and topicals
  • Sudden or unusual changes in skin texture or appearance
  • New growths or lesions that have appeared alongside the lines
  • Interest in prescription-strength treatment such as retinoids, which work on fine lines over months
  • Facial hollowing or flattening, which is volume loss and is treated differently from a crease
  • A wish to start treating dynamic lines while they are still forming, when softening a line is more straightforward than erasing one

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What causes Wrinkles?

  • Decreased collagen and elastin production with age
  • Slower skin cell division causing dermis thinning
  • Repeated facial muscle contractions from expressions
  • Loss of collagen and elastin from photoaging due to cumulative UV radiation exposure
  • Reduced skin moisture retention capacity
  • Decreased oil gland secretion

How are Wrinkles treated?

We offer a service to help manage this condition: Botox.

Prognosis

  • Wrinkles are a natural part of aging and cannot be completely prevented
  • Consistent sun protection, lifestyle modifications, and appropriate skincare may slow the development of new wrinkles
  • Treatment results vary based on wrinkle severity and type
  • Many treatments require ongoing maintenance for sustained results
  • Combination approaches often yield the most noticeable improvements
Julia Tzu, MD, FAAD, FACMS, Triple board-certified cosmetic and surgical dermatologist

Julia Tzu, MD, FAAD, FACMS

Triple board-certified cosmetic and surgical dermatologistManhattan's Financial District

Trained at Stanford, Johns Hopkins, Penn & NYU

Results that preserve natural facial movement

With over 15 years of cosmetic dermatology experience, Dr. Julia Tzu has become known for botulinum toxin results that look natural – softening wrinkles while keeping your expression intact. She builds each injection plan around your natural facial movement, so the effect is a refreshed look rather than a frozen one.

More About Dr. Tzu

Frequently Asked Questions

What are wrinkles and why do they form?
Wrinkles are visible creases or folds in the skin that develop as part of the natural aging process. They form because skin cells divide more slowly with age, the dermis thins, and the network of collagen and elastin fibers loosens. Combined with repeated facial expressions, gravity, and sun exposure, these changes create permanent lines and folds in the skin.
What are the earliest signs of wrinkles?
The earliest signs of wrinkles typically include fine lines around the eyes (crow's feet), horizontal lines across the forehead, frown lines of the glabella, and subtle creases that appear when making facial expressions. These may begin appearing after age 25, though they become more prominent with age and sun exposure.
What causes wrinkles to develop?
Wrinkles develop from multiple factors including natural aging, which reduces collagen and elastin production by about 1% per year. Sun exposure causes approximately 90% of visible skin aging. Other contributors include smoking, repeated facial expressions, genetics, and lifestyle factors like dehydration and poor nutrition.
When should I see a dermatologist about wrinkles?
Consider seeing a dermatologist if you want professional evaluation of cosmetic treatment options, are interested in prescription-strength products like retinoids, or notice unusual skin changes accompanying wrinkles. An in-person evaluation can match treatments to your skin type, wrinkle severity, and cosmetic goals.
What treatments are available for wrinkles?
Treatment options range from topical products to procedures. Over-the-counter options include retinol, moisturizers, and peptides. Professional treatments include botulinum toxin injections for expression lines, dermal fillers for volume loss, chemical peels, laser resurfacing, and microneedling. An in-person evaluation can determine the most appropriate approach.
Can wrinkles be prevented?
While wrinkles cannot be completely prevented, their development can be slowed. Dermatologists recommend daily sun protection with SPF 30 or higher, avoiding smoking, staying hydrated, eating a balanced diet rich in fruits and vegetables, and using products containing retinoids. Starting protective measures early may help delay the onset of visible aging.
What is the difference between dynamic and static wrinkles?
A dynamic wrinkle appears when the underlying muscle contracts and vanishes when your face relaxes. A static wrinkle is visible with the face completely still. Dynamic lines are the ones botulinum toxin addresses, because it reduces the contraction that creates them. Once a line has become static it needs something that restores or rebuilds the skin itself, which is where fillers and collagen-stimulating treatments such as microneedling come in.
How quickly does botulinum toxin work and how long does it last?
Treatment takes about ten minutes. The effect usually becomes visible three to seven days afterwards and lasts two to four months on average. There is no downtime; patients return to normal activity immediately. The FDA has approved Botox for frown lines, forehead lines and crow's feet.
What is Microtox?
Microtox is a microdosed approach to botulinum toxin that distributes much smaller amounts than a standard treatment. Dr. Tzu uses it for selected patients who want softening without a heavily treated look. Suitability and timing vary by patient.
What is the recovery time for wrinkle treatments?
It depends which treatment. Botulinum toxin needs no recovery at all, which is why it is straightforward to schedule around work. Microneedling and dermal fillers ask for one to three days. Most plans combine treatments, so the practical answer is whichever step in yours takes longest.
Can wrinkles be treated without injections?
Yes, though the mechanism and the timeline differ. Prescription retinoids improve fine lines over months of consistent use. Microneedling triggers collagen production through controlled micro-injury, typically over about six sessions. Daily broad-spectrum sunscreen does more to slow new wrinkle formation than either of them.

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Sources & References

This article draws from 7 peer-reviewed sources.

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Medically reviewed by Dr. Julia Tzu, MD, FAAD, FACMS · Last reviewed: 2026-08-19