What Causes Wrinkles and The Best Way to Rejuvenate the Face

As we age, our skin develops wrinkles, hollows, and age spots. Some people also lose volume in their cheeks and develop jowls. These signs of aging are the result of four processes I call the four “D’s” of aging: damage, dynamic muscle movement, deflation, and drooping.


Damage refers to the degradation of skin caused by ultraviolet radiation from either sun exposure or tanning bed use, and the cumulative effects of pollution. Over time, ultraviolet radiation leads to the appearance of dark spots (sometimes called age or liver spots); dilated facial blood vessels on the nose, chin, and cheeks; and roughness and coarsening of the skin. In the worst case scenario, sun exposure and tanning leads to skin cancer including melanoma, a potentially deadly form of cancer.

Fractional CO2 Laser Before
Fractional CO2 Laser After

A variety of treatments can help reverse and prevent the visible signs of damage. A good topical regimen should be your first line of defense. Of utmost importance is the daily use of sunscreen. Choose a sunscreen of SPF 30 or higher that contains zinc oxide in its list of active ingredients. Many other creams can also reduce the signs of damage including those containing tretinoin (Retin-A), vitamin C, bleaching agents, and glycolic acid. These can be used in combination with sunscreen to create an optimal daily skin care routine.

Chemical peels reverse the signs of damage by exfoliating the outermost layers of skin to both remove damaged skin cells and reduce the barrier for medications to work more effectively. Peels can be varied in depth depending on the type of chemical used, and peeling can last anywhere from 1 – 7 days depending on the depth.

Photodynamic therapy is a sophisticated treatment which targets pre-cancerous cells within the skin. In this procedure, a medicine called ALA (aminolevulinic acid) is applied to the skin. The damaged cells of the skin preferentially absorb this medicine over non-damaged cells. When activated using a laser or special light source, ALA selectively kills the damaged skin cells and leaves the good ones behind. The result is smoother, healthier skin. Incidentally, photodynamic therapy also effectively treats acne.

Another fundamental treatment is laser therapy. Lasers selectively target dilated facial blood vessels and discolored spots, and stimulate collagen production. Lasers are preferentially absorbed by facial blood vessels, background redness, and dark spots inducing a reaction within these targets which leads to their clearance.

Lasers also induce collagen production to restore the health of the dermis (the second layer of skin which becomes thinner as we age). Not all lasers are the same, and a true understanding of laser physics is essential for the best result.

Whereas IPL targets discoloration, fractional CO2 and radiofrequency microneedling boost collagen and reduce fine lines and wrinkles.

Dynamic Muscle Movement

Dynamic muscle movement refers to wrinkles that form as a result of facial expression. The big three areas are the frown, forehead, and crow’s feet. Movement of muscles in these areas often causes bunching and wrinkling of the overlying skin. Eventually wrinkles can become etched into the skin. It’s kind of like the old saying, “If you don’t stop making that expression, your face will freeze in that position.” Maybe mom was right!

Botox softens muscle movement. By placing this medicine strategically into the muscles that cause wrinkling, Botox reduces wrinkles and gives a more relaxed appearance.

Dysport, Xeomin, and Jeuveaux are alternatives to Botox.


As we age, our face looses volume. To illustrate this point, think of a baby’s face. It’s round and full. Now imagine the face of a very old man. It’s thin and gaunt.

Many studies have shown that as we age, we lose both fat and bone in our face. Volume loss leads to hollows under our eyes, deflation of the cheeks, and prominence of the smile lines. To combat volume loss, several fillers are available.

Sculptra is used to add volume to large areas of the face and to provide overall filling. Sculptra stimulates the dermis (the second layer of skin) to thicken, and by doing so, softens hollows and lines.

Unlike Sculptra which provides an overall fill, Juvederm, Restylane, and Radiesse fill localized hollows and depressions. These products can be used to fill the smile lines, marionette lines, lips and lip lines, hollows under the eyes, and loss of volume in the cheeks.


The last of our four “D’s” is drooping. In addition to losing volume as we age, tissue begins to sag. Drooping is ultimately the result of both volume loss and the loss of skin elasticity.

Therefore, replacing lost volume helps.  However, tissue that cannot be re-positioned needs to be tightened or removed.  Non-invasive lasers such as Thermage, and minimally invasive ThermiTight firm and tighten skin with minimal to no downtime.  If skin is too loose, surgery may be needed.

Another cause of drooping is the re-distribution of fat.  Fat often often collects under the chin, and this can be removed by liposuction.

Learn more! Call us at (818) 885-0455 or complete the form below.

Dr. Osman's Media & Awards