Wrinkles are one of the most visible and complex manifestations of skin ageing.
In the female face, they take on not only aesthetic but also physiological significance, reflecting the processes of cellular senescence, hormonal changes and the cumulative effects of environmental exposure. Their formation is a multifactorial phenomenon involving epidermis, dermis and hypodermis, with progressive structural and biochemical alterations.
Skin ageing is determined by an intrinsic (chronological) and an extrinsic (environmental) process.
The intrinsic one is genetically programmed and leads to a slowdown in cell turnover, a decrease in collagen synthesis and an alteration of elastic fibres. Already from the age of 30-35 years, collagen production drops by about 1% per year.
Extrinsic ageing, on the other hand, is induced by UV radiation, pollution, smoking and oxidative stress.
Unprotected sun exposure increases collagen degradation by 20-25% compared to photoprotected subjects.
The dermal extracellular matrix is mainly composed of collagen, elastin and hyaluronic acid. With age, the hyaluronic acid content decreases by more than 50%, impairing hydration and skin turgidity.
Metalloproteinases (MMP-1, MMP-3), activated by oxidative stress and UV radiation, degrade collagen fibres. In parallel, protein glycation (AGEs) alters elasticity, making the skin stiff and dull. On a histological level, recent studies show a disorganisation of elastic fibres and a reduction in the collagen/elastin ratio from 6:1 to 4:1 after the age of 50.
In women, the menopause represents a turning point: the drop in oestrogen leads to a reduction of up to 30% in dermal density in the first five years, with loss of elasticity, hydration and firmness. The skin thins, becoming more vulnerable to the formation of skin furrows.
From a functional point of view, wrinkles are divided into dynamic and static.
The main clinical categories include:
- Glabellar wrinkles - vertical between the eyebrows, related to stress and overactivity of the corrugator muscles.
- Frontal wrinkles - horizontal, associated with the contraction of the frontal muscle.
- Periocular wrinkles - the “crow's feet”, among the earliest, related to photodamage.
- Nasogenic wrinkles - result from sagging of malar tissue and reduction of adipose volume.
- Perilabial wrinkles - fine vertical lines around the mouth, typical of smokers.
- Chin and neck wrinkles - consequence of skin relaxation and loss of jaw definition.
Added to these are micro-wrinkles, indicative of dehydration and superficial oxidative damage.
Regarding clinical assessment, the diagnosis of wrinkles is based on visual examination, palpation and three-dimensional optical analysis tools (3D profilometry, digital dermoscopy, surface scanners).
The intensity of wrinkles is classified using clinical scales such as the Wrinkle Severity Rating Scale (WSRS) or the Larnier Scale, which correlate depth and width of furrows.
Phototype affects severity: women with phototype I-II develop deeper wrinkles than phototypes IV-V, with average differences of 18-20% in profilometric assessment.
Contemporary aesthetic medicine addresses wrinkles with a combined approach: prevention, biostimulation and correction.
Primary prevention: photoprotection, antioxidant diet, abstaining from smoking, constant hydration and topical use of retinoids and vitamins C-E.
Dermal biostimulation: use of bioactive substances (polynucleotides, amino acids, vitamin complexes, free hyaluronic acid) to promote neocollagenesis and improve dermal density.
Corrective treatments:
- Botulinum toxin A - inhibits the release of acetylcholine, reducing dynamic frontal and periocular wrinkles. Average effect: 4-6 months.
- Hyaluronic acid filler - for static wrinkles and nasolabial folds; duration 8-12 months and excellent tissue integration.
- Chemical peelings - stimulate epidermal turnover.
- Laser resurfacing and fractional radiofrequency - induce deep neocollagenesis with progressive improvement in skin tone.
- HIFU and microneedling combined with PRP - regenerative techniques that enhance dermal trophism.
Dermatological research is moving towards bio-regenerative solutions, such as active fillers with biomimetic peptides, hyaluronic acid and amino acid complexes, and the use of mesenchymal stem cells derived from adipose tissue.
New technologies, such as micro-needle radiofrequency combined with LED photobiomodulation, show an increase in collagen type I production of 25% in controlled histological studies.
Conclusions
Wrinkles are not simply signs of time, but biological indicators of skin balance. Their management requires an integrated vision that combines dermatological knowledge, hormonal expertise and customised aesthetic strategies. Modern aesthetic medicine is moving towards a paradigm of cutaneous longevity, aimed at preserving the naturalness of features and tissue quality. In this context, the concept of “pro-aging” replaces that of “anti-aging”: maintaining the vitality and function of the skin while respecting its biological history and individual identity.
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