[Doctor's Column] There are wrinkles that remain even after getting Botox: The culprit is not facial expressions, but "collagen"

There are wrinkles that can never be resolved with Botox. This might be a bit surprising news for those who have been relying solely on Botox.

Today, I will summarize the reasons along with the evidence.

▶ Q. I got Botox, but why are my wrinkles still the same?

・ Botox is muscles It is a drug that acts on [the area]. It temporarily blocks muscle contraction signals, softening the wrinkles (forehead, between the eyebrows, around the eyes) that form when making facial expressions.

・ However, there are two types of wrinkles. Those that are visible only when making facial expressions dynamic wrinkles and, remaining even if left alone static wrinkles no see.

・ According to a review in the Journal of the American Family Physician (2014), Botox shows distinct results in dynamic wrinkles, but its effectiveness is limited in static wrinkles that are visible even at rest. In other words, Wrinkles that have already remained on the skin as "folds" do not disappear even if you relax your muscles.

▶ Q. Then, what is the real cause of static wrinkles?

・ The answer is Collagen in the dermis layer When collagen, which supports the elasticity and thickness of the skin, decreases, areas that were repeatedly folded cannot be straightened out again and remain as marks.

・ A classic study in the British Journal of Dermatology (1975) confirmed that the amount of skin collagen decreases linearly with age, and that women have less than men across all age groups. There is also a follow-up study (Brincat et al., 1987) that showed the rate of decrease accelerates to 1–2% per year after menopause.

・ Ultraviolet rays are added to this. A study published in the journal Clinical, Cosmetic and Investigational Dermatology in 2013 About 80% of visible signs of facial aging are related to UV exposure I reported that it works.

・ To summarize, fine lines and static wrinkles are not caused by "making too many facial expressions," but "Because skin with reduced collagen cannot withstand the folding" It happens.

▶ Q. In that case, what procedure is necessary?

If the cause is collagen, the approach must also be collagen. At Maypure Clinic Yeonsinnae Branch, we approach wrinkles by dividing them according to their type as follows.

1) Dynamic wrinkles: Wrinkle Botox

・ Botox remains the standard for wrinkles that fold when making facial expressions, such as on the forehead, between the eyebrows, and around the eyes. The key is to manage them before they harden into static wrinkles.

2) Static fine lines: Fine line filler (Belotero Soft)

・ For fine lines that remain even when at rest, such as around the eyes and mouth, we directly fill the folds using a hyaluronic acid filler specialized for fine lines.

・ In a study published in the Archives of Dermatology (2007), surrounding fibroblasts were stimulated after hyaluronic acid filler injection Promotes the production of new collagen The fact that this is possible has been confirmed through a biopsy. It goes beyond simply filling and effectively reinforces the skin's foundation.

At our Yeonsinnae branch, we often proceed with fine wrinkle fillers along with Botox after explaining during the consultation, "These wrinkles cannot be treated with Botox."

3) Approaches to increase collagen itself: Olidia (PLLA), Rivicol, Juveluc

Olidia is a volumizer containing PLLA (polylactic acid) that induces collagen production within the skin. Multiple laboratory studies have confirmed that PLLA increases the production of Type 1 collagen in fibroblasts. The procedure is performed multiple times at intervals of at least four weeks, and gradual changes become apparent with each subsequent session.

・ Livicol (Atelocollagen Booster) and Livishine (Hyaluronic Acid Skin Booster) are administered to reinforce the foundation of overall skin moisture and elasticity.

・ For reference, it is our Yeonsinnae branch's policy to administer heat-sensitive injectables like Ollydia after energy device treatments such as CoolSonic or Dencerty.

▶ Q. Is there anything I can do in my daily life besides the procedure?

・UV protection is the top priority. As mentioned earlier, a significant portion of visible aging is related to ultraviolet rays. The habit of applying sunscreen even on cloudy days or by a window indoors is the most affordable way to protect collagen.

・Sleeping posture also creates wrinkles. A review in the Aesthetic Surgery Journal (2016) explains that the pressure and friction applied to the face when sleeping on one's side or stomach create "sleep lines" in locations different from expression lines. If possible, we recommend the habit of sleeping on your back.

・Try to reduce repetitive facial expression habits. The habit of furrowing your brow or squinting is a shortcut to turning dynamic wrinkles into static ones. If you squint because your vision is poor, I recommend starting by checking your eyeglass prescription.

▶ Summary

・ Botox works on "muscle" wrinkles, while fillers and collagen boosters work on "skin" wrinkles.

Identifying which type of wrinkles you have comes before choosing a procedure.

・ The effects and duration of any procedure may vary depending on the individual's skin condition.

📍 Maypure Clinic Yeonsinnae Branch
3rd Floor, Metro Tower, Directly Connected to Yeonsinnae Station (856 Tongil-ro, Eunpyeong-gu, Seoul)
☎ 02-389-9980
Clinic Hours: Weekdays 10:30–20:30 / Saturdays 10:00–17:00 / Closed on Sundays and Public Holidays

Skin concerns vary from person to person. After a consultation, we will guide you to the most suitable treatment based on your records.

※ This post is intended to provide general information about the procedure, and the effects and recovery period may vary depending on individual skin conditions.
※ Please be sure to consult thoroughly with medical staff before the procedure. Swelling, bruising, and redness may temporarily occur after the procedure.

References
1. Small R. Botulinum toxin injection for facial wrinkles. Am a Famous Physician. 2014;90(3):168-75.
2. Shuster S, et al. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol. 1975;93(6):639-43.
3. Brincat M, et al. A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstet Gynecol. 1987.
4. Flament F, et al. Effect of the sun on visible clinical signs of aging in Caucasian skin. Clin Cosmet Investig Dermatol. 2013;6:221-32.
5. Wang F, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;143(2):155-63.
6. Anson G, Kane MA, Lambros V. Sleep wrinkles: facial aging and facial distortion during sleep. Aesthet Surg J. 2016;36(8):931-40.

#Yeonsinnae Dermatology #Yeonsinnae Botox #Yeonsinnae Wrinkle Treatment