Dynamic versus static wrinkles, why botulinum toxin stops rather than erases, and the mid-to-late thirties as the moment to begin.
Hello. This is Dr. Lee Yumin of MeSOnBom Clinic.
In clinic I meet a great variety of patients.
Among those coming for the first time around their forties are many men in their thirties and forties who had paid little attention to skin care and arrive looking slightly sheepish, brought in by a wife or girlfriend.
They sit down and ask straight away:
"Doctor, if I have this botulinum toxin once, the deep lines on my forehead and between my brows will smooth out like they've been ironed, right?"
Meeting that hopeful look, I clear my throat and smile a little awkwardly.
I understand the earnest wish for a single injection to erase the marks of time and return the skin to its twenties, but I have to be honest first about the real medical limits.
To be clear from the start: botulinum toxin is not an all-purpose eraser that magically removes wrinkles already deeply set.
Let us look at it in more detail.
To understand what botulinum toxin does, it helps to divide wrinkles into two kinds.
Not every line on the face is the same thing.
Dynamic wrinkles (only when you make an expression): the skin is smooth at rest, but folds when you frown in anger or raise your brows in surprise. These are early-stage lines appearing temporarily with muscle movement.
Static wrinkles (set deep regardless of expression): where dynamic wrinkles have repeated over years or decades and skin firmness has declined with age, the line settles into the skin itself like a scar. It is the same as folding stiff paper hundreds of times — eventually a clear crease remains without any effort. At this stage, even at rest with a relaxed expression, you can look permanently cross or tired.
As I often tell patients in clinic, botulinum toxin is essentially a muscle relaxant.
It works by temporarily blocking the movement of the muscles we habitually or unconsciously use to frown, letting those muscles rest.
So with dynamic wrinkles, where the skin has not yet folded permanently, preventing the muscle from moving stops the line forming — and the effect can look like magic.
But it cannot iron out static wrinkles that have already creased into the skin like a scar.
Even with the muscle still, the skin itself has already folded.
"So doctor, does someone with deep lines already have no reason to have it at all?"
This is one of the most common questions.
Aesthetic treatment is a highly personal matter, so the answer rests entirely with you.
But as a doctor, and as my own conviction, I recommend it even where wrinkles are already set.
Because this moment is the moment in the rest of your life when your wrinkles are shallowest.
Botulinum toxin may not remove lines that already exist, but it acts as an excellent brake, preventing them deepening further and defending against new ones — because it stops you frowning.
So when is it wisest to begin?
The moment I recommend most is the mid-to-late thirties, when you look in the mirror as you frown and see shallow lines beginning to settle.
Starting at that point brings the following benefits.
Delaying the setting of wrinkles: it can push back by several years or more the point at which light dynamic lines worsen into deep static ones. It is like a preventive injection before the lines take hold.
Incidental improvement in skin texture: beyond relaxing muscle, it also tightens pores and brings a light sheen to the surface — an additional effect patients are very pleased with.
Practising medicine makes me think a great deal about anti-ageing.
Did you see Top Gun: Maverick when it was released?
Throughout the film I could only marvel at Tom Cruise, maintaining looks and firmness in the top fraction of a percent worldwide well past sixty.
What on earth is he doing, how much of it, and how? I watched his facial muscles and skin more closely than the story — an occupational hazard. (It is easy to say, but I know how much painstaking effort keeping that up really takes.)
There is something I always emphasise to the people who come to us.
"We cannot stop time or ageing altogether. But we can slow it considerably, as we choose."
I hope we can all aim, as he seems to, at ageing slowly — and ageing well, with a gentle face that is not set in a frown.
Wrinkles are sometimes called the medals of a life lived, but if they cause you stress every time you look in the mirror, borrowing a little help from medicine to slow ageing is a sensible approach.
I wonder how the health and skincare plans you made for the new year are going.
The first quarter of the year is already passing.
Please look after your health, and I hope your days hold more broad smiles than frowns. Thank you for reading to the end.
Our medical team will advise you based on your skin condition.
