Some of Dr. Michael Martineau’s female patients come in regularly, every few months or so, to confront their wrinkles. Others visit his office before special occasions, like a son’s wedding or a 30th high school reunion.
That’s because wrinkles — crows feet or laugh lines, whatever euphemism is applied — can be an intensely personal matter for women.
Dr. Martineau, a dermatologist specializing in non-surgical beauty treatments, sees women of all ages. The majority of female patients are in their 30s and 40s, he said. But, “I’ve had patients in their 80s who wanted Botox,” he adds.
Here’s another telling tidbit. Dr. Martineau estimates that nearly half of his patients don’t tell their spouse.
Elevating natural beauty
The idea of cosmetic dermatology is enhancement of beauty, enhancing natural features to make it better — and subtracting years of frowning and gravity.
When it comes to anti-wrinkle treatments, consider your face divided into two zones: One zone is your eyes and forehead and zone two, your mouth and cheeks. Each hemisphere needs it own approach.
The wrinkles forming on your forehead and around your eyes, like those scowl lines between your eyebrows, are caused by years of muscle tightness. These areas need a good muscle soother like Botox, he said.
The bottom part of your face, however, is a victim of gravity and age. Sagging, sunken cheeks, smoker’s wrinkles around the mouth — all of these require volumizers. Injectable fillers add volume to the skin to fill in wrinkles and folds, said Dr. Martineau.
“Generally, Botox and other injections are for the upper half of the face, and volumizers are for the lower half of the face,” he said. In many cases, they’re used together.
Although the deeper the wrinkle, the longer the treatment must be to reduce it, but patients can expect about an 80 percent improvement, he said.
Let’s look at some of the prime targets for women who need a lift in their day — but don’t want the invasive face lift.
Forehead frown lines (glabella wrinkles)
These so-called “eleven lines” between the eyebrows are caused by “the muscular action of looking like you’re concentrating or like you’re mad,” the dermatologist said.
“Muscles, even at rest, have a certain tension to them,” he said. “When you relax them and eliminate that tension, you get rid of the lines.” The value of Botox is that it decreases the muscle activity and tension.
The only actions for which we use those forehead muscles are frowning and scowling. Type A personalities may be more prone to eleven lines because of their focus and concentration. “So by getting rid of those lines,” he said, “you won’t look angry or unhappy.”
Relaxing these muscles results in a more open, happier appearance, said Dr. Martineau.
Botox may be the best known of these injectables; other brands are Xeomin and Dysport. Botox injections are effective for about three months.
These often first signs of aging — the so-called laugh lines — are not really that funny. Crows feet, Dr. Martineau said, are the result of such muscular action as squinting and smiling. Again, injections like Botox will attack the cause of crows feet, which is muscle tension.
Parentheses lines or marionette lines (labial folds)
Who wants their mouth enclosed in parentheses? No one, including the patients who visit Dr. Martineau to receive fillers that add volume to these fold wrinkles.
“We inject into the cheek area where there’s been volume loss caused by aging,” said Dr. Martineau. “By adding volume here you can essentially lift the cheeks and the tissue, essentially a mini face lift.”
Products such as Juvederm and Restylane last about six months. Radiesse can last up to a year, sometimes longer depending on location. The serums include hyaluronic acid, a substance that is present in greater quantities in young skin.
Smoker’s lines or lipstick lines
Many women aren’t looking for wrinkle repair around the mouth, he said, “they just want fuller lips.”
However, adding volume to the lips can smooth those obnoxious vertical, pursing wrinkles around the mouth.
“We enhance the red line border of the lips,” said Dr. Martineau. “Part of the aging process is you lose the little bit of a roll that you have at the border of the lip. And when that becomes indistinct, the lip looks flat — and old.”
Injecting fillers or volumizers along the border of the lip to regain some of that roll “gives the appearance of fuller, younger lips without really adding much overall volume to the lip itself,” he said.
Fine lines and wrinkles
Retin-A, made from an acidic form of vitamin A, is helpful for all fine lines and wrinkles not caused by muscular action like crows feet, said Dr. Martineau — especially those fine lines and wrinkles under the eyes.
Retin-A, the prescription-strength form of retinol, has many good anti-aging effects, said the dermatologist. In addition to reducing wrinkles, he said, “It helps even out pigmentation and texture of the skin and it helps lay down new collagen in upper layers of the skin,” he said. “It helps get rid of some of the excess dead skin layer that can occur in patients over time.”
Retin-A is generally applied topically as a cream.