What Are the Best Non-Surgical Treatments for Wrinkles?
From the practice of
Brian V. Heil, MD, FACS, board certified plastic surgeon
Published July 2, 2019 · Updated
The best non-invasive treatment for wrinkles depends on the kind of line. Frowning, squinting and raising your brows carve dynamic lines, which a wrinkle relaxer such as Botox, Dysport or Daxxify softens. Lines still there at complete rest are static: folds and hollows want filler, and fine etched lines and rough texture want laser resurfacing. Most faces have some of both.
Which treatment matches which kind of line?
Static lines are etched in by years of repetition and collagen loss, and our guide to wrinkles and volume loss sets out how each kind forms. Every treatment in the table is on the Acqua Blu menu.
| Line type | Treatment on our menu | How it works | Typical onset | Typical duration or course | Downtime |
|---|---|---|---|---|---|
| Dynamic lines: frown lines, crow’s feet and forehead lines | Botox | Relaxes the muscle that folds the skin | Softening in two to three days, peaking around ten to fourteen | About three to four months for frown lines | Little to no downtime |
| Frown lines between the brows, its FDA-approved use | Dysport | Relaxes the muscle that folds the skin, like Botox | Begins two to three days in, peaks by ten to fourteen | Up to four months | Normal activity the same day |
| Frown lines between the brows, its FDA-approved use | Daxxify | Relaxes the same muscles a Botox treatment would | Within a couple of days, peaking around two weeks | A median of 24 weeks at none or mild frown-line severity in pooled trials | Slight redness or a small bump at the injection points usually settles within a few hours |
| Static folds and hollows from lost volume | Juvéderm | Puts back lost volume beneath the skin | Works the moment it is placed | Six months to two years, depending on the product and the place | Swelling settles over a few days |
| Folds, creases and hollows from lost volume | Restylane | Hyaluronic acid gel in different weights, matched to the area | Immediate | Several months to well over a year, depending on the product and where it is placed | Swelling, bruising or redness that usually clears within a week |
| Fine etched lines and rough texture | RF microneedling | The Fraxis Duo pairs RF microneedling with a fractional CO2 laser in one session | Initial improvement in about two weeks; full results at four to six weeks | A plan may include three to five treatments | Minimal recovery time |
| Fine lines, uneven texture and tone | HALO | Two wavelengths: one remodels collagen deep, one renews the surface | Builds for weeks; better at two months than at two weeks | Many people do a single treatment; some do a short series | Redness and swelling for a few days, then a bronzed look and fine shedding |
| Deeper etched lines and rough texture | CO2 laser resurfacing | Removes damaged skin in microscopic columns so fresh skin heals in | Shows as the skin heals, about a week; pink for a few weeks after | Usually one treatment | Typically five to seven days of redness, swelling, crusting and peeling |
If Botox and Dysport are both on your shortlist, our Botox vs Dysport comparison on the Acqua Blu blog goes through how they differ.
What are the risks of each option?
Common, short-lived reactions
After Botox, slight redness or a small raised bump at the injection points usually settles within a few hours. With filler, the FDA lists bruising, redness, swelling, pain, tenderness, itching and rash as the common risks. Freshly resurfaced skin burns and pigments easily, so strict sun protection for the weeks after CO2 is part of the treatment. Sun protection after HALO is required too.
Wrinkle relaxers: drooping lids and brows
In the BOTOX Cosmetic label, the most common adverse reaction for frown lines is eyelid ptosis, a drooping lid, at 3%; for forehead lines it is headache at 9% and brow ptosis at 2%. The Daxxify label lists headache at 6%, eyelid ptosis at 2% and facial paresis at 1% for frown lines. In Dysport trials, people given a higher dose had more eyelid ptosis. The BOTOX Cosmetic label carries a boxed warning that the effects of all botulinum toxin products may spread.
Fillers: injection into a blood vessel
The FDA lists unintentional injection into a blood vessel as a rare risk of dermal fillers: it can block the vessel and cut blood supply to tissue, and reported complications include tissue death, vision problems including blindness, and stroke. Hyaluronic acid filler can be dissolved with an enzyme if the result is not what was wanted, though this is rarely needed.
Resurfacing: prolonged redness and pigment change
In a review of 1,081 procedures with one microablative CO2 laser, 13 (1.3%) had complications: eleven cases of prolonged redness and two of post-inflammatory hyperpigmentation. The same review reported no cases of scarring.
How do you decide which one to start with?
At a consultation the team reads your lines at rest and in motion, then builds a plan around your goals. Many faces want both a relaxer and a filler, and the two are planned together. Skin type, any tendency to scar or pigment, any history of cold sores and current medications all change a CO2 plan or rule it out.
Brian V. Heil, MD, FACS, is the practice’s founder and supervising plastic surgeon, and CO2 resurfacing is performed by a provider he trained.
Acqua Blu has two offices: Upper St. Clair at 100 Siena Drive, Suite 295, Upper St. Clair, PA 15241, (412) 835-5544, and Wexford at 14000 Perry Highway, Suite 300, Wexford, PA 15090, (724) 933-1800. To have your lines read in person, book a consultation.
Sources
- BOTOX Cosmetic (onabotulinumtoxinA) prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=485d9b71-6881-42c5-a620-a4360c7192ab
- DYSPORT (abobotulinumtoxinA) prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=71313a04-1349-4c26-b840-a39e4a3ddaed
- DAXXIFY (daxibotulinumtoxinA) prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3aaa6e14-a3f7-4fb2-b9f9-d3a9c3ae1f74
- Bertucci V, et al. J Am Acad Dermatol. 2020;82(4):838–845. https://pubmed.ncbi.nlm.nih.gov/31791824/
- Carruthers JD, et al. Plast Reconstr Surg. 2020;145(1):45–58. https://pubmed.ncbi.nlm.nih.gov/31609882/
- US Food and Drug Administration. Dermal Fillers (Soft Tissue Fillers). https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers
- Galderma. Restylane nasolabial folds fillers. https://www.galdermaaesthetics.com/restylane-dermal-fillers/nasolabial-folds-fillers
- Sarnoff D, et al. J Drugs Dermatol. 2018;17(11):1157–1162. https://pubmed.ncbi.nlm.nih.gov/30481953/
- Langelier N, Beleznay K, Woodward J. Dermatol Surg. 2016;42 Suppl 2:S77–82. https://pubmed.ncbi.nlm.nih.gov/27128248/
FAQ
What is the most effective non surgical wrinkle treatment?
That depends on the line. Neuromodulators quiet the muscles behind dynamic lines, while lasers and dermal fillers address the lines and volume loss that have settled into the skin. Between the lasers, HALO gives moderate to advanced correction with a manageable recovery, while CO2 resurfacing trades about a week of downtime for the deepest repair.
Can you combine Botox and filler in one visit?
Yes, and many faces want both: a relaxer stops a muscle folding the skin, while filler puts back volume from underneath, so the two are planned together. A review of combined upper-face treatment found that several treatments in one session improve patient satisfaction, with greater improvement in less time and less overall downtime than separate visits.
How long do non invasive wrinkle treatments last?
It depends on the treatment, the product and you. The BOTOX Cosmetic label puts the effect on frown lines at about three to four months, and Daxxify's trial authors concluded it may last longer, a median of 24 weeks or more. For fillers, the FDA says duration depends on the filler material and the area where it is injected.
Which wrinkle treatment has no downtime?
Wrinkle relaxers come closest: you can return to your day straight away after Botox. Lasers ask the most. After HALO, leave a week before an event. After CO2, the skin stays pink for a few weeks once the peeling is over.
Treatments at Acqua Blu Medical Spa in Upper St. Clair are provided under the direction of Brian V. Heil, MD, FACS, the practice’s founder and medical director. A consultation is the best way to find out what fits your skin and your goals.
This is general information, not medical advice. Candidacy and treatment parameters are determined by a licensed provider at a consultation.
